May Stephen, Rosedale Richard
Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, United Kingdom.
J Manipulative Physiol Ther. 2007 Sep;30(7):539-42. doi: 10.1016/j.jmpt.2007.07.010.
Researchers have begun to investigate the value of subgrouping patients with back pain to improve clinical outcomes; one method is the development of clinical prediction rules. To be of clinical value, it is important that subgroups identify distinct categories of patients with an associated optimal treatment. This case study raises the suggestion that subgroups identified in this way may not represent distinct categories.
A patient with sudden-onset back pain, who had 4 of 5 criteria for a clinical prediction rule said to identify responders to manipulation, was successfully treated using repeated flexion in lying exercises.
Pain numeric score and Roland-Morris Disability Questionnaire were used to measure changes in pain and function. Pain score changed from 9/10 to 0/10 and disability score from 19/24 to 0/24 after 1 week and at 1 and 6 months of follow-up.
We have presented a case study that was positive for 4 of 5 items of the clinical prediction rule for manipulation responders, but this patient was successfully treated with flexion exercises. The clinical prediction rule may not represent a discrete subgroup but may include patients who can be effectively managed in other ways.
研究人员已开始探讨对背痛患者进行亚组分类以改善临床疗效的价值；其中一种方法是制定临床预测规则。要具有临床价值，重要的是亚组能够识别出具有相关最佳治疗方法的不同类别患者。本病例研究提出这样一种观点，即通过这种方式识别出的亚组可能并不代表不同类别。
一名突发背痛的患者，符合一项据称可识别手法治疗反应者的临床预测规则中的5项标准中的4项，通过反复进行仰卧位屈曲练习得到成功治疗。
使用疼痛数字评分和罗兰 - 莫里斯残疾问卷来测量疼痛和功能的变化。在随访1周、1个月和6个月时，疼痛评分从9/10降至0/10，残疾评分从19/24降至0/24。
我们展示了一个病例，该病例符合手法治疗反应者临床预测规则5项中的4项，但该患者通过屈曲练习得到了成功治疗。临床预测规则可能并不代表一个离散的亚组，而是可能包括那些可以通过其他方式有效治疗的患者。
