Bath Brenna, Lovo Grona Stacey
School of Physical Therapy, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
J Pain Res. 2015 Apr 23;8:189-202. doi: 10.2147/JPR.S81485. eCollection 2015.
A spinal triage assessment service may impact a wide range of patient outcomes. Investigating potential predictors of success or improvement may reveal why some people improve and some do not, as well as help to begin to explain potential mechanisms for improvements. The objective of this study was to determine which factors were associated with improved short-term self-reported pain, function, general health status, and satisfaction in people undergoing a spinal triage assessment performed by physiotherapists.
Participants with low back-related complaints were recruited from people referred to a spinal triage assessment program (N=115). Participants completed baseline questionnaires covering a range of sociodemographic, clinical, and psychological features. Self-reported measures of pain, function, quality of life, and satisfaction were completed at 4 weeks following the assessment. Determination of "success" was based on minimal important change scores of select outcome measures. Multivariate logistic regression was used to explore potential predictors of success for each outcome.
Despite the complex and chronic presentation of most participants, some reported improvements in outcomes at 4 weeks post assessment with the highest proportion of participants demonstrating improvement (according to the minimal important change scores) in the Medical Outcomes Survey 36-item short-form version 2 physical component summary score (48.6%) and the lowest proportion of participants having improvements in the Numeric Pain Rating Scale (11.5%). A variety of different sociodemographic, psychological, clinical, and other variables were associated with success or improvement in each respective outcome.
There may be a potential mechanism of reassurance that occurs during the spinal triage assessment process as those with higher psychological distress (measured by the Fear Avoidance Beliefs Questionnaire and the Distress and Risk Assessment Measure) were more likely to improve on certain outcomes. The use of an evaluation framework guided by a biopsychosocial model may help determine potential mechanisms of action for a physiotherapy-delivered triage program.
脊柱分诊评估服务可能会影响广泛的患者预后。调查成功或改善的潜在预测因素可能会揭示为何有些人病情好转而有些人没有，同时有助于开始解释改善的潜在机制。本研究的目的是确定哪些因素与接受物理治疗师进行脊柱分诊评估的患者短期自我报告的疼痛、功能、总体健康状况及满意度的改善相关。
从被转介至脊柱分诊评估项目的人群中招募有下背部相关主诉的参与者（N = 115）。参与者完成了涵盖一系列社会人口统计学、临床和心理特征的基线问卷。在评估后4周完成自我报告的疼痛、功能、生活质量和满意度测量。“成功”的判定基于选定结局指标的最小重要变化分数。采用多变量逻辑回归来探索每个结局成功的潜在预测因素。
尽管大多数参与者表现出复杂的慢性症状，但一些人报告在评估后4周结局有所改善，其中在医学结局研究36项简表第2版身体成分汇总得分方面显示改善的参与者比例最高（48.6%），而在数字疼痛评分量表方面改善的参与者比例最低（11.5%）。各种不同的社会人口统计学、心理、临床和其他变量与各自结局的成功或改善相关。
在脊柱分诊评估过程中可能存在一种安慰的潜在机制，因为心理困扰程度较高的人（通过恐惧回避信念问卷和痛苦与风险评估量表测量）在某些结局上更有可能改善。采用以生物心理社会模型为指导的评估框架可能有助于确定物理治疗分诊项目的潜在作用机制。
