Department of Orthopaedics, The Spine Center, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA.
Spine J. 2012 Dec;12(12):1132-7. doi: 10.1016/j.spinee.2012.09.003. Epub 2012 Oct 12.
The multiplicity of biopsychosocial and economic facets of chronic disabling back and/or neck pain complicates the treatment outcomes measurement. Our previous work showed that personal functional goal achievement contributed more toward patient satisfaction with the outcome than did traditional self-reports of pain and physical function or measured strength, flexibility, and endurance among functional restoration program (FRP) graduates with chronic disabling back and/or neck pain.
The primary goal was to compare the impact on patient satisfaction of pain and functional goal achievement versus self-reports of pain and physical function.
This was an observational study of all patients with chronic disabling back and/or neck pain completing an FRP between June 2008 and May 2009.
Before the treatment, participants recorded personal 3-month goals for pain, work, recreation, and activities of daily living. At least 3 months later, all graduates were sent a follow-up survey displaying the patient's pretreatment functional goals and eliciting the patient's assessment of functional goal achievement; current pain magnitude, "satisfaction with the overall results for your pain problem;" and responses to the Short Form-36v2 Physical Functioning subscale (PF-10).
Pain goal achievement was calculated as the difference between the pretreatment pain goal and follow-up pain magnitude. Linear regression was used to evaluate the association between satisfaction and four variables (follow-up pain; PF-10; pain goal achievement; functional goal achievement), individually and then together in a full model.
Of the 82 patients surveyed, 62 responded completely. Mean age was 44 years, with 48% female and 35% on worker's compensation. The model R(2) combining all four variables explained 0.6033 of the variance in satisfaction. Each variable by itself was significantly related to patient satisfaction at p<.001, but the overlap in association was large. The unique contributions (R(2)) to the variation in satisfaction were the following: functional goal achievement: 0.0471; PF-10 score: 0.0229; pain magnitude: 0.0178; and pain goal achievement: 0.0020.
At least 3 months after the treatment, functional goal achievement had by far the greatest impact on patient satisfaction, followed by PF-10 score, pain magnitude, and, finally, pain goal achievement. Functional goal achievement has great potential as a tool for patient-centered treatment decision-making and outcomes measurement for people with chronic disabling back and/or neck pain and their health care providers.
慢性致残性腰背或颈部疼痛的生物心理社会和经济方面的多样性使治疗结果的测量变得复杂。我们之前的工作表明，个人功能目标的实现比慢性致残性腰背或颈部疼痛功能恢复计划（FRP）毕业生的传统自我报告的疼痛和身体功能或测量的力量、灵活性和耐力更能提高患者对治疗结果的满意度。
主要目标是比较疼痛和功能目标实现与疼痛和身体功能自我报告对患者满意度的影响。
这是一项对 2008 年 6 月至 2009 年 5 月间完成 FRP 的所有慢性致残性腰背或颈部疼痛患者的观察性研究。
在治疗前，参与者记录了个人 3 个月的疼痛、工作、娱乐和日常生活活动目标。至少 3 个月后，所有毕业生都收到了一份随访调查，显示患者的术前功能目标，并征求患者对功能目标实现的评估；目前的疼痛程度、“对您的疼痛问题的整体治疗结果的满意度”；以及对短格式 36v2 身体功能量表（PF-10）的反应。
疼痛目标的实现程度是通过术前疼痛目标和随访疼痛程度之间的差异来计算的。线性回归用于评估满意度与四个变量（随访疼痛；PF-10；疼痛目标实现；功能目标实现）之间的关联，单独使用和在全模型中一起使用。
在接受调查的 82 名患者中，有 62 名患者完全回复。平均年龄为 44 岁，女性占 48%，工人赔偿占 35%。将所有四个变量结合起来的模型 R(2) 解释了满意度变化的 0.6033。每个变量本身与患者满意度显著相关（p<.001），但关联的重叠度很大。对满意度变化的独特贡献（R(2)）如下：功能目标的实现：0.0471；PF-10 评分：0.0229；疼痛程度：0.0178；以及疼痛目标的实现：0.0020。
至少在治疗后 3 个月，功能目标的实现对患者满意度的影响最大，其次是 PF-10 评分、疼痛程度，最后是疼痛目标的实现。功能目标的实现作为一种以患者为中心的治疗决策和对慢性致残性腰背或颈部疼痛患者及其医疗保健提供者的治疗结果的衡量工具，具有巨大的潜力。
