Langworthy Jennifer M, Breen Alan C
Institute for Musculoskeletal Research and Clinical Implementation, Anglo-European College of Chiropractic, 13-15 Parkwood Road, Bournemouth, BH5 2DF, UK.
Chiropr Osteopat. 2007 Mar 29;15:5. doi: 10.1186/1746-1340-15-5.
Being able to estimate the likelihood of poor recovery from episodes of back pain is important for care. Studies of psychosocial factors in inception cohorts in general practice and occupational populations have begun to make inroads to these problems. However, no studies have yet investigated this in chiropractic patients.
A prospective inception cohort study of patients presenting to a UK chiropractic practice for new episodes of non-specific low back pain (LBP) was conducted. Baseline questionnaires asked about age, gender, occupation, work status, duration of current episode, chronicity, aggravating features and bothersomeness using Deyo's 'Core Set'. Psychological factors (fear-avoidance beliefs, inevitability, anxiety/distress and coping, and co-morbidity were also assessed at baseline. Satisfaction with care, number of attendances and pain impact were determined at 6 weeks. Predictors of poor outcome were sought by the calculation of relative risk ratios.
Most patients presented within 4 weeks of onset. Of 158 eligible and willing patients, 130 completed both baseline and 6-week follow-up questionnaires. Greatest improvements at 6 weeks were in interference with normal work (ES 1.12) and LBP bothersomeness (ES 1.37). Although most patients began with moderate-high back pain bothersomeness scores, few had high psychometric ones. Co-morbidity was a risk for high-moderate interference with normal work at 6 weeks (RR 2.37; 95% C.I. 1.15-4.74). An episode duration of >4 weeks was associated with moderate to high bothersomeness at 6 weeks (RR 2.07; 95% C.I. 1.19-3.38) and negative outlook (inevitability) with moderate to high interference with normal work (RR 2.56; 95% C.I. 1.08-5.08).
Patients attending a private UK chiropractic clinic for new episodes of non-specific LBP exhibited few psychosocial predictors of poor outcome, unlike other patient populations that have been studied. Despite considerable bothersomeness at baseline, scores were low at follow-up. In this independent health sector back pain population, general health and duration of episode before consulting appeared more important to outcome than psychosocial factors.
能够评估背痛发作后恢复不佳的可能性对治疗很重要。在全科医疗和职业人群的起始队列中对社会心理因素进行的研究已开始着手解决这些问题。然而，尚未有研究在脊椎按摩疗法患者中对此进行调查。
对到英国一家脊椎按摩诊所就诊新发非特异性下背痛（LBP）的患者进行了一项前瞻性起始队列研究。基线调查问卷使用迪约的“核心集”询问了年龄、性别、职业、工作状态、当前发作的持续时间、慢性程度、加重因素和困扰程度。还在基线时评估了心理因素（恐惧回避信念、必然性、焦虑/痛苦和应对方式）以及合并症。在6周时确定对治疗的满意度、就诊次数和疼痛影响。通过计算相对风险比来寻找不良结局的预测因素。
大多数患者在发病后4周内就诊。在158名符合条件且愿意参与的患者中，130名完成了基线和6周随访问卷。6周时改善最明显的是对正常工作的干扰（效应量1.12）和LBP困扰程度（效应量1.37）。尽管大多数患者开始时背痛困扰程度评分为中度至高度，但很少有人心理测量评分高。合并症是6周时对正常工作有中度至高度干扰的一个风险因素（相对风险2.37；95%置信区间1.15 - 4.74）。发作持续时间>4周与6周时中度至高度困扰相关（相对风险2.07；95%置信区间1.19 - 3.38），而消极展望（必然性）与对正常工作中度至高度干扰相关（相对风险2.56；95%置信区间1.08 - 5.08）。
与其他已研究的患者群体不同，到英国一家私立脊椎按摩诊所就诊新发非特异性LBP的患者中，不良结局的社会心理预测因素很少。尽管基线时困扰程度相当高，但随访时评分较低。在这个独立卫生部门的背痛人群中，总体健康状况和就诊前发作的持续时间对结局似乎比社会心理因素更重要。
