Rabey Martin, Smith Anne, Beales Darren, Slater Helen, O'Sullivan Peter
School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia.
Clin J Pain. 2017 Oct;33(10):877-891. doi: 10.1097/AJP.0000000000000478.
To derive prognostic models for people with chronic low back pain (CLBP) (n=294) based upon an extensive array of potentially prognostic multidimensional factors.
This study entered multidimensional data (demographics, pain characteristics, pain responses to movement, behaviors associated with pain, pain sensitivity, psychological, social, health, lifestyle) at baseline, and interventions undertaken, into prognostic models for pain intensity, disability, global rating of change and bothersomeness at 1-year.
The prognostic model for higher pain intensity (explaining 23.2% of the variance) included higher baseline pain intensity and punishing spousal interactions, and lower years in education, while participating in exercise was prognostic of lower pain intensity. The model for higher disability (33.6% of the variance) included higher baseline disability, longer forward bending time, psychological principal component scores representing negative pain-related cognitions and punishing spousal interactions; while exercising was prognostic of lower disability. The odds of reporting global rating of change much/very much improved were increased by participating in exercise, having leg pain as well as CLBP and having greater chronic pain acceptance. The receiver operating characteristic area under the curve was 0.72 indicating acceptable discrimination. The odds of reporting very/extremely bothersome CLBP were increased by having higher baseline pain intensity, longer forward bending time and receiving injection(s); while higher age, more years in education and having leg pain decreased the odds (receiver operating characteristic area under the curve, 0.80; acceptable discrimination).
The variance explained by prognostic models was similar to previous reports, despite an extensive array of multidimensional baseline variables. This highlights the inherent multidimensional complexity of CLBP.
基于一系列广泛的潜在预后多维因素，为慢性下腰痛（CLBP）患者（n = 294）推导预后模型。
本研究在基线时输入多维数据（人口统计学、疼痛特征、运动时的疼痛反应、与疼痛相关的行为、疼痛敏感性、心理、社会、健康、生活方式）以及所采取的干预措施，纳入疼痛强度、残疾程度、1年时的总体变化评分和困扰程度的预后模型。
疼痛强度较高的预后模型（解释方差的23.2%）包括较高的基线疼痛强度和惩罚性的配偶互动、较低的受教育年限，而参与运动可预测较低的疼痛强度。残疾程度较高的模型（方差的33.6%）包括较高的基线残疾程度、较长的前屈时间、代表与疼痛相关的消极认知的心理主成分得分以及惩罚性的配偶互动；而运动可预测较低的残疾程度。参与运动、同时患有腿痛和CLBP以及对慢性疼痛有更高的接受度会增加报告总体变化评分改善很多/非常大的几率。曲线下面积为0.72，表明有可接受的区分度。基线疼痛强度较高、前屈时间较长和接受注射会增加报告CLBP非常/极其困扰的几率；而年龄较大、受教育年限较长和患有腿痛会降低这种几率（曲线下面积为0.80；有可接受的区分度）。
尽管有一系列广泛的多维基线变量，但预后模型所解释的方差与先前的报告相似。这突出了CLBP固有的多维复杂性。
