评估治疗师和患者预后因素对轴性疼痛康复的影响。
Assessing the influence of treating therapist and patient prognostic factors on recovery from axial pain.
作者信息
Simon Corey B, Stryker Sandra E, George Steven Z
机构信息
Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA.
Life's Work Physical Therapy, Portland, OR, USA.
出版信息
J Man Manip Ther. 2013 Nov;21(4):187-95. doi: 10.1179/2042618613Y.0000000035.
BACKGROUND
Limited research exists regarding the influence of a treating physical therapist on patient recovery (deemed therapist effects). Recent randomized clinical trials data provide an indication of small therapist effects for manual therapy; however, the extent to which therapist effects exist in the average outpatient facility is not clear. Moreover, patient-related prognostic factors, like fear-avoidance or pain duration, are important to consider since these may also influence the extent of therapist effects.
OBJECTIVE
To assess therapist effects and the influence of patient prognostic factors on recovery from axial pain in an outpatient orthopedic physical therapy facility.
METHODS
Clinical data were collected from consecutive patients with musculoskeletal neck and low back pain. Patient outcomes included pain intensity (visual analog scale) and functional measure (CareConnections functional outcomes index) scores. Therapist effects estimates and the influence of intake fear-avoidance (fear-avoidance beliefs questionnaire) and pain duration (days) were examined using multilevel linear or regression modeling.
RESULTS
A total of 258 patients (160 females; mean age 46.4±14.9 years) completed physical therapy and the required outcome measures. Five physical therapists (1-13 years of experience, mean 5.8 years) provided treatment. Therapists effects did not exist for discharge pain intensity or function after accounting for intake scores (P > 0.05). Further, therapist experience did not influence patient outcomes. Patient prognostic factors of fear-avoidance and pain duration did not influence therapists effects on the same patient outcome measures (P > 0.05).
DISCUSSION
Preliminary findings suggest that there are no major differences in patient outcome based on either the individual therapist (therapist effect) or therapist experience in this type of PT setting. Established prognostic factors had no influence on therapist effects for this cohort. Future analyses should consider intrinsic therapist factors (beliefs, equipoise), specific treatment parameters (dosage, type), and other patient prognostic factors (psychological, age, expectation, satisfaction) to further elucidate the influence of therapist effects.
背景
关于治疗物理治疗师对患者康复的影响（即治疗师效应）的研究有限。近期随机临床试验数据表明手法治疗的治疗师效应较小；然而，在普通门诊机构中治疗师效应的存在程度尚不清楚。此外，与患者相关的预后因素，如恐惧回避或疼痛持续时间，也很重要，因为这些因素可能也会影响治疗师效应的程度。
目的
评估在门诊骨科物理治疗机构中治疗师效应以及患者预后因素对轴性疼痛康复的影响。
方法
收集连续的肌肉骨骼颈部和下背部疼痛患者的临床数据。患者的预后指标包括疼痛强度（视觉模拟量表）和功能指标（CareConnections功能预后指数）得分。使用多级线性或回归模型检查治疗师效应估计值以及初始恐惧回避（恐惧回避信念问卷）和疼痛持续时间（天数）的影响。
结果
共有258名患者（160名女性；平均年龄46.4±14.9岁）完成了物理治疗及所需的预后指标测量。五名物理治疗师（经验为1 - 13年，平均5.8年）提供治疗服务。在考虑初始得分后，出院时疼痛强度或功能不存在治疗师效应（P>0.05）。此外，治疗师的经验并未影响患者的预后。恐惧回避和疼痛持续时间等患者预后因素对治疗师对相同患者预后指标的效应没有影响（P>0.05）。
讨论
初步研究结果表明，在这种物理治疗环境中，基于个体治疗师（治疗师效应）或治疗师经验，患者的预后没有重大差异。既定的预后因素对该队列中的治疗师效应没有影响。未来的分析应考虑治疗师内在因素（信念、平衡）、特定治疗参数（剂量、类型）以及其他患者预后因素（心理、年龄、期望、满意度），以进一步阐明治疗师效应的影响因素。
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