Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway.
Eur J Pain. 2020 May;24(5):921-932. doi: 10.1002/ejp.1541. Epub 2020 Feb 27.
The multidimensional array of clinical features and prognostic factors makes it difficult to optimize management within the heterogeneity of patients with common musculoskeletal pain. This study aimed to identify phenotypes across prognostic factors and musculoskeletal complaints. Concurrent and external validity were assessed against an established instrument and a new sample, respectively, and treatment outcome was described.
We conducted a longitudinal observational study of 435 patients (aged 18-67 years) seeking treatment for nonspecific complaints in the neck, shoulder, low back or multisite/complex pain in primary health care physiotherapy in Norway. Latent class analysis was used to identify phenotypes based on 11 common prognostic factors within four biopsychosocial domains; pain, beliefs and thoughts, psychological and activity and lifestyle.
Five distinct phenotypes were identified. Phenotype 1 (n = 77, 17.7%) and 2 (n = 142, 32.6%) were characterized by the lowest scores across all biopsychosocial domains. Phenotype 2 showed somewhat higher levels of symptoms across the biopsychosocial domains. Phenotype 3 (n = 89, 20.5%) and 4 (n = 78, 17.9%) were more affected across all domains, but phenotype 3 and 4 had opposite patterns in the psychological and pain domains. Phenotype 5 (n = 49, 11.3%) were characterized by worse symptoms across all domains, indicating a complex phenotype. The identified phenotypes had good external and concurrent validity, also differentiating for the phenotypes in function and health-related quality of life outcome at 3-month follow-up.
The phenotypes may inform the development of targeted interventions aimed at improving the treatment efficiency in patients with common musculoskeletal disorders.
This observational prospective study identified five distinct and clinically meaningful phenotypes based on biopsychosocial prognostic factors across common musculoskeletal pain. These phenotypes were independent of primary pain location, showed good external validity, and clear variation in treatment outcome. The findings are particularly valuable as they describe the heterogeneity of patients with musculoskeletal pain and points to a need for more targeted interventions in common musculoskeletal disorders to improve treatment outcome.
常见肌肉骨骼疼痛患者的临床特征和预后因素多维数组使得难以在异质性中优化管理。本研究旨在确定跨预后因素和肌肉骨骼投诉的表型。分别针对既定仪器和新样本评估了同时和外部有效性，并描述了治疗结果。
我们对挪威初级保健理疗中寻求治疗颈部、肩部、下背部或多部位/复杂疼痛的非特异性投诉的 435 名患者（年龄 18-67 岁）进行了一项纵向观察性研究。基于四个生物心理社会领域内的 11 个常见预后因素，使用潜在类别分析来确定表型；疼痛、信念和思想、心理和活动与生活方式。
确定了五个不同的表型。表型 1（n=77，17.7%）和 2（n=142，32.6%）的所有生物心理社会领域得分最低。表型 2 在生物心理社会领域的症状水平稍高。表型 3（n=89，20.5%）和 4（n=78，17.9%）在所有领域受到的影响更大，但表型 3 和 4 在心理和疼痛领域呈现相反的模式。表型 5（n=49，11.3%）的所有领域症状更严重，表明是一种复杂的表型。所确定的表型具有良好的外部和同时有效性，在 3 个月随访时，也能区分功能和健康相关生活质量结果的表型。
这些表型可以为针对常见肌肉骨骼疾病患者的靶向干预措施的开发提供信息，以提高治疗效率。
这项前瞻性观察研究根据常见肌肉骨骼疼痛的生物心理社会预后因素确定了五个不同的、具有临床意义的表型。这些表型与主要疼痛部位无关，具有良好的外部有效性，并且在治疗结果上有明显的差异。这些发现特别有价值，因为它们描述了肌肉骨骼疼痛患者的异质性，并表明需要针对常见肌肉骨骼疾病进行更有针对性的干预措施，以改善治疗效果。
