Institute of Health Promotion and Clinical Movement Science, German Sport University Cologne, Cologne, Germany.
PLoS One. 2013 Apr 19;8(4):e61587. doi: 10.1371/journal.pone.0061587. Print 2013.
From observational studies, there is only sparse information available on the predictors of development of impairment in daily life for patients receiving physiotherapy. Therefore, our aim was to identify factors which predict impairment in daily life for patients with back pain 6 months after receiving physiotherapy.
We conducted a prospective cohort study with 6-month follow-up. Patients were enrolled for treatment in private physiotherapy practices. Patients with a first physiotherapy referral because of thoracic or low back pain, aged 18 to 65 years were included. Primary outcome impairment was measured utilising the 16-item version of the Musculoskeletal Function Assessment Questionnaire. Therapy was documented on a standardized form. Baseline scores for impairment in daily life, symptom characteristics, sociodemographic and psychosocial factors, physical activity, nicotine consumption, intake of analgesics, comorbidity and delivered primary therapy approach were investigated as possible predictors. Univariate and multiple linear regression analyses were performed.
A total of 792 patients participated in the study (59% female, mean age 44.4 (SD 11.4), with 6-month follow-up results available from 391 patients. In univariate analysis 17 variables reached significance. In multiple linear regression identified predictors were: impairment in daily life before therapy, mental disorders, duration of the complaints, self-prognosis on work ability, rheumatoid arthritis, age, form of stress at work and physical activity. The variables explain 34% of variance (adjusted R(2), p<0.001).
With minimal information available from observational studies on the predictors of development of back problems for physiotherapy patients, this study adds new knowledge for forming appropriate referral guidelines. Impairment in daily life before therapy, mental disorder as comorbidity and the duration of the complaints can be named as outstanding factors. The results of this study can be used to facilitate comparison of patient therapy goals with the prognosis in everyday practice.
从观察性研究中，我们仅能得到关于接受物理治疗的患者日常生活功能损害发展的预测因素的零星信息。因此，我们的目的是确定预测接受物理治疗 6 个月后腰痛患者日常生活功能损害的因素。
我们进行了一项前瞻性队列研究，随访 6 个月。患者被招募到私人物理治疗诊所接受治疗。纳入标准为：因胸或腰痛首次接受物理治疗转诊，年龄 18-65 岁。主要结局指标为日常生活功能损害，采用肌肉骨骼功能评估问卷的 16 项版本进行测量。治疗情况记录在标准化表格上。分析了日常生活功能损害的基线评分、症状特征、社会人口学和心理社会因素、身体活动、尼古丁摄入、镇痛药摄入、合并症和主要治疗方法，以评估其是否为可能的预测因素。进行了单变量和多变量线性回归分析。
共有 792 名患者参与了研究（59%为女性，平均年龄 44.4（11.4）岁），其中 391 名患者完成了 6 个月的随访。单变量分析中，有 17 个变量具有统计学意义。多变量线性回归分析确定的预测因素为：治疗前日常生活功能损害、精神障碍、症状持续时间、对工作能力的自我预后、类风湿关节炎、年龄、工作压力形式和身体活动。这些变量解释了 34%的方差（调整 R²，p<0.001）。
由于观察性研究中关于物理治疗患者背部问题发展预测因素的信息有限，本研究提供了新的知识，有助于制定适当的转诊指南。治疗前的日常生活功能损害、作为合并症的精神障碍以及症状持续时间可以被视为重要因素。本研究的结果可用于促进将患者的治疗目标与日常实践中的预后进行比较。
