Ferreira Manuela L, Ferreira Paulo H, Herbert Robert D, Latimer Jane
Clinical & Rehabilitation Sciences Research Group, The University of Sydney, Lidcombe, NSW, Australia.
Aust J Physiother. 2009;55(2):123-7. doi: 10.1016/s0004-9514(09)70042-x.
How much of an effect do five common physiotherapy interventions need to have for patients with low back pain to perceive they are worth their cost, discomfort, risk, and incovenience? Are there any differences between the interventions? Do specific characteristics of people with low back pain predict the smallest important difference?
Cross-sectional, observational study.
77 patients with non-specific low back pain who had not yet commenced physiotherapy intervention.
The smallest worthwhile effect was measured in terms of global perceived change (0 to 4) and percentage perceived change.
Participants perceived that intervention would have to make them 'much better', which corresponded to 1.7 (SD 0.7) on the 4-point scale, or improve their symptoms by 42% (SD 23), to make it worthwhile. There was little distinction made between interventions, regardless of whether smallest worthwhile effects were quantified as global perceived change (p = 0.09) or percentage perceived change (p = 1.00). Severity of symptoms independently (p = 0.01) predicted percentage perceived change explaining 9% of the variance, so that for each increase in severity of symptoms of 1 point out of 10 there was an increase of 4% in the percentage perceived change that participants considered would make intervention worthwhile.
Typically people with low back pain feel that physiotherapy intervention must reduce their symptoms by 42%, or make them feel 'much better' for intervention to be worthwhile.
对于腰痛患者而言，五种常见的物理治疗干预措施需要产生多大效果，才能让他们觉得这些干预措施物有所值，值得承受其带来的不适、风险和不便？这些干预措施之间是否存在差异？腰痛患者的特定特征能否预测最小重要差异？
横断面观察性研究。
77名尚未开始物理治疗干预的非特异性腰痛患者。
最小有价值效果通过整体感知变化（0至4分）和感知变化百分比来衡量。
参与者认为干预措施必须让他们“好多了”，在4分制量表上相当于1.7分（标准差0.7），或症状改善42%（标准差23%），才值得。无论最小有价值效果是以整体感知变化（p = 0.09）还是感知变化百分比（p = 1.00）来量化，干预措施之间几乎没有区别。症状严重程度独立地（p = 0.01）预测感知变化百分比，解释了9%的方差，因此，在10分制中症状严重程度每增加1分，参与者认为能使干预措施值得的感知变化百分比就增加4%。
一般来说，腰痛患者觉得物理治疗干预必须将他们的症状减轻42%，或者让他们感觉“好多了”，干预才值得。
