北欧亚人群研究计划：脊医治疗下的腰痛患者治疗结果预测——心理特征重要吗？
The Nordic Subpopulation Research Programme: prediction of treatment outcome in patients with low back pain treated by chiropractors--does the psychological profile matter?
作者信息
Leboeuf-Yde Charlotte, Rosenbaum Annika, Axén Iben, Lövgren Peter W, Jørgensen Kristian, Halasz Laszlo, Eklund Andreas, Wedderkopp Niels
机构信息
Department of Research, Spine Center, Hospital Lillebaelt, University of Southern Denmark, Denmark.
出版信息
Chiropr Osteopat. 2009 Dec 30;17:14. doi: 10.1186/1746-1340-17-14.
BACKGROUND
It is clinically important to be able to select patients suitable for treatment and to be able to predict with some certainty the outcome for patients treated for low back pain (LBP). It is not known to what degree outcome among chiropractic patients is affected by psychological factors.
OBJECTIVES
To investigate if some demographic, psychological, and clinical variables can predict outcome with chiropractic care in patients with LBP.
METHODS
A prospective multi-center practice-based study was carried out, in which demographic, clinical and psychological information was collected at base-line. Outcome was established at the 4(th )visit and after three months. The predictive value was studied for all base-line variables, individually and in a multivariable analysis.
RESULTS
In all, 55 of 99 invited chiropractors collected information on 731 patients. At the 4(th )visit data were available on 626 patients and on 464 patients after 3 months. Fee subsidization (OR 3.2; 95% CI 1.9-5.5), total duration of pain in the past year (OR 1.5; 95% CI 1.0-2.2), and general health (OR 1.2; 95% CI 1.1-1.4) remained in the final model as predictors of treatment outcome at the 4(th )visit. The sensitivity was low (12%), whereas the specificity was high (97%). At the three months follow-up, duration of pain in the past year (OR 2.1; 95% CI 1.4-3.1), and pain in other parts of the spine in the past year (OR1.6; 1.1-2.5) were independently associated with outcome. However, both the sensitivity and specificity were relatively low (60% and 50%). The addition of the psychological variables did not improve the models and none of the psychological variables remained significant in the final analyses. There was a positive gradient in relation to the number of positive predictor variables and outcome, both at the 4(th )visit and after 3 months.
CONCLUSION
Psychological factors were not found to be relevant in the prediction of treatment outcome in Swedish chiropractic patients with LBP.
背景
能够挑选出适合治疗的患者，并在一定程度上准确预测腰痛（LBP）患者的治疗结果在临床上具有重要意义。目前尚不清楚整脊治疗患者的治疗结果受心理因素影响的程度。
目的
研究某些人口统计学、心理和临床变量能否预测整脊治疗LBP患者的治疗结果。
方法
开展了一项基于多中心实践的前瞻性研究，在基线时收集人口统计学、临床和心理信息。在第4次就诊时以及三个月后确定治疗结果。对所有基线变量的预测价值进行了单独研究，并进行了多变量分析。
结果
总共99名受邀整脊师中的55名收集了731名患者的信息。在第4次就诊时，有626名患者的数据可用，三个月后有464名患者的数据可用。费用补贴（比值比[OR]3.2；95%置信区间[CI]1.9 - 5.5）、过去一年的疼痛总时长（OR 1.5；95% CI 1.0 - 2.2）和总体健康状况（OR 1.2；95% CI 1.1 - 1.4）在最终模型中仍作为第4次就诊时治疗结果的预测因素。敏感性较低（12%），而特异性较高（97%）。在三个月随访时，过去一年的疼痛时长（OR 2.1；95% CI 1.4 - 3.1）和过去一年脊柱其他部位的疼痛（OR 1.6；1.1 - 2.5）与治疗结果独立相关。然而，敏感性和特异性都相对较低（分别为60%和50%）。添加心理变量并没有改善模型，且在最终分析中没有一个心理变量仍然显著。在第4次就诊时以及三个月后，预测变量阳性数量与治疗结果之间均存在正梯度关系。
结论
在瑞典接受整脊治疗的LBP患者中，未发现心理因素与治疗结果的预测相关。
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