Arthritis Research UK Primary Care Centre, Keele University, Keele, Staffordshire ST5 5BG, UK.
Best Pract Res Clin Rheumatol. 2013 Oct;27(5):649-61. doi: 10.1016/j.berh.2013.10.005. Epub 2013 Oct 10.
Stratified care for back pain involves targeting treatment to subgroups of patients based on their key characteristics such as prognostic factors, likely response to treatment and underlying mechanisms. It aims to tailor therapeutic decisions in ways that maximise treatment benefit, reduce harm and increase health-care efficiency by offering the right treatment to the right patient at the right time. From being called the 'Holy Grail' of back pain research over a decade ago, stratified care is becoming the zeitgeist in research and clinical practice. In this chapter, we introduce and evaluate the quality and underpinning evidence for three examples of stratified care for back pain to highlight their general principles, research design issues and clinical practice implications. We include consideration of their merits for implementation in practice. We conclude with a set of remaining, key research questions.
分层治疗腰痛是指根据患者的关键特征(如预后因素、可能的治疗反应和潜在机制)将治疗靶向于亚组患者。它旨在通过在适当的时间为适当的患者提供适当的治疗,最大程度地提高治疗效果、减少伤害和提高医疗保健效率,从而定制治疗决策。十多年前,分层治疗曾被称为腰痛研究的“圣杯”,如今它正成为研究和临床实践的主流。在本章中,我们介绍和评估了三种腰痛分层治疗的质量和基础证据,以突出其一般原则、研究设计问题和临床实践意义。我们还考虑了它们在实践中实施的优点。最后,我们提出了一组仍然存在的关键研究问题。