Løchting Ida, Garratt Andrew M, Storheim Kjersti, Werner Erik L, Grotle Margreth
Communication- and Research Unit for Musculoskeletal Disorders (FORMI), Oslo University Hospital & University of Oslo, Ullevaal, Nydalen, P.O. Box 4950, 0424, Oslo, Norway.
Department of Clinical Medicine, University of Oslo, Blindern, P.O. Box 1171, 0318, Oslo, Norway.
Health Qual Life Outcomes. 2017 Feb 21;15(1):40. doi: 10.1186/s12955-017-0593-0.
An individualized patient reported outcome (PRO) has recently been recommended within LBP research, but no study has evaluated this instrument with commonly applied PROs. Moreover, the impact of psychological factors has mostly been assessed for disease-specific instruments. The objective of this study was to assess the predictive value of illness perceptions, pain catastrophizing and psychological distress on 12 month outcomes assessed by specific, generic and individualized PROs recommended in low back pain (LBP).
Secondary analysis of patients with sub-acute or chronic LBP recruited for a cluster randomized controlled trial in primary care who completed a self-administered questionnaire at baseline and 12 months. 12 month scores for the Roland Morris Disability Questionnaire (RMDQ), the EuroQol (EQ-5D), and the Patient Generated Index (PGI) were dependent variables in hierarchical regression analysis. Independent variables included baseline scores for the Brief Illness Perceptions Questionnaire (Brief IPQ), Hopkins Symptom Check List (HSCL-25), Pain Catastrophizing Scale (PCS), health/clinical and sociodemographic variables.
Of the 216 eligible patients included, 203 patients responded to the baseline questionnaire and 150 (74%) responded at 12 months. The mean age was 38.3 (SD 10.2) years and 57.6% were female. The Brief IPQ showed a statistically significant variation in the 12-months score of all the PROs, explaining 2.5% in RMDQ, 7.9% in EQ-5D, and 3.6% in PGI. Most of the explained variation for EQ-5D scores related to illness perceptions. The PCS explained 3.7% of the RMDQ and 2.5% in the EQ-5D scores. The HSCL-25 did not make a significant contribution.
Illness perceptions and pain catastrophizing were associated with 12-month outcomes as assessed by condition-specific, generic and individualized PROs. The Brief IPQ and PCS have relevance to applications in primary care that include interventions designed to enhance psychological aspects of health and where the contribution of such variables to outcomes is of interest. Further studies should assess whether the Brief IPQ perform similarly in LBP populations in other health care settings.
近期腰痛（LBP）研究推荐采用个体化患者报告结局（PRO），但尚无研究将该工具与常用的PRO进行评估比较。此外，心理因素的影响大多是针对特定疾病的工具进行评估的。本研究的目的是评估疾病认知、疼痛灾难化和心理困扰对通过LBP推荐的特定、通用和个体化PRO评估的12个月结局的预测价值。
对在初级保健中招募参加整群随机对照试验的亚急性或慢性LBP患者进行二次分析，这些患者在基线和12个月时完成了一份自我管理问卷。罗兰·莫里斯残疾问卷（RMDQ）、欧洲生活质量量表（EQ-5D）和患者生成指数（PGI）的12个月得分是分层回归分析中的因变量。自变量包括简短疾病认知问卷（简短IPQ）、霍普金斯症状清单（HSCL-25）、疼痛灾难化量表（PCS）的基线得分、健康/临床和社会人口统计学变量。
纳入的216例合格患者中，203例患者对基线问卷做出了回应，150例（74%）在12个月时做出了回应。平均年龄为38.3（标准差10.2）岁，57.6%为女性。简短IPQ显示，所有PRO的12个月得分存在统计学显著差异，在RMDQ中解释了2.5%的变异，在EQ-5D中解释了7.9%的变异，在PGI中解释了3.6%的变异。EQ-5D得分中大部分解释的变异与疾病认知有关。PCS在RMDQ中解释了3.7%的变异，在EQ-5D得分中解释了2.5%的变异。HSCL-25没有做出显著贡献。
疾病认知和疼痛灾难化与通过特定疾病、通用和个体化PRO评估的12个月结局相关。简短IPQ和PCS与初级保健中的应用相关，这些应用包括旨在增强健康心理方面的干预措施，以及这些变量对结局的贡献受到关注的情况。进一步的研究应评估简短IPQ在其他医疗环境中的LBP人群中是否表现相似。
