亚急性非恶性疼痛患者残疾和病假的预后因素：队列研究的系统评价
Prognostic factors for disability and sick leave in patients with subacute non-malignant pain: a systematic review of cohort studies.
作者信息
Valentin Gitte H, Pilegaard Marc S, Vaegter Henrik B, Rosendal Marianne, Ørtenblad Lisbeth, Væggemose Ulla, Christensen Robin
机构信息
Department of Central Denmark Region, Health Technology Assessment and Health Services Research, CFK-Public Health and Quality Improvement, Aarhus, Denmark.
Department of Public Health, Research Initiative for Activity Studies and Occupational Therapy, General Practice, University of Southern Denmark, Odense, Denmark.
出版信息
BMJ Open. 2016 Jan 6;6(1):e007616. doi: 10.1136/bmjopen-2015-007616.
OBJECTIVE
This systematic review aims to identify generic prognostic factors for disability and sick leave in subacute pain patients.
SETTING
General practice and other primary care facilities.
PARTICIPANTS
Adults (>18 years) with a subacute (≤ 3-month) non-malignant pain condition. Eligibility criteria were cohort studies investigating the prediction of disability or long-term sick leave in adults with a subacute pain condition in a primary care setting. 19 studies were included, referring to a total of 6266 patients suffering from pain in the head, neck, back and shoulders.
PRIMARY AND SECONDARY OUTCOME MEASURES
The primary outcome was long-term disability (>3 months) due to a pain condition. The secondary outcome was sick leave, defined as 'absence from work' or 'return-to-work'.
RESULTS
PubMed, EMBASE, CINAHL and PEDro databases were searched from 16 January 2003 to 16 January 2014. The quality of evidence was presented according to the GRADE WG recommendations. Several factors were found to be associated with disability at follow-up for at least two different pain symptoms. However, owing to insufficient studies, no generic risk factors for sick leave were identified.
CONCLUSIONS
Multiple site pain, high pain severity, older age, baseline disability and longer pain duration were identified as potential prognostic factors for disability across pain sites. There was limited evidence that anxiety and depression were associated with disability in patients with subacute pain, indicating that these factors may not play as large a role as expected in developing disability due to a pain condition. Quality of evidence was moderate, low or very low, implying that confidence in the results is limited. Large prospective prognostic factor studies are needed with sufficient study populations and transparent reporting of all factors examined.
TRIAL REGISTRATION NUMBER
CRD42014008914.
目的
本系统评价旨在确定亚急性疼痛患者残疾和病假的一般预后因素。
设置
全科医疗及其他初级保健机构。
参与者
患有亚急性（≤3个月）非恶性疼痛疾病的成年人（>18岁）。纳入标准为队列研究，调查初级保健机构中亚急性疼痛患者残疾或长期病假的预测情况。共纳入19项研究，涉及6266例头部、颈部、背部和肩部疼痛患者。
主要和次要结局指标
主要结局为因疼痛疾病导致的长期残疾（>3个月）。次要结局为病假，定义为“缺勤”或“返岗”。
结果
检索了2003年1月16日至2014年1月16日期间的PubMed、EMBASE、CINAHL和PEDro数据库。根据GRADE工作组的建议呈现证据质量。发现几个因素与至少两种不同疼痛症状随访时的残疾相关。然而，由于研究不足，未确定病假的一般风险因素。
结论
多部位疼痛、疼痛严重程度高、年龄较大、基线残疾和疼痛持续时间较长被确定为不同疼痛部位残疾的潜在预后因素。有有限的证据表明焦虑和抑郁与亚急性疼痛患者的残疾相关，这表明这些因素在因疼痛疾病导致残疾的过程中可能没有预期的那么重要。证据质量为中等、低或极低，这意味着对结果的信心有限。需要进行大规模前瞻性预后因素研究，要有足够的研究人群，并对所有检查因素进行透明报告。
试验注册号
CRD42014008914。
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