Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Arthritis Program, University Health Network, Toronto, Ontario, Canada.
Spine (Phila Pa 1976). 2017 Nov 15;42(22):E1318-E1325. doi: 10.1097/BRS.0000000000002237.
MINI: The authors wanted to determine which existing primary-care low back pain stratification schema is associated with distinct subpopulations. Initial stratification by DMPP identified potentially distinct epidemiological groups. DMPP stratification resulted in discrimination beyond that provided by disability or chronicity risk stratification alone.
A cross-sectional study of Canadian patients suffering from low back pain (LBP) seeking primary care.
The aim of this study was to determine which existing primary care LBP stratification schema is associated with distinct subpopulations as characterized by easily identifiable primary epidemiological factors.
LBP is among the most frequent reasons for visits to primary care physicians and a leading cause of years lived with disability. In an effort to improve treatment response/outcomes in LBP primary care, different classification systems have been proposed in an effort to provide more tailored treatment with the intent of improving outcomes. Group-specific risk factors and underlying etiology might suggest a need for, or inform, changes to treatment approaches to optimize LBP outcomes.
Stratification by dominant mechanical pain patterns; chronicity risk; disability severity. Multinomial logistic regression was used to identify the system showing greatest variability in associations with age, sex, obesity, and comorbidity. Once identified, the remaining schemas were incorporated into the model.
N = 970; mean age: 50 years (range: 18-93); 56% female. Stratification by pain pattern revealed greater variability. Adjusted analysis: Increasing age was associated with greater odds of intermittent, extension-based back- or leg-dominant pain [odds ratio (OR): 1.02 and 1.06; P < 0.01]; being male with leg-dominant pain (ORs > 2; P < 0.01). Overweight/obesity was associated with extension-based leg-dominant pain (OR = 2.6; P < 0.02) and increasing comorbidity with extension-based back-dominant pain (OR = 1.3; P < 0.01). Severe disability was associated only with constant leg pain (OR = 3.9; P < 0.01), and high chronicity risk with extension-based leg-dominant pain (OR = 0.4; P = 0.03).
Dominant mechanical symptom stratification resulted in further discrimination of an epidemiologically distinct and a large subgroup of LBP patients not identified by disability or chronicity risk stratification alone. Findings suggest a need for primary care initiated multidimensional stratification in chronic LBP.
MINI：作者们想确定现有的初级保健腰痛分层方案中哪一种与不同的亚群相关。通过 DMPP 进行的初始分层确定了潜在的不同流行病学群体。DMPP 分层的结果不仅提供了残疾或慢性风险分层的结果，而且还提供了更好的区分。
对在初级保健中寻求治疗的患有腰痛（LBP）的加拿大患者进行的横断面研究。
本研究的目的是确定现有的初级保健腰痛分层方案中哪一种与易于识别的主要流行病学因素所描述的不同亚群相关。
腰痛是初级保健医生就诊最常见的原因之一，也是导致残疾年限最长的原因之一。为了改善腰痛初级保健的治疗反应/结果，已经提出了不同的分类系统，以提供更具针对性的治疗，目的是改善结果。特定于组的风险因素和潜在病因可能表明需要改变或告知治疗方法以优化腰痛结果。
通过主要机械性疼痛模式、慢性风险、残疾严重程度进行分层。使用多项逻辑回归来确定与年龄、性别、肥胖和合并症相关性变化最大的系统。一旦确定，其余的方案就被纳入模型。
N=970；平均年龄：50 岁（范围：18-93）；56%为女性。疼痛模式分层显示出更大的可变性。调整分析：年龄增长与间歇性、伸展为主的腰背或下肢主导性疼痛的可能性增加有关[优势比（OR）：1.02 和 1.06；P<0.01]；男性下肢主导性疼痛（ORs>2；P<0.01）。超重/肥胖与伸展为主的下肢主导性疼痛有关（OR=2.6；P<0.02），而增加的合并症与伸展为主的腰背主导性疼痛有关（OR=1.3；P<0.01）。严重残疾仅与持续的腿部疼痛有关（OR=3.9；P<0.01），而高慢性风险与伸展为主的下肢主导性疼痛有关（OR=0.4；P=0.03）。
主要机械症状分层进一步区分了腰痛患者中具有不同流行病学特征的亚群和未被残疾或慢性风险分层单独识别的亚群。研究结果表明，慢性腰痛需要在初级保健中启动多维分层。
