Hayden J A, Chou R, Hogg-Johnson S, Bombardier C
Centre of Research Expertise in Improved Disability Outcomes (CREIDO), University Health Network, Toronto, Ontario, Canada.
J Clin Epidemiol. 2009 Aug;62(8):781-796.e1. doi: 10.1016/j.jclinepi.2008.09.004. Epub 2009 Jan 10.
Systematic reviews of prognostic factors for low back pain vary substantially in design and conduct. The objective of this study was to identify, describe, and synthesize systematic reviews of low back pain prognosis, and explore the potential impact of review methods on the conclusions.
We identified 17 low back pain prognosis reviews published between 2000 and 2006. One reviewer extracted and a second checked review characteristics and results. Two reviewers independently assessed review quality.
Review questions and selection criteria varied; there were both focused and broad reviews of prognostic factors. A quarter of reviews did not clearly define search strategies. The number of potential citations identified ranged from 15 to 4,458 and the number of included prognosis studies ranged from 3 to 32 (of 162 distinct citations included across reviews). Seventy percent of reviews assessed quality of included studies, but assessed only a median of four of six potential biases. All reviews reported associations based on statistical significance; they used various strategies for syntheses. Only a small number of important prognostic factors were consistently reported: older age, poor general health, increased psychological or psychosocial stress, poor relations with colleagues, physically heavy work, worse baseline functional disability, sciatica, and the presence of compensation. We found discrepancies across reviews: differences in some selection criteria influenced studies included, and various approaches to data interpretation influenced review conclusions about evidence for specific prognostic factors.
There is an immediate need for methodological work in the area of prognosis systematic reviews. Because of methodological shortcomings in the primary and review literature, there remains uncertainty about reliability of conclusions regarding prognostic factors for low back pain.
关于腰痛预后因素的系统评价在设计和实施方面差异很大。本研究的目的是识别、描述和综合腰痛预后的系统评价，并探讨评价方法对结论的潜在影响。
我们识别出2000年至2006年间发表的17篇腰痛预后评价。一名评价者提取信息，另一名检查评价特征和结果。两名评价者独立评估评价质量。
评价问题和选择标准各不相同；既有对预后因素的聚焦评价，也有宽泛评价。四分之一的评价未明确界定检索策略。识别出的潜在引文数量从15篇到4458篇不等，纳入的预后研究数量从3项到32项不等（在各评价纳入的162篇不同引文中）。70%的评价评估了纳入研究的质量，但仅对六个潜在偏倚中的四个进行了中位数评估。所有评价均基于统计学显著性报告关联；它们采用了各种综合策略。只有少数重要的预后因素被一致报告：年龄较大、总体健康状况较差、心理或社会心理压力增加、与同事关系不佳、体力劳动繁重、基线功能残疾更严重、坐骨神经痛以及存在赔偿情况。我们发现各评价之间存在差异：一些选择标准的差异影响了纳入的研究，而各种数据解释方法影响了关于特定预后因素证据的评价结论。
迫切需要在预后系统评价领域开展方法学研究。由于原始文献和评价文献中存在方法学缺陷，关于腰痛预后因素结论的可靠性仍存在不确定性。
