Garcia Alessandra Narciso, Costa Leonardo O P, Costa Luciola Da Cunha Menezes, Hancock Mark, Cook Chad
a Doctor of Physical Therapy Division, Department of Orthopaedic Surgery, Duke University , Durham , NC , USA.
b Physical Therapy, University Cidade de Sao Paulo , Sao Paulo , Brazil.
J Man Manip Ther. 2019 Sep;27(4):197-207. doi: 10.1080/10669817.2019.1597435. Epub 2019 Apr 4.
: The objective was to explore for universal prognostic variables, or predictors, across three different outcome measures in patients with chronic low back pain (LBP). We hypothesized that selected prognostic variables would be 'universal' prognostic variables, regardless of the outcome measures used. : This study was a secondary analysis of data from a previous randomized controlled trial comparing the McKenzie treatment approach with placebo in patients with chronic LBP. Ten baseline prognostic variables were explored in predictive models for three outcomes: pain intensity, disability, and global perceived effect, at 6 and 12 months. Predictive models were created using backward stepwise logistic and linear multivariate regression analyses. : Several predictors were present including age, expectancy of improvement, global perceived effect; however, we only identified baseline disability as a universal predictor of outcomes at 6 months. The second most represented universal predictor was baseline pain intensity for outcomes at 12 months. : Only two predictors demonstrated an association with more than one outcome measure. High baseline disability predicts multidimensional outcome measures at 6 months in patients with chronic LBP while baseline pain intensity can best predict the outcome at 12 months. Nevertheless, other predictors seem to be unique to the outcome used. Level of evidence: 2c.
目的是探索慢性下腰痛(LBP)患者在三种不同结局指标中的通用预后变量或预测因素。我们假设,无论使用何种结局指标,选定的预后变量都将是“通用”的预后变量。
本研究是对先前一项随机对照试验的数据进行的二次分析,该试验比较了麦肯齐治疗方法与安慰剂对慢性LBP患者的疗效。在预测模型中探讨了10个基线预后变量,用于预测6个月和12个月时的三个结局:疼痛强度、功能障碍和整体感知效果。使用向后逐步逻辑回归和线性多元回归分析创建预测模型。
存在多个预测因素,包括年龄、改善预期、整体感知效果;然而,我们仅确定基线功能障碍是6个月时结局的通用预测因素。第二大常见的通用预测因素是12个月时结局的基线疼痛强度。
只有两个预测因素与不止一个结局指标相关。高基线功能障碍可预测慢性LBP患者6个月时的多维结局指标,而基线疼痛强度最能预测12个月时的结局。然而,其他预测因素似乎因所使用的结局而异。证据水平:2c。