Rubinstein Sidney M, Knol Dirk L, Leboeuf-Yde Charlotte, de Koekkoek Tammy E, Pfeifle Charles E, van Tulder Maurits W
Institute for Research in Extramural Medicine (EMGO-Institute), VU University Medical Center, Amsterdam, The Netherlands.
Spine (Phila Pa 1976). 2008 Jun 1;33(13):1451-8. doi: 10.1097/BRS.0b013e3181753cc9.
Prospective, multicenter, cohort study.
To examine which clinical and sociodemographic baseline variables can predict a favorable outcome in subjects with neck pain treated by chiropractors.
Relatively little is known on predictors of neck pain, particularly for those subjects undergoing chiropractic care. No previous study has examined predictors of outcome for subjects with neck pain by modeling the trajectories of subjects in a longitudinal design.
All new, consecutive patients, between 18 and 65 years of age with neck pain of any duration, who had not undergone chiropractic or manual therapy in the prior 3 months, were recruited. Questionnaires were administered at the first 3 visits, and at 3 and 12 months. In all, 29 putative prognostic baseline variables were evaluated. Multivariate multilevel longitudinal regression analyses were conducted using neck pain, neck disability, and perceived recovery as outcomes.
In total, 529 patients fulfilled the inclusion criteria. The response rate at 12-months was 92%. In the multivariate analyses, 14 (48%) of the prognostic variables examined were retained in at least one of the models. Shorter duration of neck pain at the first visit was the only variable retained in all 3 final regression models. The following were predictive of a favorable outcome for any 2 of the 3 outcome measures examined: intermittent neck pain, those not on sick-leave or receiving workers compensation at baseline, a higher level of education, less tiredness, higher expectations that the treatment would be beneficial, lack of morning pain, and worse perceived general health.
On the basis of the patient's history, the clinician can identify a number of determinants, which are predictive of a favorable outcome. Shorter duration of neck pain at the first visit was the only variable consistently found to be predictive of a favorable outcome for all 3 outcome measures examined.
前瞻性、多中心队列研究。
探讨哪些临床和社会人口统计学基线变量能够预测接受脊椎按摩治疗的颈部疼痛患者的良好预后。
关于颈部疼痛的预测因素所知相对较少，尤其是对于那些接受脊椎按摩治疗的患者。以前没有研究通过纵向设计对患者轨迹进行建模来研究颈部疼痛患者的预后预测因素。
招募所有年龄在18至65岁之间、有任何时长颈部疼痛、在过去3个月内未接受过脊椎按摩或手法治疗的新的连续患者。在最初3次就诊时以及3个月和12个月时进行问卷调查。总共评估了29个假定的预后基线变量。以颈部疼痛、颈部功能障碍和感知恢复为结局进行多变量多层次纵向回归分析。
共有529名患者符合纳入标准。12个月时的应答率为92%。在多变量分析中，所检查的14个（48%）预后变量至少在一个模型中被保留。首次就诊时颈部疼痛持续时间较短是所有3个最终回归模型中唯一保留的变量。以下因素对于所检查的3项结局指标中的任意2项的良好预后具有预测作用：间歇性颈部疼痛、基线时未休病假或未领取工伤赔偿、教育程度较高、疲劳感较轻、对治疗有益的期望较高、无晨痛以及自我感觉总体健康状况较差。
根据患者病史，临床医生可以识别出一些能够预测良好预后的决定因素。首次就诊时颈部疼痛持续时间较短是在所检查的所有3项结局指标中始终被发现能够预测良好预后的唯一变量。
