腰背疼痛的个人和社会影响：格罗宁根脊柱队列研究。

Personal and Societal Impact of Low Back Pain: The Groningen Spine Cohort.

机构信息

University of Groningen, University Medical Center Groningen, Department of Rehabilitation, Groningen, The Netherlands.

University of Groningen, University Medical Center Groningen, Groningen Spine Center, Groningen, The Netherlands.

出版信息

Spine (Phila Pa 1976). 2019 Dec 15;44(24):E1443-E1451. doi: 10.1097/BRS.0000000000003174.

DOI:10.1097/BRS.0000000000003174

PMID:31369481

Abstract

STUDY DESIGN

Cross-sectional study.

OBJECTIVE

The aim of this study was to study the personal and societal impact of low back pain (LBP) in patients admitted to a multidisciplinary spine center.

SUMMARY OF BACKGROUND DATA

The socioeconomic burden of LBP is very high. A minority of patients visit secondary or tertiary care because of severe and long-lasting complaints. This subgroup may account for a major part of disability and costs, yet could potentially gain most from treatment. Currently, little is known about the personal and societal burden in patients with chronic complex LBP visiting secondary/tertiary care.

METHODS

Baseline data were acquired through patient-reported questionnaires and health insurance claims. Primary outcomes were LBP impact (Impact Stratification, range 8-50), functioning (Pain Disability Index, PDI; 0-70), quality of life (EuroQol-5D, EQ5D; -0.33 to 1.00), work ability (Work Ability Score, WAS; 0-10), work participation, productivity costs (Productivity Cost Questionnaire), and healthcare costs 1 year before baseline. Healthcare costs were compared with matched primary and secondary care LBP samples. Descriptive and inferential statistics were applied.

RESULTS

In total, 1502 patients (age 46.3 ± 12.8 years, 57% female) were included. Impact Stratification was 35.2 ± 7.5 with severe impact (≥35) for 58% of patients. PDI was 38.2 ± 14.1, EQ5D 0.39 (interquartile range, IQR: 0.17-0.72); WAS 4.0 (IQR: 1.0-6.0) and 17% were permanently work-disabled. Mean total health care costs (&OV0556;4875, 95% confidence interval [CI]: 4309-5498) were higher compared to the matched primary care sample (n = 4995) (&OV0556;2365, 95% CI: 2219-2526, P < 0.001), and similar to the matched secondary care sample (n = 4993) (&OV0556;4379, 95% CI: 4180-4590). Productivity loss was estimated at &OV0556;4315 per patient (95% CI: 3898-4688) during 6 months.

CONCLUSION

In patients seeking multidisciplinary spine care, the personal and societal impact of LBP is very high. Specifically, quality of life and work ability are poor and health care costs are twice as high compared to patients seeking primary LBP care.

LEVEL OF EVIDENCE

摘要

研究设计

横断面研究。

目的

本研究旨在研究因腰痛（LBP）而就诊于多学科脊柱中心的患者的个人和社会影响。

背景资料概要

LBP 的社会经济学负担非常高。由于严重和长期的投诉，只有少数患者会去二级或三级医疗机构就诊。这一亚组可能会导致大部分残疾和费用，但可能会从治疗中受益最大。目前，对于因慢性复杂 LBP 而就诊于二级/三级医疗机构的患者，人们对其个人和社会负担知之甚少。

方法

通过患者报告的问卷和健康保险索赔获得基线数据。主要结局指标为腰痛影响（影响分层，范围 8-50）、功能（疼痛残疾指数，PDI；0-70）、生活质量（EuroQol-5D，EQ5D；-0.33 至 1.00）、工作能力（工作能力评分，WAS；0-10）、工作参与度、生产力成本（生产力成本问卷）和医疗保健成本在基线前 1 年。将医疗保健成本与匹配的初级和二级护理 LBP 样本进行比较。应用描述性和推断性统计。

结果

共纳入 1502 名患者（年龄 46.3±12.8 岁，57%为女性）。影响分层为 35.2±7.5，58%的患者有严重影响（≥35）。PDI 为 38.2±14.1，EQ5D 为 0.39（四分位距，IQR：0.17-0.72）；WAS 为 4.0（IQR：1.0-6.0），17%的患者永久性工作能力丧失。与匹配的初级保健样本（n=4995）相比，平均总医疗保健费用（&OV0556;4875，95%置信区间[CI]：4309-5498）较高（&OV0556;2365，95%CI：2219-2526，P<0.001），与匹配的二级保健样本（n=4993）相似（&OV0556;4379，95%CI：4180-4590）。估计每位患者在 6 个月内的生产力损失为 &OV0556;4315（95%CI：3898-4688）。