CentraState Medical Center, Freehold, NJ 07728, USA.
J Orthop Sports Phys Ther. 2011 Dec;41(12):969-80. doi: 10.2519/jospt.2011.3814. Epub 2011 Nov 29.
Prospective, longitudinal, observational cohort design.
The primary aim was to examine the association between changes in psychosocial distress (PD), and functional status (FS) and pain intensity at discharge from physical therapy.
Patients with lumbar impairments seeking physical therapy commonly demonstrate elevated PD. However, it is not clear if PD changes that occur during physical therapy management are associated with improved clinical outcomes.
Data from adults (n = 692) with lumbar impairment were analyzed. Patients were screened using the Symptom Checklist Back Pain Prediction Model questionnaire (SCL BPPM) to identify patients at intake and discharge into 3 levels of risk for persistent disability (high, intermediate, or low). SCL BPPM classifications allowed for 5 patterns of change in PD during therapy (decreased, stable low, stable intermediate, stable high, or increased). Associations between PD change patterns and discharge FS and pain intensity were assessed using multivariable linear regression models, controlling for selected risk-adjustment variables.
Proportions of patients classified by patterns of PD change for decreased, stable low, stable intermediate, stable high, and increased were 0.34, 0.52, 0.05, 0.06, and 0.03, respectively. Compared to the decreased PD group, (1) increased, stable high, and stable intermediate PD patterns were associated with worse discharge FS scores (-7.9 [95% CI: -13.5, -2.21], -10.9 [95% CI: -15.25, -6.49], and -8.9 [95% CI: -13.65, -4.21] units, respectively), and (2) stable high and stable intermediate PD patterns were associated with higher pain intensity (2.59 [95% CI: 1.81, 3.56] and 2.14 [95% CI: 1.25, 3.04] units, respectively).
Lower FS and higher pain intensity outcomes were associated in similar but not identical patterns with patients whose SCL BPPM classification of PD increased, or remained at high or intermediate levels during physical therapy. Serial assessments of change in PD during rehabilitation are recommended as a possible treatment-monitoring tool.
前瞻性、纵向、观察性队列设计。
主要目的是探讨心理困扰（PD）和功能状态（FS）以及物理治疗出院时疼痛强度的变化之间的关系。
接受物理治疗的腰椎损伤患者通常表现出较高的 PD。然而，尚不清楚在物理治疗管理过程中发生的 PD 变化是否与改善临床结果相关。
分析了 692 名患有腰椎损伤的成年人的数据。使用症状检查表腰痛预测模型问卷（SCL BPPM）对患者进行筛查，以确定在摄入和出院时进入持续性残疾高、中、低 3 个风险水平的患者。SCL BPPM 分类允许在治疗期间 PD 发生 5 种变化模式（减少、稳定低、稳定中、稳定高或增加）。使用多变量线性回归模型评估 PD 变化模式与出院 FS 和疼痛强度之间的关联，同时控制选定的风险调整变量。
按 PD 变化模式（减少、稳定低、稳定中、稳定高和增加）分类的患者比例分别为 0.34、0.52、0.05、0.06 和 0.03。与 PD 减少组相比，（1）PD 增加、稳定高和稳定中 PD 模式与较差的出院 FS 评分相关（-7.9 [95%CI：-13.5，-2.21]、-10.9 [95%CI：-15.25，-6.49]和-8.9 [95%CI：-13.65，-4.21]单位），（2）稳定高和稳定中 PD 模式与较高的疼痛强度相关（2.59 [95%CI：1.81，3.56]和 2.14 [95%CI：1.25，3.04]单位）。
FS 降低和疼痛强度增加与 SCL BPPM 分类为 PD 增加或在物理治疗期间保持高水平或中等水平的患者存在相似但不完全相同的模式相关。建议在康复期间定期评估 PD 的变化，作为可能的治疗监测工具。
