Physical Therapy Sciences, Program in Clinical Health Sciences, University Medical Center Utrecht, Utrecht, the Netherlands; Center for Physical Therapy Research and Innovation in Primary Care, Leidsche Rijn Julius Health Care Centers, Utrecht, the Netherlands; Fysio Center Den Haag, The Hague, the Netherlands.
Center for Physical Therapy Research and Innovation in Primary Care, Leidsche Rijn Julius Health Care Centers, Utrecht, the Netherlands; Physical Therapy Research, Department of Rehabilitation, Physical Therapy Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Health Innovation and Technology, Fontys University of Applied Sciences, Eindhoven, the Netherlands.
J Psychosom Res. 2019 Oct;125:109785. doi: 10.1016/j.jpsychores.2019.109785. Epub 2019 Jul 22.
Medically Unexplained Physical Symptoms (MUPS) are a major burden on both patients and society and frequently develop into chronic MUPS. Self-management interventions may prevent moderate MUPS from becoming chronic. Tailoring interventions to the patient population is strongly recommended. This can be facilitated by identifying subgroups based on self-management skills. This study aimed to identify these subgroups and their clinical profiles in primary care patients with moderate MUPS.
A cross-sectional study was performed on baseline measurements from a randomized clinical trial (PARASOL-study). To identify subgroups based on self-management skills, a hierarchical cluster analysis was conducted for adults with moderate MUPS from primary health care centers. Self-management skills were measured with the Health education impact Questionnaire. Cluster variables were seven constructs of this questionnaire. Additionally, specific patient profiles were determined by comparing the identified clusters on the clinical variables pain, fatigue and physical functioning.
Four subgroups were identified: High-Self-Management Skills (SMS) (n = 29), Medium-SMS (n = 55), Low-SMS (n = 49) and Active & Low Distress-SMS (n = 20). The latter showed a distinctly different pattern on cluster variables, while the other subgroups differed significantly on means of the cluster variables (p < .001). On clinical variables, significant differences between subgroups were mainly found on fatigue and physical functioning.
This study found four specific subgroups based on self-management skills in moderate MUPS-patients. One subgroup demonstrated a distinctly different pattern on self-management skills. In other subgroups, more similar patterns on self-management skills were found that negatively correlated with pain and fatigue and positively correlated with physical functioning.
医学无法解释的躯体症状（MUPS）给患者和社会都带来了沉重负担，并且常常发展为慢性 MUPS。自我管理干预可能防止中等程度的 MUPS 发展为慢性。强烈建议根据患者人群来调整干预措施。这可以通过基于自我管理技能来识别亚组来实现。本研究旨在确定初级保健中有中等 MUPS 的患者中的这些亚组及其临床特征。
这是一项横断面研究，对随机临床试验（PARASOL 研究）的基线测量值进行了分析。为了根据自我管理技能来识别亚组，对来自初级保健中心的中等 MUPS 的成年人进行了层次聚类分析。自我管理技能使用健康教育影响问卷进行测量。聚类变量是该问卷的七个结构。此外，通过比较所确定的簇在疼痛、疲劳和身体机能等临床变量上的特征来确定特定的患者特征。
确定了四个亚组：高自我管理技能（SMS）（n=29）、中 SMS（n=55）、低 SMS（n=49）和积极且低压力 SMS（n=20）。后者在聚类变量上表现出明显不同的模式，而其他亚组在聚类变量的平均值上差异显著（p<0.001）。在临床变量上，亚组之间的显著差异主要在疲劳和身体机能上。
本研究在中等 MUPS 患者中基于自我管理技能发现了四个特定的亚组。一个亚组在自我管理技能上表现出明显不同的模式。在其他亚组中，发现了更为相似的自我管理技能模式，这些模式与疼痛和疲劳呈负相关，与身体机能呈正相关。
