Kovacs Francisco M, Abraira Víctor, Zamora Javier, Fernández Carmen
Departamento Científico, Fundación Kovacs, Palma de Mallorca, Spain.
Spine (Phila Pa 1976). 2005 Aug 1;30(15):1786-92. doi: 10.1097/01.brs.0000172159.47152.dc.
Follow-up study.
To document differences between acute and subacute low back pain (LBP) based on the risk of developing chronic disability and on the correlation between pain, disability, and quality of life.
The subacute stage should identify the time in which the risk of developing chronic disability increases and specific measures should be considered, but its definition is currently inconsistent.
366 patients were given Visual Analog Scales (VAS) for LBP and referred pain (RP), Roland-Morris questionnaires (RMQs), and EuroQol (EQ) questionnaires on their first visit and 14 and 59 days later.
Median duration of pain when entering the study was 4 days (P25, P75: 2,10). Simple correlations among LBP, VAS, and RMQ were r = 0.407 (day 1), 0.688 (day 15), and 0.739 (day 60). Among LBP, VAS, and EQ, r = -0.523, r = -0.701, and r = -0.760. Among RP, VAS, and RMQ, r = 0.280, r = 0.561, and r = 0.583. Between RP, VAS, and EQ, r = -0.306, r = -0.534 and r = -0.600. Between RMQ and EQ, r = -0.650, r = -0.765 and r = -0.815. In 42 patients, disability did not improve throughout the study period, and a prestudy duration of > or = 14 days was the only independent predictor. All these models were significant at the P < 0.007 level. Improvement in quality of life was more likely to occur in patients in which disability improved [odds ratio (OR), 18.29; 95% CI; 8.64, 38.73; P < 0.001]. As opposed to acute patients, in those with a prestudy duration of pain of > or = 14 days, on day 60 RP had no influence on disability, and LBP had no influence on quality of life.
LBP influences disability and quality of life more than RP. Disability is predicted by pain duration and quality of life is predicted by disability, but pain severity predicts neither one of them. Changes related to determinants of disability and quality of life, and to the prediction of chronic disability, appear 14 days after the onset of pain, supporting that cutoff point for considering a patient as being subacute.
随访研究。
根据发展为慢性残疾的风险以及疼痛、残疾和生活质量之间的相关性，记录急性和亚急性下腰痛（LBP）之间的差异。
亚急性期应确定慢性残疾风险增加的时间，并应考虑采取特定措施，但其定义目前并不一致。
366例患者在首次就诊时、14天后和59天后接受了下腰痛视觉模拟量表（VAS）、牵涉痛（RP）、罗兰·莫里斯问卷（RMQ）和欧洲生活质量量表（EQ）问卷调查。
进入研究时疼痛的中位持续时间为4天（第25百分位数，第75百分位数：2，10）。下腰痛、VAS和RMQ之间的简单相关性分别为r = 0.407（第1天）、0.688（第15天）和0.739（第60天）。在下腰痛、VAS和EQ之间，r = -0.523、r = -0.701和r = -0.760。在牵涉痛、VAS和RMQ之间，r = 0.280、r = 0.561和r = 0.583。在牵涉痛、VAS和EQ之间，r = -0.306、r = -0.534和r = -0.600。在RMQ和EQ之间，r = -0.650、r = -0.765和r = -0.815。42例患者在整个研究期间残疾状况未改善，研究前疼痛持续时间≥14天是唯一的独立预测因素。所有这些模型在P < 0.007水平上均具有显著性。残疾状况改善的患者更有可能出现生活质量改善[优势比（OR），18.29；95%可信区间（CI）：8.64，38.73；P < 0.001]。与急性患者不同，对于研究前疼痛持续时间≥14天的患者，在第60天时牵涉痛对残疾无影响，下腰痛对生活质量无影响。
下腰痛对残疾和生活质量的影响大于牵涉痛。残疾状况由疼痛持续时间预测，生活质量由残疾状况预测，但疼痛严重程度均不能预测两者。与残疾和生活质量决定因素以及慢性残疾预测相关的变化在疼痛发作14天后出现，支持将该时间点作为考虑患者为亚急性的分界点。
