The George Institute for International Health, University of Sydney, PO Box M201, Missenden Rd, Camperdown, NSW 2050, Australia.
Best Pract Res Clin Rheumatol. 2010 Apr;24(2):181-91. doi: 10.1016/j.berh.2009.11.003.
There has been a recent increase in research evaluating treatment-based subgroups of non-specific low back pain. The aim of these sub-classification schemes is to identify subgroups of patients who will respond preferentially to one treatment as opposed to another. Our article provides accessible guidance on to how to interpret this research and determine its implications for clinical practice. We propose that studies evaluating treatment-based subgroups can be interpreted in the context of a three-stage process: (1) hypothesis generation-proposal of clinical features to define subgroups; (2) hypothesis testing-a randomised controlled trial (RCT) to test that subgroup membership modifies the effect of a treatment; and (3) replication-another RCT to confirm the results of stage 2 and ensure that findings hold beyond the specific original conditions. At this point, the bulk of research evidence in defining subgroups of patients with low back pain is in the hypothesis generation stage; no classification system is supported by sufficient evidence to recommend implementation into clinical practice.
最近，评估非特异性下腰痛基于治疗的亚组的研究有所增加。这些分类方案的目的是确定对一种治疗反应优于另一种治疗的患者亚组。我们的文章提供了关于如何解释此类研究并确定其对临床实践的影响的易懂指南。我们提出，基于治疗的亚组的研究可以在三个阶段的过程中进行解释：（1）假设生成-提出定义亚组的临床特征；（2）假设检验-随机对照试验（RCT）来检验亚组归属是否改变治疗效果；（3）复制-另一个 RCT 来确认第 2 阶段的结果，并确保研究结果超出特定的原始条件。此时，定义下腰痛患者亚组的大部分研究证据处于假设生成阶段；没有任何分类系统得到足够的证据支持，无法推荐将其应用于临床实践。
