Hestbaek Lise, Myburgh Cornelius, Lauridsen Henrik Hein, Boyle Eleanor, Kongsted Alice
1Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
2Nordic Institute of Chiropractic and Clinical Biomechanics, Campusvej 55, 5230 Odense M, Denmark.
Chiropr Man Therap. 2019 Feb 26;27:12. doi: 10.1186/s12998-018-0222-y. eCollection 2019.
Due to the recurrent nature of low back pain (LBP), the traditional concepts of cure and recovery are challenged, and investigating the course rather than status at fixed time-points may help us understand prognosis as well as treatment effect. However, methods of frequent measuring still need development and validation. Therefore, this study aims to evaluate the agreement between continuous, quantitative self-assessment (weekly SMS) of the course of LBP over a one-year period and qualitatively derived retrospective patient self-appraisal of the same time-period.
Participants were 32 subjects with LBP from primary care. The quantitative measures consisted of weekly SMS questions for one-year about pain intensity, days with LBP, and activity limitations for that week. For each subject, the weekly responses were graphed and categorized into categories based on intensity, variation and overall change patterns. Qualitative measures were based on semi-structured telephone interviews one-year after a consultation for LBP, where two coders independently categorized the self-appraisal of LBP course into the same predefined categories as the SMS-based trajectories. Furthermore, patients' perceived overall recovery was related to variation patterns from SMS track.
There was perfect agreement for 48% in the pain intensity domain, 53% in the variation domain and 63% in the change pattern domain. Most of the discordant cases were classified in neighboring categories with the majority relating to fluctuating patterns. The self-perceived overall recovery status seemed to be reflected quite well by the quantitative measures of pain intensity and days with pain in this study.
This study shows that a real time quantitative measure (weekly SMS) and the patient's retrospective appraisal do not fundamentally differ in their reflection of the one-year course of LBP.As a first investigation into this area, these results are promising, as longitudinal quantitatively derived trajectories of LBP seem to reflect the lived experience of the patient to a large degree. Furthermore, the patient's ability to retrospectively recall their one-year course of LBP appears to be quite good. Future studies should focus on refining the categories of trajectories.
由于腰痛（LBP）具有复发性，传统的治愈和康复概念受到挑战，研究病程而非固定时间点的状态可能有助于我们理解预后以及治疗效果。然而，频繁测量的方法仍需开发和验证。因此，本研究旨在评估在一年期间对LBP病程进行连续、定量的自我评估（每周短信）与同一时期定性得出的患者回顾性自我评估之间的一致性。
参与者为32名来自初级保健机构的LBP患者。定量测量包括为期一年的每周短信问题，涉及疼痛强度、腰痛天数以及该周的活动受限情况。对于每个受试者，将每周的回答绘制成图表，并根据强度、变化和总体变化模式进行分类。定性测量基于LBP咨询一年后的半结构化电话访谈，两名编码员将LBP病程的自我评估独立分类为与基于短信的轨迹相同的预定义类别。此外，患者感知的总体恢复情况与短信轨迹的变化模式相关。
疼痛强度领域的一致性为48%，变化领域为53%，变化模式领域为63%。大多数不一致的病例被归类为相邻类别，大多数与波动模式有关。在本研究中，疼痛强度和疼痛天数的定量测量似乎很好地反映了自我感知的总体恢复状态。
本研究表明，实时定量测量（每周短信）和患者的回顾性评估在反映LBP一年病程方面没有根本差异。作为对该领域的首次调查，这些结果很有前景，因为LBP纵向定量得出的轨迹似乎在很大程度上反映了患者的实际经历。此外，患者回顾性回忆其LBP一年病程的能力似乎相当好。未来的研究应专注于完善轨迹类别。
