Department of public Health, Regional Health Authority of Castilla-León, Valladolid, Spain.
Spine (Phila Pa 1976). 2010 Mar 1;35(5):483-96. doi: 10.1097/BRS.0b013e3181b9c9a7.
STUDY DESIGN: Cluster randomized clinical trial. OBJECTIVE: To assess the efficacy of a short education program and short physiotherapy program for treating low back pain (LBP) in primary care. SUMMARY OF BACKGROUND DATA: There is sparse evidence on the effectiveness of education and physiotherapy programs that are short enough to be feasible in primary care. METHODS: Sixty-nine primary care physicians were randomly assigned to 3 groups and recruited 348 patients consulting for LBP; 265 (79.8%) were chronic. All patients received usual care, were given a booklet and received a consistent 15 minutes group talk on health education, which focused on healthy nutrition habits in the control group, and on active management for LBP in the "education" and "education + physiotherapy" groups. Additionally, in the "education + physiotherapy" group, patients were given a second booklet and a 15-minute group talk on postural hygiene, and 4 one-hour physiotherapy sessions of exercise and stretching which they were encouraged to keep practicing at home. The main outcome measure was improvement of LBP-related disability at 6 months. Patients' assessment and data analyses were blinded. RESULTS: During the 6-month follow-up period, improvement in the "control" group was negligible. Additional improvement in the "education" and "education + physiotherapy" groups was found for disability (2.0 and 2.2 Roland Morris Questionnaire points, respectively), LBP (1.8 and 2.10 Visual Analogue Scale points), referred pain (1.3 and 1.6 Visual Analogue Scale points), catastrophizing (1.6 and 1.8 Coping Strategies Questionnaire points), physical quality of life (2.9 and 2.9 SF-12 points), and mental quality of life (3.7 and 5.1 SF-12 points). CONCLUSION: The addition of a short education program on active management to usual care in primary care leads to small but consistent improvements in disability, pain, and quality of life. The addition of a short physiotherapy program composed of education on postural hygiene and exercise intended to be continued at home, increases those improvements, although the magnitude of that increase is clinically irrelevant.
研究设计：整群随机临床试验。 目的：评估在初级保健中进行短期教育计划和短期物理治疗计划治疗腰痛（LBP）的疗效。 背景数据概要：针对足够短期可行的初级保健教育和物理治疗计划的有效性，证据稀少。 方法：69 名初级保健医生被随机分配到 3 组，并招募了 348 名因腰痛就诊的患者；265 名（79.8%）为慢性腰痛患者。所有患者均接受常规护理，给予小册子，并接受关于健康教育的 15 分钟小组讨论，该讨论在对照组中侧重于健康的营养习惯，在“教育”和“教育+物理治疗”组中侧重于积极管理腰痛。此外，在“教育+物理治疗”组中，患者还收到了第二本小册子，并进行了 15 分钟的小组讨论，讨论有关姿势卫生的内容，还进行了 4 次 1 小时的运动和伸展练习，鼓励他们在家中继续练习。主要结局指标为 6 个月时腰痛相关残疾的改善。对患者的评估和数据分析进行了盲法处理。 结果：在 6 个月的随访期间，“对照组”的改善微不足道。在“教育”和“教育+物理治疗”组中，残疾（分别为 2.0 和 2.2 个 Roland Morris 问卷点）、腰痛（分别为 1.8 和 2.10 个视觉模拟量表点）、牵涉痛（1.3 和 1.6 个视觉模拟量表点）、灾难化（分别为 1.6 和 1.8 个应对策略问卷点）、身体质量生活（分别为 2.9 和 2.9 个 SF-12 点）和精神质量生活（分别为 3.7 和 5.1 个 SF-12 点）方面均有进一步改善。 结论：在初级保健中，在常规护理的基础上增加短期的主动管理教育计划可导致残疾、疼痛和生活质量的小但一致的改善。增加由在家中继续进行的有关姿势卫生和运动的教育组成的短期物理治疗计划，可增加这些改善，尽管增加的幅度在临床上无关紧要。
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