Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom.
Phys Ther. 2011 May;91(5):712-21. doi: 10.2522/ptj.20100280. Epub 2011 Mar 30.
Evidence suggests that psychosocial factors have an influence on the outcome of physical therapy treatment and that the extent of their influence differs considerably among patients. As a consequence, substantial research efforts are focused on developing new clinical tools designed to identify and highlight when psychosocial factors are present at a level relevant to decision making. The conceptual differences in the ways that psychosocial factors influence outcome are described, structured around 3 common research terms: (1) prognostic factors, (2) treatment effect modifiers or moderators, and (3) treatment mediators. Prognostic factors are those characteristics that help estimate a patient's likely outcome irrespective of the chosen management. Treatment effect modifiers or moderators are factors measured at baseline that influence the relationship between a specific intervention and outcome. Treatment mediators are factors that have an intermediary role in the link between treatment and outcome. How these different influences on outcome can be translated into useful and complementary tools that aim to reduce treatment variability in clinical practice is described. One approach is to use prognostic factors to develop screening tools that identify an individual's risk status, typically based on predictive psychosocial factors such as catastophizing and depression. Another approach is to identify specific treatment effect modifiers to derive treatment decision aids or prediction rules to help match a patient's characteristics to the interventions available. A third approach is to use treatment mediators (eg, self-efficacy) to develop monitoring tools to inform the clinician about which aspects of treatment to strengthen.
有证据表明，心理社会因素对物理治疗的治疗效果有影响，而且其影响程度在患者之间有很大差异。因此，大量的研究工作集中在开发新的临床工具上，旨在识别和突出心理社会因素何时处于与决策相关的水平。描述了心理社会因素影响结果的方式在概念上的差异，围绕 3 个常见的研究术语进行了结构化：（1）预后因素，（2）治疗效果修饰剂或调节剂，以及（3）治疗中介。预后因素是指有助于估计患者可能的结果的特征，而不考虑所选择的管理方式。治疗效果修饰剂或调节剂是在基线测量的因素，影响特定干预措施与结果之间的关系。治疗中介因素在治疗和结果之间的联系中起中介作用。描述了如何将这些对结果的不同影响转化为有用且互补的工具，旨在减少临床实践中的治疗变异性。一种方法是使用预后因素来开发筛选工具，以确定个体的风险状况，通常基于预测性心理社会因素，如灾难化和抑郁。另一种方法是确定特定的治疗效果修饰剂，以得出治疗决策辅助工具或预测规则，以帮助将患者的特征与可用的干预措施相匹配。第三种方法是使用治疗中介因素（例如自我效能）来开发监测工具，以便向临床医生提供有关加强治疗哪些方面的信息。
