Low Back Research Team, School of Allied Health, La Trobe University, Melbourne, Australia.
Physiotherapy Department, Northern Health, Melbourne, Australia.
Spine (Phila Pa 1976). 2017 Nov 1;42(21):E1215-E1224. doi: 10.1097/BRS.0000000000002148.
A preplanned effect modifier analysis of the Specific Treatment of Problems of the Spine randomized controlled trial.
To identify characteristics associated with larger or smaller treatment effects in people with low back disorders undergoing either individualized physical therapy or guideline-based advice.
Identifying subgroups of people who attain a larger or smaller benefit from particular treatments has been identified as a high research priority for low back disorders.
The trial involved 300 participants with low back pain and/or referred leg pain (≥6 wk, ≤6 mo duration), who satisfied criteria to be classified into five subgroups (with 228 participants classified into three subgroups relating to disc-related disorders, and 64 classified into the zygapophyseal joint dysfunction subgroup). Participants were randomly allocated to receive either two sessions of guideline based advice (n = 144), or 10 sessions of individualized physical therapy targeting pathoanatomical, psychosocial, and neurophysiological factors (n = 156). Univariate and multivariate linear mixed models determined the interaction between treatment group and potential effect modifiers (defined a priori) for the primary outcomes of back pain, leg pain (0-10 Numeric Rating Scale) and activity limitation (Oswestry Disability Index) over a 52-week follow-up.
Participants with higher levels of back pain, higher Örebro scores (indicative of higher risk of persistent pain) or longer duration of symptoms derived the largest benefits from individualized physical therapy relative to advice. Poorer coping also predicted larger benefits from individualized physical therapy in the univariate analysis.
These findings suggest that people with low back disorders could be preferentially targeted for individualized physical therapy rather than advice if they have higher back pain levels, longer duration of symptoms, or higher Örebro scores.
一项针对脊柱特定治疗问题的随机对照试验的预先计划的效应修饰因子分析。
确定在接受个体化物理治疗或基于指南的建议的下腰痛患者中，与更大或更小治疗效果相关的特征。
确定从特定治疗中获得更大或更小益处的亚组人群已被确定为下腰痛的一个高度优先研究重点。
该试验涉及 300 名腰痛和/或放射腿痛（≥6 周，≤6 个月）的患者，他们符合分为五个亚组的标准（228 名患者分为与椎间盘相关疾病相关的三个亚组，64 名患者分为椎间关节功能障碍亚组）。参与者被随机分配接受两次基于指南的建议（n=144），或 10 次针对病理解剖、心理社会和神经生理学因素的个体化物理治疗（n=156）。单变量和多变量线性混合模型确定了治疗组和潜在效应修饰因子（预先定义）之间的相互作用，这些修饰因子对主要结局（腰痛、腿痛（0-10 数字评分量表）和活动受限（Oswestry 残疾指数）在 52 周随访期间的影响。
腰痛程度较高、Örebro 评分较高（表示持续疼痛风险较高）或症状持续时间较长的患者从个体化物理治疗中获益最大，相对于建议。在单变量分析中，应对能力较差也预示着个体化物理治疗的更大获益。
这些发现表明，如果下腰痛患者腰痛程度较高、症状持续时间较长或Örebro 评分较高，他们可能更适合接受个体化物理治疗，而不是建议。
2 级。
