灾难性思维对非特异性下腰痛患者治疗结局的影响：系统评价。
Influence of catastrophizing on treatment outcome in patients with nonspecific low back pain: a systematic review.
机构信息
*Horten Centre for Patient Oriented Research and Knowledge Transfer, Department of Internal Medicine, University of Zurich, Pestalozzistrasse, Zurich, Switzerland; and †NYU Hospital for Joint Diseases, Occupational and Industrial Orthopaedic Center (OIOC), New York University, New York, NY.
出版信息
Spine (Phila Pa 1976). 2014 Feb 1;39(3):263-73. doi: 10.1097/BRS.0000000000000110.
STUDY DESIGN
Systematic review.
OBJECTIVE
The aim of this study was to assess the effect of catastrophizing on treatment efficacy and outcome in patients treated for low back pain.
SUMMARY OF BACKGROUND DATA
Psychological factors including catastrophizing thoughts are thought to increase the risk for chronic low back pain. The influence of catastrophizing is debated.
METHODS
In September 2012, the following databases were searched: BIOSIS, CINAHL, Cochrane Library, EMBASE, OTseeker, PeDRO, PsycINFO, MEDLINE, Scopus, and Web of Science. For 50 of 706 references, full text was assessed. Results based on 11 studies were included in this analysis.
RESULTS
In the 11 studies, a total of 2269 patients were included. Seven studies were of good and 4 of moderate methodological quality. Heterogeneity in study settings, treatments, outcomes, and patient populations impeded meta-analysis. Catastrophizing at baseline was predictive for disability at follow-up in 4 studies and for pain in 2 studies. Three studies found no predictive effect of catastrophizing. A mediating effect was found in all studies (n = 5) assessing the impact of a decrease in catastrophizing during treatment. A greater decrease was associated with better outcome. Most studies that investigated the moderating effects on treatment efficacy found no effect (n = 5). However, most studies did not look for a direct interaction between the treatment and catastrophizing thoughts. No study investigated the influence of catastrophizing on work-related outcomes including return to work.
CONCLUSION
Catastrophizing predicted degree of pain and disability and mediated treatment efficacy in most studies. The presence of catastrophizing should be considered in patients with persisting back pain. Limited evidence was found for the moderating effects on treatment efficacy. Future research should aim to clarify the role of catastrophizing as a moderator of outcome and investigate its importance for work-related outcomes.
LEVEL OF EVIDENCE
研究设计
系统评价。
目的
本研究旨在评估灾难性思维对腰痛患者治疗效果和结局的影响。
背景资料概要
心理因素包括灾难性思维被认为会增加慢性腰痛的风险。灾难性思维的影响存在争议。
方法
2012 年 9 月，检索了以下数据库：BIOSIS、CINAHL、Cochrane 图书馆、EMBASE、OTseeker、PeDRO、PsycINFO、MEDLINE、Scopus 和 Web of Science。对 706 篇参考文献中的 50 篇进行了全文评估。基于 11 项研究的结果被纳入本分析。
结果
在 11 项研究中，共纳入 2269 名患者。7 项研究的方法学质量良好，4 项为中等。研究环境、治疗方法、结局和患者人群的异质性阻碍了荟萃分析。4 项研究表明基线时的灾难性思维与随访时的残疾有关，2 项研究表明与疼痛有关。3 项研究未发现灾难性思维的预测作用。所有评估治疗过程中灾难性思维减少对结局影响的研究（n=5）都发现了中介效应。更大的减少与更好的结局相关。大多数研究（n=5）在调查治疗效果的调节作用时未发现效果。然而，大多数研究并没有寻找治疗和灾难性思维之间的直接相互作用。没有研究调查灾难性思维对与工作相关的结局（包括重返工作岗位）的影响。
结论
在大多数研究中，灾难性思维预测了疼痛和残疾的严重程度，并介导了治疗效果。对于持续存在腰痛的患者，应考虑存在灾难性思维。治疗效果的调节作用的证据有限。未来的研究应旨在阐明灾难性思维作为结局的调节因素的作用，并研究其对与工作相关的结局的重要性。
证据水平
1。
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