Department of Pharmacy, University of Sydney, Camperdown, New South Wales, Australia.
Department of Health Sciences, University of Sydney, Sydney, New South Wales, Australia.
Br J Sports Med. 2019 Nov;53(22):1424-1431. doi: 10.1136/bjsports-2018-100080. Epub 2019 Feb 26.
One model of care that has not been tested for chronic low back pain (LBP) is patient-led goal setting. We aimed to compare the clinical effectiveness and healthcare use of a patient-led goal setting approach (intervention) with simple advice to exercise (control) over 12 months.
An assessor-blinded randomised controlled trial. Intervention was education combined with patient-led goal setting compared with a control group receiving a standardised exercise programme. The primary outcomes were back pain disability and pain intensity. Secondary outcomes were quality of life, kinesiophobia, self-efficacy, depression, anxiety and stress. Outcomes and healthcare use were assessed immediately post-treatment (2 months) and after 4 and 12 months. Analysis was by intention to treat.
Seventy-five patients were randomly assigned to either the intervention (n=37) or the control (n=38) group. Using linear mixed model analyses, adjusted mean changes in primary outcomes of disability and pain intensity were greater in the intervention group than in the control group (disability post-treatment: p<0.05). These differences were clinically meaningful. Mean differences in all secondary measures were greater in the intervention group than in the control group (p<0.05). There was no difference in healthcare use between groups over 12 months.
A patient-led goal setting intervention was significantly more effective than advice to exercise for improving outcomes in disability, pain intensity, quality of life, self-efficacy and kinesiophobia in chronic LBP. These improvements were maintained at 12 months. Smaller effects were seen in measures of depression, anxiety and stress.
ACTRN12614000830695.
一种尚未针对慢性下背痛（LBP）进行测试的护理模式是患者主导的目标设定。我们旨在比较患者主导的目标设定方法（干预组）与简单的运动建议（对照组）在 12 个月内的临床效果和医疗保健使用情况。
这是一项评估者盲法随机对照试验。干预措施是教育与患者主导的目标设定相结合，与对照组接受标准化运动方案相比。主要结果是下背痛残疾和疼痛强度。次要结果是生活质量、运动恐惧、自我效能、抑郁、焦虑和压力。在治疗后（2 个月）和治疗后 4 个月和 12 个月时立即评估结果和医疗保健使用情况。分析是基于意向治疗。
75 名患者被随机分配到干预组（n=37）或对照组（n=38）。使用线性混合模型分析，干预组残疾和疼痛强度的主要结果调整后的平均变化大于对照组（治疗后残疾：p<0.05）。这些差异具有临床意义。干预组所有次要指标的平均差异均大于对照组（p<0.05）。两组在 12 个月内的医疗保健使用无差异。
与运动建议相比，患者主导的目标设定干预在改善慢性 LBP 的残疾、疼痛强度、生活质量、自我效能和运动恐惧方面更为有效。这些改善在 12 个月时得以维持。在抑郁、焦虑和压力方面，效果较小。
ACTRN12614000830695。
