Kent Peter M, Keating Jennifer L
Monash Department of Clinical Epidemiology at Cabrini Hospital, Vic., Australia.
Man Ther. 2008 Feb;13(1):12-28. doi: 10.1016/j.math.2007.05.009. Epub 2007 Jul 19.
This systematic review of prospective cohort studies investigated the evidence for prognostic factors for poor recovery in recent-onset nonspecific low back pain (NSLBP). Medline, Cinahl, Embase, PsychINFO, and AMED databases were searched and citation tracking was performed. Fifty studies met the inclusion criteria. Bivariate and multivariable prognostic factor/outcome associations were extracted. Two reviewers independently performed data extraction and method quality assessment. Where data were available, odds ratios for bivariate associations were calculated and meta-analysis was performed on comparable prognostic factor/outcome associations. Despite the number of studies that have investigated these prognostic factors, uncertainty remains regarding which factors are associated with particular outcomes, the strength of those associations and the extent of confounding between prognostic factors. This uncertainty is the result of the disparate methods that have been used in these investigations, incomplete and contradictory findings, and an inverse relationship between study quality and the reported strength of these associations. The clinical implication is that the formation of clinically useful predictive models remains dependent on further high-quality research. The research implications are that subsequent studies can use the findings of this review to inform prognostic factor selection, and that prognostic studies would ideally be designed to enhance the capacity for findings to be pooled with those of other studies.
这项对前瞻性队列研究的系统评价调查了近期发生的非特异性腰痛（NSLBP）恢复不佳的预后因素的证据。检索了Medline、Cinahl、Embase、PsychINFO和AMED数据库，并进行了引文追踪。五十项研究符合纳入标准。提取了双变量和多变量预后因素/结果关联。两名评审员独立进行数据提取和方法质量评估。在有数据的情况下，计算双变量关联的优势比，并对可比的预后因素/结果关联进行荟萃分析。尽管有许多研究调查了这些预后因素，但对于哪些因素与特定结果相关、这些关联的强度以及预后因素之间的混杂程度仍存在不确定性。这种不确定性是由于这些研究中使用的方法不同、研究结果不完整且相互矛盾，以及研究质量与所报告的这些关联强度之间呈反比关系所致。临床意义在于，形成临床有用的预测模型仍依赖于进一步的高质量研究。研究意义在于，后续研究可以利用本综述的结果为预后因素的选择提供信息，并且预后研究理想情况下应设计成增强将研究结果与其他研究结果进行汇总的能力。
