Artus Majid, Campbell Paul, Mallen Christian D, Dunn Kate M, van der Windt Danielle A W
Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, UK.
BMJ Open. 2017 Jan 17;7(1):e012901. doi: 10.1136/bmjopen-2016-012901.
To summarise the evidence for generic prognostic factors across a range of musculoskeletal (MSK) conditions.
primary care.
Comprehensive systematic literature review. MEDLINE, CINAHL, PsychINFO and EMBASE were searched for prospective cohort studies, based in primary care (search period-inception to December 2015). Studies were included if they reported on adults consulting with MSK conditions and provided data on associations between baseline characteristics (prognostic factors) and outcome. A prognostic factor was identified as generic when significantly associated with any outcome for 2 or more different MSK conditions. Evidence synthesis focused on consistency of findings and study quality.
14 682 citations were identified and 78 studies were included (involving more than 48 000 participants with 18 different outcome domains). 51 studies were on spinal pain/back pain/low back pain, 12 on neck/shoulder/arm pain, 3 on knee pain, 3 on hip pain and 9 on multisite pain/widespread pain. Total quality scores ranged from 5 to 14 (mean 11) and 65 studies (83%) scored 9 or more. Out of a total of 78 different prognostic factors for which data were provided, the following factors are considered to be generic prognostic factors for MSK conditions: widespread pain, high functional disability, somatisation, high pain intensity and presence of previous pain episodes. In addition, consistent evidence was found for use of pain medications not to be associated with outcome, suggesting that this factor is not a generic prognostic factor for MSK conditions.
This large review provides new evidence for generic prognostic factors for MSK conditions in primary care. Such factors include pain intensity, widespread pain, high functional disability, somatisation and movement restriction. This information can be used to screen and select patients for targeted treatment in clinical research as well as to inform the management of MSK conditions in primary care.
总结一系列肌肉骨骼（MSK）疾病通用预后因素的证据。
初级保健。
全面的系统文献综述。检索MEDLINE、CINAHL、PsychINFO和EMBASE数据库，查找基于初级保健的前瞻性队列研究（检索时间段为起始至2015年12月）。纳入的研究需报告患有MSK疾病的成年人情况，并提供基线特征（预后因素）与结局之间关联的数据。当一个预后因素与两种或更多不同MSK疾病的任何结局显著相关时，该因素被确定为通用预后因素。证据综合聚焦于研究结果的一致性和研究质量。
共识别出14682条引文，纳入78项研究（涉及超过48000名参与者，有18个不同的结局领域）。51项研究针对脊柱疼痛/背痛/下背痛，12项针对颈部/肩部/手臂疼痛，3项针对膝关节疼痛，3项针对髋关节疼痛，9项针对多部位疼痛/广泛性疼痛。总体质量评分范围为5至14分（平均11分），65项研究（83%）评分在9分及以上。在总共提供数据的78个不同预后因素中，以下因素被认为是MSK疾病的通用预后因素：广泛性疼痛、高度功能残疾、躯体化、高疼痛强度以及既往疼痛发作史。此外，发现使用止痛药物与结局无关联的证据一致，表明该因素不是MSK疾病的通用预后因素。
这项大型综述为初级保健中MSK疾病的通用预后因素提供了新证据。这些因素包括疼痛强度、广泛性疼痛、高度功能残疾、躯体化和活动受限。这些信息可用于在临床研究中筛选和选择患者进行针对性治疗，以及为初级保健中MSK疾病的管理提供参考。
