Bishop Mark D, Bialosky Joel E, Penza Charles W, Beneciuk Jason M, Alappattu Meryl J
Department of Physical Therapy, University of Florida.
Center for Pain Research and Behavioral Health.
J Pain Res. 2017 Apr 26;10:965-972. doi: 10.2147/JPR.S130931. eCollection 2017.
Expected pain relief from treatment is associated with positive clinical outcomes in patients with musculoskeletal pain. Less studied is the influence on outcomes related to the preference of patients and providers for a specific treatment.
We sought to determine how provider and patient preferences for a manual therapy intervention influenced outcomes in individuals with acutely induced low back pain (LBP).
Pain-free participants were randomly assigned to one of two manual therapies (joint biased [JB] or constant touch [CT]) 48 hours after completing an exercise protocol to induce LBP. Expectations for pain relief and preferences for treatment were collected at baseline, prior to randomization. Pain relief was assessed using a 100 mm visual analog scale. All study procedures were conducted in a private testing laboratory at the University of Florida campus.
Sixty participants were included in this study. After controlling for preintervention pain intensity, the multivariate model included only preintervention pain (=0.12, =0.07) and provider preference (=3.05, <0.0001) and explained 35.8% of the variance in postintervention pain. When determining whether a participant met his or her expected pain relief, receiving an intervention from a provider with a strong preference for that intervention increased the odds of meeting a participant's expected pain relief 68.3 times (=0.013) compared to receiving any intervention from a provider with no preference. Receiving JB intervention from any provider increased the odds of meeting expected relief 29.7 times (=0.023). The effect of a participant receiving an intervention they preferred was retained in the model but did not meet the criteria for a significant contribution.
Our primary findings were that participant and provider preferences for treatment positively influence pain outcomes in individuals with acutely induced LBP, and joint-biased interventions resulted in a greater chance of meeting participants' expected outcomes. This is contrary to our hypothesis that the interaction of receiving an intervention for which a participant had a preference would result in the best outcome.
在肌肉骨骼疼痛患者中，预期的治疗疼痛缓解与积极的临床结果相关。而关于患者和提供者对特定治疗的偏好对结果的影响，研究较少。
我们试图确定提供者和患者对手法治疗干预的偏好如何影响急性诱发下腰痛（LBP）个体的治疗结果。
无痛参与者在完成诱发LBP的运动方案48小时后，被随机分配到两种手法治疗（关节偏向[JB]或持续触摸[CT]）之一。在随机分组前的基线时收集疼痛缓解的期望和治疗偏好。使用100毫米视觉模拟量表评估疼痛缓解情况。所有研究程序均在佛罗里达大学校园的私人测试实验室进行。
本研究纳入了60名参与者。在控制干预前的疼痛强度后，多变量模型仅包括干预前疼痛（=0.12，=0.07）和提供者偏好（=3.05，<0.0001），并解释了干预后疼痛方差的35.8%。在确定参与者是否达到其预期的疼痛缓解时，与从无偏好的提供者接受任何干预相比，从对该干预有强烈偏好的提供者接受干预使达到参与者预期疼痛缓解的几率增加了68.3倍（=0.013）。从任何提供者接受JB干预使达到预期缓解的几率增加了29.7倍（=0.023）。参与者接受其偏好的干预的效果在模型中保留，但未达到显著贡献的标准。
我们的主要发现是，参与者和提供者对治疗的偏好对急性诱发LBP个体的疼痛结果有积极影响，且关节偏向干预导致达到参与者预期结果的机会更大。这与我们的假设相反，即接受参与者偏好的干预的相互作用会产生最佳结果。
