Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
Pain. 2013 Jun;154(6):951-7. doi: 10.1016/j.pain.2013.03.007. Epub 2013 Mar 14.
The aim of the current study was to determine the course of back pain in older patients and identify prognostic factors for non-recovery at 3 months' follow-up. We conducted a prospective cohort study (the BACE study) of patients aged >55 years visiting a general practitioner (GP) with a new episode of back pain in the Netherlands. The course of back pain was described in terms of self-perceived recovery, pain severity, disability, pain medication, and GP visits at 6 weeks' and 3 months' follow-up. Prognostic factors for non-recovery at 3 months' follow-up were derived from the baseline questionnaire and physical examination. Variables with a prognostic value were identified with multivariable logistic regression analysis (method backward), and an area under the receiver operating curve (AUC) was calculated for the prognostic model. A total of 675 back pain patients (mean age 66.4 (SD 7.6) years) participated in the BACE cohort study. At 6 weeks' follow-up 64% of the patients reported non-recovery from back pain. At 3 months' follow-up 61% still reported non-recovery, but only 26% of these patients had revisited the GP. Longer duration of the back pain, severity of back pain, history of back pain, absence of radiating pain in the leg below the knee, number of comorbidities, patients' expectation of non-recovery, and a longer duration of the timed 'Up and Go' test were significantly associated with non-recovery in a multiple regression model (AUC 0.79). This information can help GPs identify older back pain patients at risk for non-recovery.
本研究旨在确定老年患者腰痛的病程，并确定 3 个月随访时未恢复的预后因素。我们在荷兰对一位新出现腰痛的老年患者（年龄>55 岁）进行了一项前瞻性队列研究（BACE 研究）。在 6 周和 3 个月的随访中，通过患者自认为的恢复情况、疼痛严重程度、残疾程度、疼痛药物使用情况和全科医生就诊情况来描述腰痛的病程。3 个月随访时未恢复的预后因素来源于基线问卷和体格检查。使用多变量逻辑回归分析（后退法）确定具有预后价值的变量，并计算预测模型的受试者工作特征曲线下面积（AUC）。共有 675 名腰痛患者（平均年龄 66.4（7.6）岁）参与了 BACE 队列研究。在 6 周随访时，64%的患者报告腰痛未恢复。在 3 个月随访时，仍有 61%的患者报告腰痛未恢复，但只有 26%的患者再次就诊。腰痛持续时间较长、腰痛严重程度较高、腰痛病史、膝以下腿部无放射痛、合并症数量较多、患者对未恢复的预期以及计时“站起来走”测试时间较长，与多变量回归模型中的未恢复显著相关（AUC 0.79）。这些信息可以帮助全科医生识别有未恢复风险的老年腰痛患者。
