Cheshire Anna, Polley Marie, Peters David, Ridge Damien
Faculty of Science and Technology, University of Westminster, 115 New Cavendish Street, W1W 6UW, London, UK, England.
BMC Complement Altern Med. 2013 Nov 1;13:300. doi: 10.1186/1472-6882-13-300.
Supported self-management, acupuncture and information can help reduce the symptoms of low back pain. These approaches are currently recommended by NICE guidance as treatment options for patients with persistent low back pain. However, there has been no previous evaluation of a service providing them together for this common problem. The purpose of this service evaluation was to report patient outcomes and experiences of the Beating Back Pain Service (BBPS), a pilot service based in a primary and community care setting, delivering acupuncture, self-management and information to patients with chronic low back pain.
Patients completed a questionnaire at three time points: pre-BBPS, immediately post-BBPS and three months post-BBPS. Outcome measures included the Bournemouth Questionnaire (measuring musculoskeletal, MSK, problems), EuroQoL-5D (measuring quality of life), Pain and Self-efficacy Questionnaire, and additional questions on medication use, physical activity, understanding of pain and positive well-being. Additionally, the STarT Back (measuring risk of developing chronic pain) was collected at BBPS information sessions. Non-parametric tests were used to evaluate pre- and post- variables. Questionnaires also collected qualitative data (open-text responses) regarding patient views and experiences of the BBPS, which were analysed using thematic analysis.
80 (out of 108) patients who attended the initial BBPS information session agreed to participate in the service evaluation (mean age 47 years, 65% female). 65 patients attended subsequent BBPS acupuncture and/or self-management sessions and were asked to complete post-treatment questionnaires; complete datasets were available for 61 patients.There were statistically significant improvements over time for pain (p <0.0001), quality of life (p = 0.006), understanding of pain (p <0.001), physical activity (p = 0.047) and relaxation (p = 0.012). Post-hoc analysis revealed that scores improved between baseline and post-treatment, these improvements were maintained at 3-month follow-up (except relaxation). Patients receiving a combination of acupuncture and self-management sessions produced the most positive results. Patient satisfaction with the BBPS was high.
The BBPS provided a MSK pain management service that many patients found effective and valuable. Combining self-management with acupuncture was found to be particularly effective, although further consideration is required regarding how best to engage patients in self-management.
支持性自我管理、针灸和信息提供有助于减轻腰痛症状。目前，英国国家卫生与临床优化研究所（NICE）指南推荐这些方法作为持续性腰痛患者的治疗选择。然而，此前尚无针对将这些方法结合起来用于解决这一常见问题的服务进行评估。本服务评估的目的是报告“击退背痛服务”（BBPS）的患者治疗结果及体验，这是一项在初级和社区护理环境中开展的试点服务，为慢性腰痛患者提供针灸、自我管理和信息服务。
患者在三个时间点完成问卷调查：BBPS治疗前、BBPS治疗后即刻以及BBPS治疗后三个月。结局指标包括伯恩茅斯问卷（用于测量肌肉骨骼问题，即MSK问题）、欧洲五维度健康量表（用于测量生活质量）、疼痛与自我效能问卷，以及关于药物使用、身体活动、对疼痛的理解和积极幸福感的附加问题。此外，在BBPS信息咨询会上收集了“STarT Back”（用于测量发展为慢性疼痛的风险）。使用非参数检验评估治疗前后变量。问卷还收集了关于患者对BBPS的看法和体验的定性数据（开放式文本回答），并采用主题分析法进行分析。
参加首次BBPS信息咨询会的108名患者中有80名（平均年龄47岁，65%为女性）同意参与服务评估。65名患者参加了后续的BBPS针灸和/或自我管理课程，并被要求完成治疗后问卷；61名患者有完整的数据集。随着时间推移，疼痛（p <0.0001）、生活质量（p = 0.006）、对疼痛的理解（p <0.001）、身体活动（p = 0.047）和放松程度（p = 0.012）均有统计学意义的改善。事后分析显示，从基线到治疗后分数有所提高，这些改善在3个月随访时得以维持（放松程度除外）。接受针灸和自我管理课程相结合的患者取得了最积极的结果。患者对BBPS的满意度较高。
BBPS提供了一项肌肉骨骼疼痛管理服务，许多患者认为该服务有效且有价值。虽然在如何让患者更好地参与自我管理方面还需要进一步考虑，但发现将自我管理与针灸相结合特别有效。
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