University Clinic of Heidelberg, Department of Orthopaedics, Trauma Surgery and Paraplegiology, Schlierbacher Landstrasse 200a, Heidelberg, Germany.
J Clin Rheumatol. 2012 Mar;18(2):76-82. doi: 10.1097/RHU.0b013e318247b96a.
The effectiveness of multidisciplinary treatment programs varies throughout the literature, and it remains controversial how therapy outcome is affected by patients' individual parameters and which treatment settings work best.
We set out to examine the impact of patient variables on the effectiveness of a 3-week multidisciplinary treatment program in patients with chronic low back pain. By presenting effect sizes, we aimed to enable the comparison of our findings with other studies across disciplines.
Data on 395 patients were prospectively collected at study entry, at the end of the program (T1) and after 6 months' follow-up (T2). Relevant therapy outcomes were analyzed by presenting effect sizes with Cohen's d. Group comparisons were performed for sociodemographic and clinical features to determine the impact on therapy outcome.
Medium effect sizes (d = -0.6 to -0.7) were shown for visual analog scale (VAS) after treatment and at T2, indicating clinically relevant pain relief. Significant changes in pain-related disability were observed immediately at T1 with a strong treatment effect (d = 0.8). Functional capacity was improved with low to medium effect sizes (0.4-0.5). Quality-of-life subscales (36-item Short Form Health Survey) improved significantly at T1 for physical function, vitality, and mental health (d = 0.5-0.8). Center for Epidemiological Studies - Depression Scale scores improved significantly with strong effect sizes of d = 0.7. Sociodemographic parameters displayed a significant impact on effect sizes for visual analog scale at T2, with females (d = -0.9), age group 30 to 39 years (d = -1), and patients with low physical job exposure (d = -0.9) benefiting most. An increase in number of pain locations (-0.7) and severity of accompanying pain (-0.7) in other body areas significantly impaired therapy outcome and effect sizes of VAS.
Thus, multidisciplinary treatment ameliorates pain, functional restoration, and quality of life with medium to high effect sizes even for patients with a long history of chronic back pain. Effect sizes are higher than for monodisciplinary treatments and treatment effects remained stable at 6-month follow-up in a longitudinal uncontrolled study design. Thus, we believe that multidisciplinary treatment is vital for the treatment of patients with chronic low back pain. The impact of sociodemographic and pain-related parameters needs to be taken into account when including patients in an appropriate treatment program. We emphasize the presentation of effect sizes as a vital treatment evaluation to enable cross-sectional comparison of therapy outcomes.
多学科治疗方案的疗效在文献中存在差异，患者的个体参数如何影响治疗效果以及哪种治疗环境效果最佳仍存在争议。
我们旨在研究患者变量对慢性下腰痛患者进行为期 3 周的多学科治疗方案效果的影响。通过呈现效应大小，我们旨在使我们的研究结果能够与跨学科的其他研究进行比较。
在研究开始时（T1）、方案结束时（T1）和 6 个月随访时（T2），前瞻性地收集了 395 名患者的数据。通过呈现 Cohen's d 的效应大小来分析相关治疗结果。对社会人口统计学和临床特征进行组间比较，以确定其对治疗效果的影响。
治疗后和 T2 时的视觉模拟量表（VAS）显示出中等效应大小（d = -0.6 至-0.7），表明疼痛缓解具有临床意义。疼痛相关残疾在 T1 时立即出现显著变化，治疗效果较强（d = 0.8）。功能能力也有所改善，效应大小为低至中等（0.4-0.5）。健康调查简表 36 项（36-item Short Form Health Survey）的生理功能、活力和心理健康子量表在 T1 时显著改善（d = 0.5-0.8）。流行病学研究中心抑郁量表（Center for Epidemiological Studies - Depression Scale）评分也显著改善，效应大小较大（d = 0.7）。社会人口统计学参数对 T2 时 VAS 的效应大小有显著影响，女性（d = -0.9）、30 至 39 岁年龄组（d = -1）和体力工作暴露程度较低的患者（d = -0.9）获益最大。其他身体部位疼痛部位数量的增加（-0.7）和伴随疼痛的严重程度（-0.7）显著损害了治疗效果和 VAS 的效应大小。
因此，多学科治疗可改善慢性腰痛患者的疼痛、功能恢复和生活质量，具有中等到较高的效应大小。效应大小高于单学科治疗，且在纵向非对照研究设计中，6 个月随访时治疗效果保持稳定。因此，我们认为多学科治疗对慢性下腰痛患者的治疗至关重要。在将患者纳入适当的治疗方案时，需要考虑社会人口统计学和疼痛相关参数的影响。我们强调以效应大小作为重要的治疗评估手段，以便对治疗结果进行跨学科比较。
