Eleswarapu Ananth S, Divi Srikanth N, Dirschl Douglas R, Mok James M, Stout Christopher, Lee Michael J
University of Chicago Medical Center, Chicago, IL.
ATI, Bolingbrook, IL.
Spine (Phila Pa 1976). 2016 Aug 15;41(16):1325-1329. doi: 10.1097/BRS.0000000000001506.
A retrospective review.
The aim of this study is to evaluate whether the treatment of low back pain with physical therapy results in clinically significant improvements in patient-reported pain and functional outcomes.
Low back pain is a major cause of morbidity and disability in health care. Previous studies have found poor efficacy for surgery in the absence of specific indications. A variety of nonoperative treatments are available; however, there is scant evidence to guide the practitioner as to the efficacy of these treatments.
Four thousand five hundred ninety-seven patients who underwent physical therapy for the nonoperative treatment of low back pain were included. The primary outcome measures were pre-and post-treatment scores on the Oswestry Disability Index (ODI), Numeric Pain Rating Scale (NPRS) during activity, and NPRS during rest. Previously published thresholds for minimal clinically important difference (MCID) were used to determine the proportion of patients meeting MCID for each of our outcomes. Patients with starting values below the MCID for each variable were excluded from analysis. Logistic regression analysis was used to determine patient risk factors predictive of treatment failure.
About 28.5% of patients met the MCID for improvement in ODI. Presence of night symptoms, obesity, and smoking were predictors of treatment failure for ODI. Fifty-nine percent of patients met the MCID for improvement in resting NPRS, with a history of venous thromboembolism, night symptoms, psychiatric disease, workers' compensation status, smoking, and obesity predictive of treatment failure. Sixty percent of patients met the MCID for improvement in activity NPRS, with night symptoms, workers' compensation status, and smoking predictive of treatment failure.
We observed that a substantial percentage of the population did not meet MCID for pain and function following treatment of low back pain with physical therapy. Common risk factors for treatment failure included smoking and presence of night symptoms.
一项回顾性研究。
本研究旨在评估物理治疗下腰痛是否能使患者报告的疼痛和功能结果在临床上有显著改善。
下腰痛是医疗保健中发病和致残的主要原因。先前的研究发现，在没有特定指征的情况下，手术疗效不佳。有多种非手术治疗方法；然而，几乎没有证据可指导从业者了解这些治疗方法的疗效。
纳入4597例接受物理治疗以非手术方式治疗下腰痛的患者。主要结局指标为治疗前后的Oswestry功能障碍指数（ODI）评分、活动时数字疼痛评分量表（NPRS）评分和静息时NPRS评分。使用先前发表的最小临床重要差异（MCID）阈值来确定达到各结局MCID的患者比例。每个变量起始值低于MCID的患者被排除在分析之外。采用逻辑回归分析确定预测治疗失败的患者风险因素。
约28.5%的患者ODI改善达到MCID。夜间症状、肥胖和吸烟是ODI治疗失败的预测因素。59%的患者静息NPRS改善达到MCID，静脉血栓栓塞病史、夜间症状、精神疾病、工伤赔偿状况、吸烟和肥胖是治疗失败的预测因素。60%的患者活动NPRS改善达到MCID，夜间症状、工伤赔偿状况和吸烟是治疗失败的预测因素。
我们观察到，相当一部分人群在接受物理治疗下腰痛后，疼痛和功能未达到MCID。治疗失败的常见风险因素包括吸烟和夜间症状的存在。
4级。
