Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria, Australia.
Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria, Australia.
Arch Phys Med Rehabil. 2018 Dec;99(12):2504-2512.e12. doi: 10.1016/j.apmr.2018.04.026. Epub 2018 May 28.
To identify predictors for back pain, leg pain, and activity limitation in patients with early persistent low back disorders (LBDs).
Prospective inception cohort study.
Primary care private physiotherapy clinics in Melbourne, Australia.
Individuals (N=300) aged 18-65 years with low back and/or referred leg pain of ≥6 weeks and ≤6 months duration.
Not applicable.
Numeric rating scales for back pain and leg pain as well as the Oswestry Disability Scale.
Prognostic factors included sociodemographics, treatment related factors, subjective/physical examination, subgrouping factors, and standardized questionnaires. Univariate analysis followed by generalized estimating equations were used to develop a multivariate prognostic model for back pain, leg pain, and activity limitation. Fifty-eight prognostic factors progressed to the multivariate stage where 15 showed significant (P<.05) associations with at least 1 of the 3 outcomes. There were 5 indicators of positive outcome (2 types of LBD subgroups, paresthesia below waist, walking as an easing factor, and low transversus abdominis tone) and 10 indicators of negative outcome (both parents born overseas, deep leg symptoms, longer sick leave duration, high multifidus tone, clinically determined inflammation, higher back and leg pain severity, lower lifting capacity, lower work capacity, and higher pain drawing percentage coverage). The preliminary model identifying predictors of LBDs explained up to 37% of the variance in outcome.
This study evaluated a comprehensive range of prognostic factors reflective of both the biomedical and psychosocial domains of LBDs. The preliminary multivariate model requires further validation before being considered for clinical use.
确定早期持续性下腰痛（LBD）患者腰痛、腿痛和活动受限的预测因素。
前瞻性起始队列研究。
澳大利亚墨尔本的私人初级保健物理治疗诊所。
年龄在 18-65 岁之间的腰痛和/或腿痛持续时间≥6 周且≤6 个月的个体（N=300）。
不适用。
腰痛和腿痛的数字评分量表以及 Oswestry 残疾量表。
预后因素包括社会人口统计学因素、治疗相关因素、主观/体格检查、亚组因素和标准化问卷。使用单变量分析和广义估计方程来建立腰痛、腿痛和活动受限的多变量预后模型。58 个预后因素进入多变量阶段，其中 15 个因素与至少 1 个结局具有显著相关性（P<.05）。有 5 个阳性结果指标（2 种 LBD 亚组、腰部以下感觉异常、步行作为缓解因素以及腹横肌张力低）和 10 个阴性结果指标（父母均为海外出生、下肢深部症状、病假时间较长、多裂肌张力高、临床确定的炎症、腰痛和腿痛严重程度较高、举重能力较低、工作能力较低以及疼痛绘图百分比覆盖率较高）。初步模型确定了 LBD 预测因素，解释了结局变量的 37%的变异性。
本研究评估了反映 LBD 的生物医学和心理社会领域的广泛预后因素。初步的多变量模型需要进一步验证，然后才能考虑用于临床应用。
