Departments of Family and Community Medicine.
Clinical Sciences, University of Kentucky, Lexington, Kentucky.
Pain Med. 2017 Jul 1;18(7):1394-1405. doi: 10.1093/pm/pnw347.
While efficacy of massage and other nonpharmacological treatments for chronic low back pain is established, stakeholders have called for pragmatic studies of effectiveness in "real-world" primary health care. The Kentucky Pain Research and Outcomes Study evaluated massage impact on pain, disability, and health-related quality of life for primary care patients with chronic low back pain. We report effectiveness and feasibility results, and make comparisons with established minimal clinically important differences.
Primary care providers referred eligible patients for 10 massage sessions with community practicing licensed massage therapists. Oswestry Disability Index and SF-36v2 measures obtained at baseline and postintervention at 12 and 24 weeks were analyzed with mixed linear models and Tukey's tests. Additional analyses examined clinically significant improvement and predictive patient characteristics.
Of 104 enrolled patients, 85 and 76 completed 12 and 24 weeks of data collection, respectively. Group means improved at 12 weeks for all outcomes and at 24 weeks for SF-36v2's Physical Component Summary and Bodily Pain Domain. Of those with clinically improved disability at 12 weeks, 75% were still clinically improved at 24 weeks ( P < 0.01). For SF-36v2 Physical and Mental Component Summaries, 55.4% and 43.4%, respectively, showed clinically meaningful improvement at 12 weeks, 46.1% and 30.3% at 24 weeks. For Bodily Pain Domain, 49.4% were clinically improved at 12 weeks, 40% at 24 weeks. Adults older than age 49 years had better pain and disability outcomes than younger adults.
Results provide a meaningful signal of massage effect for primary care patients with chronic low back pain and call for further research in practice settings using pragmatic designs with control groups.
虽然按摩和其他非药物治疗慢性下腰痛的疗效已得到证实，但利益相关者呼吁对“真实世界”基层医疗保健中的有效性进行务实研究。肯塔基州疼痛研究和结局研究评估了按摩对慢性下腰痛的基层医疗保健患者的疼痛、残疾和健康相关生活质量的影响。我们报告了有效性和可行性结果，并与既定的最小临床重要差异进行了比较。
基层医疗保健提供者将符合条件的患者转介给社区执业的有执照的按摩治疗师进行 10 次按摩治疗。在基线和 12 周和 24 周的干预后，使用混合线性模型和图基检验分析 Oswestry 残疾指数和 SF-36v2 量表。其他分析检查了临床显著改善和预测性患者特征。
在 104 名入组患者中，85 名和 76 名患者分别完成了 12 周和 24 周的数据收集。所有结局在 12 周时，组平均值均有所改善，SF-36v2 的生理成分综合评分和身体疼痛域在 24 周时也有所改善。在 12 周时残疾程度有临床改善的患者中，75%在 24 周时仍有临床改善（P<0.01）。在 SF-36v2 生理和心理成分综合评分中，分别有 55.4%和 43.4%在 12 周时具有临床意义的改善，46.1%和 30.3%在 24 周时具有临床意义的改善。在身体疼痛域中，49.4%在 12 周时有临床改善，40%在 24 周时有临床改善。年龄大于 49 岁的成年人比年轻成年人的疼痛和残疾结局更好。
结果为慢性下腰痛的基层医疗保健患者提供了按摩效果的有意义信号，并呼吁在实践环境中使用具有对照组的实用设计进行进一步研究。
