Deyo Richard A, Bryan Matthew, Comstock Bryan A, Turner Judith A, Heagerty Patrick, Friedly Janna, Avins Andrew L, Nedeljkovic Srdjan S, Nerenz David R, Jarvik Jeffrey G
*Departments of Family Medicine, Medicine, and Public Health and Preventive Medicine, and the Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR †Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA; Departments of ‡Biostatistics §Psychiatry and Behavioral Sciences, and ¶Rehabilitation Medicine, Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, Seattle, WA ‖Division of Research, Northern California Kaiser-Permanente, Oakland, CA **Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital and Spine Unit, Harvard Vanguard Medical Associates, Boston, MA ††Neuroscience Institute, Henry Ford Hospital, Detroit, MI; and ‡‡Departments of Radiology, Neurological Surgery, and Health Services, Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, Seattle, WA.
Spine (Phila Pa 1976). 2015 Sep 1;40(17):1352-62. doi: 10.1097/BRS.0000000000000975.
Prospective cohort study.
To determine whether there are distinct trajectories of back pain and function among older adults and to identify characteristics that distinguish among patients with substantially different prognoses.
Although the differential diagnosis and course of low back pain among older adults may differ from middle-aged adults, there is little evidence. Better understanding variability in recovery among older adults may help target patients for more intensive clinical interventions, plan resource use, and design clinical studies of more homogeneous patient groups.
Patients aged 65 years or older with a new episode of care for back pain were recruited at 3 geographically diverse sites. Patients completed pain intensity and Roland-Morris Disability measures at baseline and 3, 6, and 12 months later. We used latent class analysis to identify distinct trajectories of pain and function and then logistic regression to identify predictors of membership in the improving trajectories.
There were 3929 participants who completed outcome measures at every follow-up interval. Latent class analysis identified subgroups with low, intermediate, or high pain or disability scores who remained relatively stable over time. However, small subgroups showed dramatic improvement from baseline to 1 year (17% with major improvement in Roland score, pain intensity, or both). Shorter pain duration, higher patient confidence in improvement, and fewer comorbid conditions at baseline were each associated independently with favorable prognosis.
Although most patients remained relatively stable over a year, latent class analysis identified small groups with major improvement in pain, function, or both. This technique may, therefore, be useful for studying back pain prognosis. Our results should help assemble more prognostically homogeneous groups for research, and the technique may help identify subgroups of patients with uniquely successful responses to investigational interventions.
前瞻性队列研究。
确定老年人背痛和功能是否存在不同轨迹，并识别区分预后差异显著的患者的特征。
尽管老年人下背痛的鉴别诊断和病程可能与中年人不同，但证据很少。更好地了解老年人康复的变异性可能有助于针对患者进行更强化的临床干预、规划资源使用以及设计更同质化患者群体的临床研究。
在3个地理位置不同的地点招募65岁及以上因新发背痛接受治疗的患者。患者在基线时以及3个月、6个月和12个月后完成疼痛强度和罗兰-莫里斯残疾测量。我们使用潜在类别分析来识别疼痛和功能的不同轨迹，然后使用逻辑回归来识别改善轨迹成员的预测因素。
有3929名参与者在每个随访间隔完成了结局测量。潜在类别分析确定了疼痛或残疾评分低、中或高的亚组，这些亚组随时间相对稳定。然而，小亚组从基线到1年有显著改善（17%的患者罗兰评分、疼痛强度或两者有重大改善）。疼痛持续时间较短、患者对改善的信心较高以及基线时合并症较少均与良好预后独立相关。
尽管大多数患者在一年中保持相对稳定，但潜在类别分析识别出了疼痛、功能或两者有重大改善的小群体。因此，该技术可能有助于研究背痛预后。我们的结果应有助于组建更具预后同质性的研究群体，并且该技术可能有助于识别对研究性干预有独特成功反应的患者亚组。
3级。
