Underwood M R, Harding G, Klaber Moffett J
Centre for Health Sciences, Barts and The London.
Rheumatology (Oxford). 2006 Jun;45(6):751-6. doi: 10.1093/rheumatology/kei254. Epub 2006 Jan 17.
To explore the views of participants in a randomized controlled trial of physical treatments for low back pain about the treatment packages they received in the trial.
Within a randomized controlled trial that found small to moderate benefits from adding a manipulation package or an exercise programme to general practice care, we elicited participants' views on the treatment using an open question in participant questionnaires. These data were analysed using an adapted framework approach.
We received a total of 1259 comments from 1334 participants. Participants randomized to usual general practice care reported dissatisfaction with receiving only 'usual care', which consisted of providing analgesic medication without providing an explanation for their pain. Those randomized to a manipulation package felt the intervention was appropriate to their needs and commonly reported striking benefits. Participants assigned to the exercise programme developed a sense of self-reliance in managing back pain, although some failed to be sufficiently motivated to continue their exercise regimen outside the classes.
This qualitative analysis has found much clearer differences between the groups than the main quantitative analysis. This suggests that some of the added value from being allocated to additional physical treatment for low back pain is not being captured by existing methods of measurement. Improved methods of assessment that consider a wider range of domains may be needed when interpreting the added value of such treatments to individual patients.
探讨参与一项腰痛物理治疗随机对照试验的受试者对其在试验中所接受治疗方案的看法。
在一项随机对照试验中，发现将推拿方案或运动计划添加到全科医疗中可带来小到中度的益处，我们通过在受试者问卷中设置开放性问题来征集他们对治疗的看法。这些数据采用一种经过调整的框架方法进行分析。
我们共收到1334名受试者的1259条评论。被随机分配到常规全科医疗组的受试者对仅接受“常规护理”表示不满，这种常规护理仅包括提供止痛药物，却未对他们的疼痛作出解释。被随机分配到推拿方案组的受试者认为该干预措施符合他们的需求，并且普遍报告有显著益处。被分配到运动计划组的受试者在管理背痛方面培养了一种自力更生的意识，尽管有些人缺乏足够的动力在课程之外继续他们的锻炼计划。
这项定性分析发现各组之间的差异比主要的定量分析更为明显。这表明，现有测量方法未能捕捉到分配额外的腰痛物理治疗所带来的一些附加值。在解释此类治疗对个体患者的附加值时，可能需要改进评估方法，以考虑更广泛的领域。
