Ramond-Roquin Aline, Bouton Céline, Bègue Cyril, Petit Audrey, Roquelaure Yves, Huez Jean-François
Department of General Practice, University of Angers, L'Université Nantes Angers Le Mans , Angers , France ; Laboratory of Ergonomics and Epidemiology in Occupational Health, University of Angers, L'Université Nantes Angers Le Mans , Angers , France.
Laboratory of Ergonomics and Epidemiology in Occupational Health, University of Angers, L'Université Nantes Angers Le Mans , Angers , France ; Department of General Practice, University of Nantes, L'Université Nantes Angers Le Mans , Nantes , France.
Front Med (Lausanne). 2015 Oct 8;2:73. doi: 10.3389/fmed.2015.00073. eCollection 2015.
Non-specific low back pain (LBP) affects many people and has major socio-economic consequences. Traditional therapeutic strategies, mainly focused on biomechanical factors, have had moderate and short-term impact. Certain psychosocial factors have been linked to poor prognosis of LBP and they are increasingly considered as promising targets for management of LBP. Primary health care providers (HCPs) are involved in most of the management of people with LBP and they are skilled in providing comprehensive care, including consideration of psychosocial dimensions. This review aims to discuss three pieces of recent research focusing on psychosocial issues in LBP patients in primary care. In the first systematic review, the patients' or HCPs' overall judgment about the likely evolution of LBP was the factor most strongly linked to poor outcome, with predictive validity similar to that of multidimensional scales. This result may be explained by the implicit aggregation of many prognostic factors underlying this judgment and suggests the relevance of considering the patients from biopsychosocial and longitudinal points of view. The second review showed that most of the interventions targeting psychosocial factors in LBP in primary care have to date focused on the cognitive-behavioral factors, resulting in little impact. It is unlikely that any intervention focusing on a single factor would ever fit the needs of most patients; interventions targeting determinants from several fields (mainly psychosocial, biomechanical, and occupational) may be more relevant. Should multiple stakeholders be involved in such interventions, enhanced interprofessional collaboration would be critical to ensure the delivery of coordinated care. Finally, in the third study, the prevalence of psychosocial comorbidity in chronic LBP patients was not found to be significantly higher than in other patients consulting in primary care. Rather than specifically screening for psychosocial conditions, this suggests taking into account any potential comorbidity in patients with chronic LBP, as in other patients. All these results support the adoption of a more comprehensive and patient-centered approach when dealing with patients with LBP in primary care. As this condition is illustrative of many situations encountered in primary care, the strategies proposed here may benefit most patients consulting in this setting.
非特异性下腰痛（LBP）影响着许多人，并产生重大的社会经济后果。传统的治疗策略主要侧重于生物力学因素，其影响是适度且短期的。某些心理社会因素与LBP的不良预后有关，并且它们越来越被视为LBP管理的有前景的目标。初级卫生保健提供者（HCPs）参与了大多数LBP患者的管理，并且他们有能力提供全面的护理，包括考虑心理社会层面。本综述旨在讨论三项近期研究，这些研究聚焦于初级保健中LBP患者的心理社会问题。在第一项系统综述中，患者或HCPs对LBP可能发展的总体判断是与不良结局联系最紧密的因素，其预测效度与多维量表相似。这一结果可能由该判断背后许多预后因素的隐性汇总来解释，并表明从生物心理社会和纵向角度考虑患者的相关性。第二项综述表明，迄今为止，大多数针对初级保健中LBP心理社会因素的干预措施都集中在认知行为因素上，结果影响甚微。专注于单一因素的任何干预措施都不太可能满足大多数患者的需求；针对多个领域（主要是心理社会、生物力学和职业）的决定因素的干预措施可能更具相关性。如果多个利益相关者参与此类干预，加强跨专业协作对于确保提供协调一致的护理至关重要。最后，在第三项研究中，未发现慢性LBP患者心理社会共病的患病率显著高于在初级保健中就诊的其他患者。这表明，与其他患者一样，对于慢性LBP患者，应考虑任何潜在的共病，而不是专门筛查心理社会状况。所有这些结果都支持在初级保健中处理LBP患者时采用更全面、以患者为中心的方法。由于这种情况是初级保健中遇到的许多情况的典型代表，这里提出的策略可能会使在此环境中就诊的大多数患者受益。
