RehaClinic Rehabilitation Clinic, Bad Zurzach, Switzerland -
Department of Physiotherapy, Insel Group, Bern University Hospital, Berne, Switzerland -
Eur J Phys Rehabil Med. 2018 Jun;54(3):358-370. doi: 10.23736/S1973-9087.17.04716-5. Epub 2017 Aug 29.
Prospective classification of patients with nonspecific chronic back pain into homogeneous subgroups might be an important objective in order to tailor interventions and improve treatment outcomes.
This study investigated the effect of a subgroup-specific pain rehabilitation program based on the Multidimensional Pain Inventory (MPI) Classification System compared to standard care.
Single blinded, parallel group, pragmatic randomized controlled trial.
Inpatient subjects of a rehabilitation clinic.
A total of 139 patients with chronic back pain.
Patients in both the experimental group and control group received during their 4-week in-house stay at the rehabilitation clinic on average four daily sessions of therapy. The patients in the experimental group received specific interventions, which were tailored to their subgroup classification profile. The patients in the control group participated in state-of-the-art care. The primary outcome was self-reported disability measured at 1, 3 and 12 months after randomization with the Oswestry Disability Index (ODI). Secondary outcomes were pain intensity, examiner-reported disability, anxiety and depression, catastrophizing, self-efficacy and global perceived effect.
Groups were comparable under demographic and clinical characteristics. No significant differences between the experimental group and the control group for any of the outcomes and follow-up times were found in the intention-to-treat analysis. Compared to the 8-10 points considered as minimal clinically important difference for the ODI, effects within groups were small, e.g. the experimental group improved by 2.2 points at 1-month follow-up, 3.7 points at 3 months and 5.3 points at 12 months.
This study failed to demonstrate that a subgroup-specific program was more effective than standard care.
Since the subgroup-specific interventions were equally effective as standard pain rehabilitation, subgroup classification and tailoring interventions may be an alternative in clinical care.
将非特异性慢性腰痛患者前瞻性地分为同质亚组可能是一个重要的目标，以便定制干预措施并改善治疗结果。
本研究调查了基于多维疼痛量表（MPI）分类系统的亚组特异性疼痛康复计划与标准护理相比的效果。
单盲、平行组、实用随机对照试验。
康复诊所的住院患者。
共 139 名慢性腰痛患者。
实验组和对照组的患者在康复诊所住院的 4 周内平均每天接受 4 次治疗。实验组的患者接受了特定的干预措施，这些干预措施是根据他们的亚组分类情况量身定制的。对照组的患者接受了最先进的护理。主要结果是在随机分组后 1、3 和 12 个月用 Oswestry 残疾指数（ODI）自我报告的残疾程度。次要结果是疼痛强度、检查者报告的残疾、焦虑和抑郁、灾难化、自我效能和整体感知效果。
两组在人口统计学和临床特征方面具有可比性。意向治疗分析显示，实验组和对照组在任何结果和随访时间上均无显著差异。与 ODI 被认为是最小临床重要差异的 8-10 分相比，组内的效果较小，例如实验组在 1 个月随访时改善了 2.2 分，在 3 个月时改善了 3.7 分，在 12 个月时改善了 5.3 分。
本研究未能证明亚组特异性方案比标准护理更有效。
由于亚组特异性干预与标准疼痛康复同样有效，因此亚组分类和定制干预可能是临床护理的一种替代方法。
