Arthritis Research Campaign National Primary Care Centre, Keele University, UK.
Pain. 2010 Mar;148(3):398-406. doi: 10.1016/j.pain.2009.11.002. Epub 2009 Dec 22.
Many psychological factors have been suggested to be important obstacles to recovery from low back pain, yet most studies focus on a limited number of factors. We compared a more comprehensive range of 20 factors in predicting outcome in primary care. Consecutive patients consulting 8 general practices were eligible to take part in a prospective cohort study; 1591 provided data at baseline and 810 at 6 months. Clinical outcome was defined using the Roland and Morris Disability Questionnaire (RMDQ). The relative strength of the baseline psychological measures to predict outcome was investigated using adjusted multiple linear regression techniques. The sample was similar to other primary care cohorts (mean age 44 years, 59% women, mean baseline RMDQ 8.6). The 20 factors each accounted for between 0.04% and 33.3% of the variance in baseline RMDQ score. A multivariate model including all 11 scales that were associated with outcome in the univariate analysis accounted for 47.7% of the variance in 6 months RMDQ score; rising to 55.8% following adjustment. Four scales remained significantly associated with outcome in the multivariate model explaining 56.6% of the variance: perceptions of personal control, acute/chronic timeline, illness identify and pain self-efficacy. When all independent factors were included, depression, catastrophising and fear avoidance were no longer significant. Thus, a small number of psychological factors are strongly predictive of outcome in primary care low back pain patients. There is clear redundancy in the measurement of psychological factors. These findings should help to focus targeted interventions for back pain in the future.
许多心理因素被认为是阻碍腰背痛康复的重要障碍，但大多数研究都集中在有限数量的因素上。我们比较了更全面的 20 个因素，以预测初级保健中的结果。连续咨询 8 家普通诊所的患者有资格参加前瞻性队列研究；1591 人在基线时提供了数据，810 人在 6 个月时提供了数据。临床结果使用 Roland 和 Morris 残疾问卷 (RMDQ) 定义。使用调整后的多元线性回归技术研究基线心理测量对结果的预测强度。该样本与其他初级保健队列相似（平均年龄 44 岁，59%为女性，平均基线 RMDQ 为 8.6）。这 20 个因素各自占基线 RMDQ 评分方差的 0.04%至 33.3%。一个包含所有 11 个与单因素分析中结果相关的量表的多变量模型，占 6 个月 RMDQ 评分方差的 47.7%；调整后上升到 55.8%。在多变量模型中，有四个量表与结果仍然显著相关，解释了 56.6%的方差：个人控制感、急性/慢性时间线、疾病认同和疼痛自我效能感。在多变量模型中，当所有独立因素都包括在内时，抑郁、灾难化和恐惧回避不再显著。因此，一小部分心理因素对初级保健腰痛患者的预后有很强的预测性。心理因素的测量存在明显的冗余。这些发现有助于为未来的腰痛提供有针对性的干预措施。
