Buchner Matthias, Neubauer Eva, Zahlten-Hinguranage Anita, Schiltenwolf Marcus
Department of Orthopaedic Surgery, University of Heidelberg, Heidelberg, Germany.
Spine (Phila Pa 1976). 2007 Dec 15;32(26):3060-6. doi: 10.1097/BRS.0b013e31815cde5a.
Prospective longitudinal clinical study.
The objective of the study was to analyze the outcome of different stages of chronicity in patients with chronic low back pain treated with a multidisciplinary therapy.
Results of studies comparing different grades of chronicity in therapy for chronic low back pain have not been published so far.
A total of 387 patients with chronic low back pain for 3 months or longer and a corresponding sick leave for longer than 6 weeks underwent a 3-week standardized multidisciplinary therapy. At baseline (T0), patients were assigned into 3 groups of chronicity grades according to the classification of von Korff et al (Group A, Grades I and II; Group B, Grade III; Group C, Grade IV) and were prospectively followed. At the the 6-month follow-up (T1), 5 different therapy outcomes were analyzed and compared in the 3 groups: back-to-work status, generic health status (SF-36), pain intensity (visual analogue scale), functional capacity (Hannover back capacity score), and satisfaction with the therapy.
At T0, patients in Group C had a higher pain level, a longer history of pain, and more general and more psychosomatic comorbidities than patients with lower levels of chronicity. All 3 treatment groups improved significantly in all outcome criteria between T0 and T1. In the total group, the back-to-work rate was 67.4%. At the final follow-up, there were significantly better results in terms of functional capacity and pain level in patients with lower grades of chronicity but mostly due also to worse initial baseline values. Back-to-work rate, satisfaction with therapy, and the Mental Component Summary of the SF-36 did not show a significant difference at T1 between the groups analyzed.
According to the results of this study, patients with chronic low back pain also derive significant benefit from a multidisciplinary treatment strategy in higher stages of chronicity. Therefore, therapy should not be limited to the patients in lower stages of chronicity.
前瞻性纵向临床研究。
本研究的目的是分析采用多学科疗法治疗的慢性下腰痛患者不同慢性阶段的治疗结果。
目前尚未发表比较慢性下腰痛不同慢性程度治疗效果的研究结果。
共有387例慢性下腰痛3个月或更长时间且相应病假超过6周的患者接受了为期3周的标准化多学科治疗。在基线时（T0），根据冯·科夫等人的分类将患者分为3组慢性程度等级（A组，I级和II级；B组，III级；C组，IV级），并进行前瞻性随访。在6个月随访时（T1），分析并比较3组的5种不同治疗结果：重返工作状态、一般健康状况（SF-36）、疼痛强度（视觉模拟量表）、功能能力（汉诺威背部能力评分）以及对治疗的满意度。
在T0时，C组患者比慢性程度较低的患者疼痛水平更高、疼痛病史更长，且有更多的全身和身心合并症。所有3个治疗组在T0和T1之间的所有结果标准上均有显著改善。在整个组中，重返工作率为67.4%。在最终随访时，慢性程度较低的患者在功能能力和疼痛水平方面有明显更好的结果，但这主要也是由于初始基线值更差。在分析的组之间，T1时的重返工作率、对治疗的满意度以及SF-36的心理成分总结没有显著差异。
根据本研究结果，慢性下腰痛患者在慢性程度较高阶段也能从多学科治疗策略中获得显著益处。因此，治疗不应局限于慢性程度较低阶段的患者。
