Jellema Petra, van der Windt Daniëlle A W M, van der Horst Henriëtte E, Twisk Jos W R, Stalman Wim A B, Bouter Lex M
Department of General Practice, Institute for Research in Extramural Medicine, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, Netherlands.
BMJ. 2005 Jul 9;331(7508):84. doi: 10.1136/bmj.38495.686736.E0. Epub 2005 Jun 20.
To compare the effects of a minimal intervention strategy aimed at assessment and modification of psychosocial prognostic factors and usual care for treatment of (sub)acute low back pain in general practice.
Cluster randomised clinical trial.
60 general practitioners in 41 general practices.
314 patients with non-specific low back pain of less than 12 weeks' duration, recruited by their general practitioner.
In the minimal intervention strategy group the general practitioner explored the presence of psychosocial prognostic factors, discussed these factors, set specific goals for reactivation, and provided an educational booklet. The consultation took about 20 minutes. Usual care was not standardised.
Functional disability (Roland-Morris disability questionnaire), perceived recovery, and sick leave because of low back pain assessed at baseline and after 6, 13, 26, and 52 weeks.
The dropout rate was 8% in the minimal intervention strategy group and 9% in the usual care group. Multilevel analyses showed no significant differences between the groups on any outcome measure during 12 months of follow-up in the whole group or in relevant subgroups (patients with high scores on psychosocial measures at baseline or a history of frequent or prolonged low back pain).
This study provides no evidence that (Dutch) general practitioners should adopt our new treatment strategy aimed at psychosocial prognostic factors in patients with (sub)acute low back pain. Further research should examine why our new strategy was not more effective than usual care.
比较旨在评估和调整社会心理预后因素的最低限度干预策略与常规护理在全科医疗中治疗（亚）急性腰痛的效果。
整群随机临床试验。
41家全科诊所的60名全科医生。
由其全科医生招募的314例持续时间少于12周的非特异性腰痛患者。
在最低限度干预策略组中，全科医生探究社会心理预后因素的存在情况，讨论这些因素，设定恢复正常活动的具体目标，并提供一本教育手册。咨询过程约20分钟。常规护理未标准化。
在基线时以及6周、13周、26周和52周后评估功能障碍（罗兰-莫里斯功能障碍问卷）、感知恢复情况以及因腰痛导致的病假情况。
最低限度干预策略组的失访率为8%，常规护理组为9%。多水平分析显示，在整个组或相关亚组（基线时社会心理测量得分高或有频繁或长期腰痛病史的患者）的12个月随访期间，两组在任何观察指标上均无显著差异。
本研究没有证据表明（荷兰的）全科医生应该对（亚）急性腰痛患者采用我们针对社会心理预后因素的新治疗策略。进一步的研究应探讨为何我们的新策略并不比常规护理更有效。
