Chenot Jean-François, Pfingsten Michael, Marnitz Ulf, Pfeifer Klaus, Kohlmann Thomas, Lindena Gabriele, Schmidt Carsten Oliver
Abteilung Allgemeinmedizin, Institut für Community Medicine, Universitätsmedizin Greifswald, Fleischmannstraße 6, 17485, Greifswald, Deutschland.
Schmerz-Tagesklinik und -Ambulanz, Klinik für Anästhesiologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland.
Schmerz. 2019 Jun;33(3):226-235. doi: 10.1007/s00482-019-0362-6.
A subgroup of patients with acute low back pain (LBP) will develop chronic LBP. Risk factors summarized as yellow flags are fear-avoidance beliefs, depression, catastrophizing, and work-related problems.
The aim was to evaluate the effectiveness of screening for yellow flags in general practice followed by a risk-tailored group intervention compared to care as usual.
This is a cluster-randomized controlled trial in 35 general practices with 354 patients with acute LBP. Information or a standardized group intervention was offered to patients in the intervention group according to the screening algorithm with a short questionnaire for physical and psychosocial risk factors for chronic LBP. Standardized group information contained education concerning back pain and strategies for physical activities and planning of actions. Primary outcome was functional capacity assessed after 6 and 12 months with a questionnaire. Secondary outcomes were pain severity, fear avoidance beliefs, depression score, self-rated health and health service utilization.
The intervention had no clinically relevant effect on the primary outcome functional capacity and secondary outcomes, although the course was consistently slightly better. Adherence to the offered intervention was low. Health service utilization was not altered to a relevant extent. A subgroup analysis comparing adherent and non-adherent patients showed a consistently better course of adherent patients.
A risk-tailored short intervention to prevent chronic LBP in general practice had no significant impact on the clinical course compared to care as usual. A subgroup analysis comparing adherent and non-adherent patients suggests that it is possible to have a positive impact on patient-relevant outcomes.
一部分急性腰痛（LBP）患者会发展为慢性腰痛。总结为“黄旗”的风险因素包括恐惧回避信念、抑郁、灾难化思维和工作相关问题。
旨在评估在全科医疗中筛查“黄旗”因素并随后进行风险定制的小组干预与常规护理相比的有效性。
这是一项在35家全科诊所对354例急性腰痛患者进行的整群随机对照试验。根据筛查算法，通过一份关于慢性腰痛身体和心理社会风险因素的简短问卷，为干预组患者提供信息或标准化的小组干预。标准化的小组信息包括有关背痛的教育以及体育活动和行动计划策略。主要结局是在6个月和12个月后通过问卷评估的功能能力。次要结局包括疼痛严重程度、恐惧回避信念、抑郁评分、自评健康状况和卫生服务利用情况。
尽管病程始终略好，但干预对主要结局功能能力和次要结局没有临床相关影响。对所提供干预的依从性较低。卫生服务利用情况在相关程度上没有改变。一项比较依从和不依从患者的亚组分析显示，依从患者的病程始终较好。
与常规护理相比，在全科医疗中进行风险定制的短期干预以预防慢性腰痛对临床病程没有显著影响。一项比较依从和不依从患者的亚组分析表明，有可能对与患者相关的结局产生积极影响。
