不同解剖部位肌肉骨骼疼痛与工作相关的恐惧回避信念的比较。
Comparison of work-related fear-avoidance beliefs across different anatomical locations with musculoskeletal pain.
机构信息
Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA.
出版信息
J Pain Res. 2011;4:253-62. doi: 10.2147/JPR.S22457. Epub 2011 Sep 1.
BACKGROUND
The influence of work-related fear-avoidance on pain and function has been consistently reported for patients with musculoskeletal low back pain. Emerging evidence suggests similar influences exist for other anatomical locations of musculoskeletal pain, such as the cervical spine and extremities. However, research is limited in comparing work-related fear-avoidance and associations with clinical outcomes across different anatomical locations. The purpose of this study was to examine the associations between work-related fear-avoidance, gender, and clinical outcomes across four different musculoskeletal pain locations for patients being treated in an outpatient physical therapy setting.
METHODS
This study was a secondary analysis of data obtained prospectively from a cohort of 313 participants receiving physical therapy from an outpatient clinic.
RESULTS
No interaction was found between gender and anatomical location of musculoskeletal pain on work-related fear-avoidance scores. Work-related fear-avoidance scores were higher in the cervical group versus the lower extremity group; however, there were no other differences across anatomical locations. Work-related fear-avoidance influenced intake pain intensity in patients with spine pain but not extremity pain. Conversely, work-related fear-avoidance influenced intake function for participants with extremity pain but not spine pain. Similar results were observed for change scores, with higher work-related fear-avoidance being associated with more, not less, change in pain and function for certain anatomical locations.
CONCLUSION
These findings suggest that work-related fear-avoidance is similar for patients experiencing musculoskeletal pain. However, associations between work-related fear-avoidance and clinical outcomes may differ based on the anatomical location of that pain. Further, increased work-related fear-avoidance may not be indicative of poor clinical outcomes for this type of patient population.
背景
工作相关的恐惧回避对肌肉骨骼下背痛患者的疼痛和功能有持续的影响。新出现的证据表明，对于肌肉骨骼疼痛的其他解剖部位，如颈椎和四肢，也存在类似的影响。然而，研究在比较不同解剖部位的工作相关恐惧回避与临床结果之间的关联方面是有限的。本研究的目的是检验在门诊物理治疗环境中治疗的 4 个不同肌肉骨骼疼痛部位的患者中，工作相关恐惧回避、性别与临床结果之间的关系。
方法
这是对从一家门诊诊所接受物理治疗的 313 名参与者前瞻性获得的数据进行的二次分析。
结果
在肌肉骨骼疼痛的工作相关恐惧回避评分方面，性别与解剖部位之间没有发现相互作用。颈椎组的工作相关恐惧回避评分高于下肢组；然而，在其他解剖部位没有差异。工作相关恐惧回避影响脊柱疼痛患者的摄入疼痛强度，但不影响四肢疼痛患者。在四肢疼痛患者中，工作相关恐惧回避影响摄入量的功能，而在脊柱疼痛患者中则没有。对于变化分数也观察到类似的结果，较高的工作相关恐惧回避与某些解剖部位的疼痛和功能的更多变化相关，而不是更少的变化。
结论
这些发现表明，工作相关恐惧回避对患有肌肉骨骼疼痛的患者是相似的。然而，工作相关恐惧回避与临床结果之间的关联可能因疼痛的解剖部位而异。此外，对于这种类型的患者群体，增加工作相关恐惧回避不一定预示着临床结果不佳。
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