Malmqvist Stefan, Leboeuf-Yde Charlotte, Ahola Tuomo, Andersson Olli, Ekström Kristian, Pekkarinen Harri, Turpeinen Markku, Wedderkopp Niels
Faculty of Social Sciences, University of Stavanger, Stavanger University Hospital, Stavanger, Norway.
Chiropr Osteopat. 2008 Nov 7;16:13. doi: 10.1186/1746-1340-16-13.
In a previous Swedish study it was shown that it is possible to predict which chiropractic patients with persistent LBP will not report definite improvement early in the course of treatment, namely those with LBP for altogether at least 30 days in the past year, who had leg pain, and who did not report definite general improvement by the second treatment. The objectives of this study were to investigate if the predictive value of this set of variables could be reproduced among chiropractic patients in Finland, and if the model could be improved by adding some new potential predictor variables.
The study was a multi-centre prospective outcome study with internal control groups, carried out in private chiropractic practices in Finland. Chiropractors collected data at the 1st, 2nd and 4th visits using standardized questionnaires on new patients with LBP and/or radiating leg pain. Status at base-line was identified in relation to pain and disability, at the 2nd visit in relation to disability, and "definitely better" at the 4th visit in relation to a global assessment. The Swedish questionnaire was used including three new questions on general health, pain in other parts of the spine, and body mass index.
The Swedish model was reproduced in this study sample. An alternative model including leg pain (yes/no), improvement at 2nd visit (yes/no) and BMI (underweight/normal/overweight or obese) was also identified with similar predictive values. Common throughout the testing of various models was that improvement at the 2nd visit had an odds ratio of approximately 5. Additional analyses revealed a dose-response in that 84% of those patients who fulfilled none of these (bad) criteria were classified as "definitely better" at the 4th visit, vs. 75%, 60% and 34% of those who fulfilled 1, 2 or all 3 of the criteria, respectively.
When treating patients with LBP, at the first visits, the treatment strategy should be different for overweight/obese patients with leg pain as it should be for all patients who fail to improve by the 2nd visit. The number of predictors is also important.
在瑞典之前的一项研究中表明，有可能预测哪些患有持续性腰痛的脊椎按摩疗法患者在治疗早期不会报告明显改善，即那些在过去一年中腰痛总计至少30天、有腿痛且在第二次治疗时未报告明显整体改善的患者。本研究的目的是调查这组变量的预测价值在芬兰的脊椎按摩疗法患者中是否能够重现，以及该模型是否可以通过添加一些新的潜在预测变量来改进。
该研究是一项设有内部对照组的多中心前瞻性结局研究，在芬兰的私人脊椎按摩疗法诊所进行。脊椎按摩治疗师在第1次、第2次和第4次就诊时使用标准化问卷收集患有腰痛和/或放射性腿痛的新患者的数据。在基线时确定疼痛和残疾状况，在第2次就诊时确定残疾状况，在第4次就诊时根据整体评估确定“明显好转”情况。使用了瑞典问卷，包括关于总体健康、脊柱其他部位疼痛和体重指数的三个新问题。
本研究样本重现了瑞典模型。还确定了一个替代模型，包括腿痛（是/否）、第2次就诊时的改善情况（是/否）和体重指数（体重过轻/正常/超重或肥胖），其预测价值相似。在各种模型的测试中普遍存在的情况是，第2次就诊时的改善情况的优势比约为5。进一步分析显示存在剂量反应，即那些不符合这些（不良）标准中任何一项的患者中有84%在第4次就诊时被归类为“明显好转”，而符合1项、2项或所有3项标准的患者分别为75%、60%和34%。
在治疗腰痛患者时，在初次就诊时，对于有腿痛的超重/肥胖患者的治疗策略应与所有在第2次就诊时未改善的患者不同。预测变量的数量也很重要。
