Keedy Nicole H, Keffala Valerie J, Altmaier Elizabeth M, Chen Joseph J
Department of Psychological and Quantitative Foundations University of Iowa.
Department of Orthopaedics and Rehabilitation University of Iowa.
Iowa Orthop J. 2014;34:158-65.
Chronic back pain treatments have generally been costly and/or ineffective despite advances in medical technology. Patient selection and factors intrinsic to patients, including beliefs and behaviors, have been increasingly looked upon as possible predictive factors for success following multidisciplinary intervention for chronic back pain. The current study investigated the value of using patients' perceived control over health changes (health locus of control) and their perceived ability to engage in pain management behaviors (pain-related self-efficacy) to predict physical and mental health outcomes.
We retrospectively analyzed 61 patients who completed a two-week multidisciplinary chronic back pain rehabilitation program at our institution between 2007 and 2009. Patient demographics were identified and categorized. Pre- and post-intervention functional surveys, including the Multidimensional Health Locus of Control Form C, Chronic Pain Self-Efficacy Scale, Medical Outcomes Study Short Form-36 Version 2, Beck Depression Inventory-II, and Oswestry Disability Index Version 2, were used to evaluate benefit from back pain intervention and to examine patient factors that may predict physical and mental health outcomes.
Participants included 28 males and 33 females, ages 28 to 72, completing chronic back pain rehabilitation. Locus of control, self-efficacy, and physical and mental health demonstrated treatment-related changes, with notable improvements in physical and mental health. Regression analyses examined the value of pre-treatment health locus of control and pain-related self-efficacy as predictors of physical and mental health one month following treatment. Higher internal and lower doctor health locus of control, and higher self-efficacy at baseline predicted higher lift scores one month after treatment (p <. 05; p <. 01; p <. 01, respectively). Higher baseline self-efficacy also predicted better physical functioning (p <. 01) and lower disability (p <. 01) at one month.
In addition to supporting the multiple benefits of multidisciplinary rehabilitation, this study suggests that pain-related self-efficacy and health locus of control may be valuable predictors of treatment benefit for chronic back pain patients. These results provide direction in screening for factors that may maximize the potential to benefit from multidisciplinary intervention for chronic back pain.
尽管医疗技术有所进步，但慢性背痛的治疗通常成本高昂且/或效果不佳。患者的选择以及患者自身的因素，包括信念和行为，越来越被视为慢性背痛多学科干预后成功的可能预测因素。本研究调查了利用患者对健康变化的感知控制（健康控制点）及其参与疼痛管理行为的感知能力（疼痛相关自我效能）来预测身心健康结果的价值。
我们回顾性分析了2007年至2009年间在我们机构完成为期两周多学科慢性背痛康复计划的61名患者。确定并分类了患者的人口统计学特征。干预前后的功能调查，包括多维健康控制点C表、慢性疼痛自我效能量表、医学结果研究简短形式-36第2版、贝克抑郁量表-II和奥斯维斯特里残疾指数第2版，用于评估背痛干预的益处，并检查可能预测身心健康结果的患者因素。
参与者包括28名男性和33名女性，年龄在28至72岁之间，完成了慢性背痛康复。控制点、自我效能以及身心健康表现出与治疗相关的变化，身心健康有显著改善。回归分析检验了治疗前健康控制点和疼痛相关自我效能作为治疗后一个月身心健康预测指标的价值。更高的内控和更低的医生健康控制点，以及基线时更高的自我效能预测治疗后一个月更高的提升分数（分别为p <.05；p <.01；p <.01）。更高的基线自我效能还预测一个月时更好的身体功能（p <.01）和更低的残疾程度（p <.01）。
除了支持多学科康复的多种益处外，本研究表明疼痛相关自我效能和健康控制点可能是慢性背痛患者治疗益处的有价值预测指标。这些结果为筛选可能使慢性背痛多学科干预受益潜力最大化的因素提供了方向。
