School of Health and Social Care, Teesside University, Middlesbrough, UK.
South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK.
Spine (Phila Pa 1976). 2018 Sep 1;43(17):E998-E1004. doi: 10.1097/BRS.0000000000002612.
Longitudinal observational study.
To investigate the association between the duration of pain at baseline and the clinical outcomes of patients with low back pain (LBP) enrolled on the North East of England Regional Back Pain and Radicular Pain Pathway (NERBPP).
The NERBPP is a clinical pathway based upon National Institute for Health and Care Excellence (NICE) guidelines (2009) for LBP of <1-year duration. Recent changes to NICE guidelines (2016) advocate the same management for all LBP patients regardless of pain duration.
Patients with LBP referred onto the NERBPP by their General Practitioner between May 2015 and January 2017 were included. Data from 667 patients, who provided pre- and post data for pain (Numerical rating scale), function (Oswestry Disability Index), quality-of-life (EuroQol five-dimension, five-level questionnaire), anxiety (the Generalized Anxiety Disorder Screener), and depression (the Patient Health Questionnaire), were analyzed using a series of covariate-adjusted models. Patients were categorized into four groups based upon baseline pain duration: <3 months, ≥3 to <6 months, ≥6 months to <12 months, ≥12 months.
Each group showed improved outcomes greater than the minimal clinically important difference (MCID) for each measure as defined in NICE guidelines (2016). There was a trend toward better outcomes for those with shorter pain durations. The magnitude of the differences between the groups, in most instances, was below the MCID. For example, mean improvement in function for those with baseline pain duration <3 months was 20 points and 12 points for those of pain duration ≥12 months, both above the MCID of ≥10.
Patients with different durations of LBP at baseline improved on the NERBPP, supporting the recent modification to NICE guidelines. However, those with shorter durations of pain may have superior outcomes in the short term, suggesting added benefit in getting patients onto the pathway in the early stages of LBP.
纵向观察性研究。
调查基线疼痛持续时间与纳入英格兰东北部地区腰痛和神经根痛通路（NERBPP）的腰痛患者临床结局之间的关联。
NERBPP 是基于国家卫生与保健卓越研究所（NICE）（2009 年）针对腰痛持续时间<1 年的临床路径。NICE 指南（2016 年）的最新修订版主张对所有腰痛患者采用相同的管理方法，无论疼痛持续时间如何。
纳入 2015 年 5 月至 2017 年 1 月期间由全科医生转介至 NERBPP 的腰痛患者。对 667 名提供疼痛（数字评分量表）、功能（Oswestry 残疾指数）、生活质量（EuroQol 五维，五水平问卷）、焦虑（广泛性焦虑障碍筛查器）和抑郁（患者健康问卷）前后数据的患者进行了分析，使用了一系列协变量调整模型。根据基线疼痛持续时间将患者分为四组：<3 个月、≥3 至<6 个月、≥6 至<12 个月、≥12 个月。
每个组的各项指标的改善均大于 NICE 指南（2016 年）定义的最小临床重要差异（MCID）。疼痛持续时间较短的患者的改善趋势更为明显。在大多数情况下，组间差异的幅度低于 MCID。例如，基线疼痛持续时间<3 个月的患者功能改善均值为 20 分，而疼痛持续时间≥12 个月的患者为 12 分，均高于≥10 分的 MCID。
基线时腰痛持续时间不同的患者在 NERBPP 上均有所改善，支持了 NICE 指南的最新修订版。然而，疼痛持续时间较短的患者在短期内可能会有更好的结果，这表明在腰痛的早期阶段让患者进入该路径可能会带来额外的益处。
3 级。
