Foster Nadine E, Hill Jonathan C, Hay Elaine M
Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire ST5 5BG, UK.
Man Ther. 2011 Feb;16(1):3-8. doi: 10.1016/j.math.2010.05.013. Epub 2010 Jun 30.
Low back pain is a common, disabling condition with high personal and economic costs. Despite clinical guidelines, there have not been tangible reductions in the population prevalence of back pain or its serious long-term consequences. One reason for this might be that the 'one-size fits all approach' advocated by many guidelines fails to target treatments at patients who might benefit the most, thus diluting their potential benefits. Identifying subgroups of patients for whom different treatments are superior has been referred to as the 'Holy Grail' of low back pain research. Maximising the potential for targeted interventions is predicated on better understanding of the prognostic factors that are causally related to clinical outcome and identifying which are a) most predictive of outcome and b) most likely to be modifiable. Systematic identification of key obstacles to recovery in primary care back pain patients from high quality epidemiological studies can inform the development of early, targeted interventions. Only then can closer matching of treatments to patient characteristics be a clinical reality. This paper critically reviews progress in subgrouping for targeted treatment for patients with low back pain, identifies the key arguments for and against subgrouping and highlights the attributes of robust approaches in this field.
腰痛是一种常见的致残性疾病，会给个人和经济带来高昂代价。尽管有临床指南，但背痛在人群中的患病率及其严重的长期后果并未切实降低。造成这种情况的一个原因可能是，许多指南所倡导的“一刀切方法”未能针对可能受益最大的患者进行治疗，从而削弱了其潜在益处。确定不同治疗方法更具优势的患者亚组，一直被称为腰痛研究的“圣杯”。最大限度地发挥靶向干预的潜力，取决于更好地理解与临床结果有因果关系的预后因素，并确定哪些因素：a）对结果最具预测性；b）最有可能被改变。通过高质量的流行病学研究系统地识别初级保健背痛患者康复的关键障碍，可以为早期靶向干预措施的制定提供参考。只有这样，治疗与患者特征的更紧密匹配才能成为临床现实。本文批判性地回顾了腰痛患者靶向治疗亚组划分的进展，确定了支持和反对亚组划分的关键论点，并强调了该领域稳健方法的特点。
