Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, 553 St Kilda Rd, Melbourne, VIC 3004, Australia.
Imaging Section, Diagnostic Centre, Regional Hospital Silkeborg, Silkeborg, Denmark; Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark; Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark.
Spine J. 2020 Jun;20(6):857-865. doi: 10.1016/j.spinee.2020.02.002. Epub 2020 Feb 8.
Psychological characteristics are important in the development and progression of low back pain (LBP); however, their role in persistent, severe LBP is unclear.
To investigate the relationship between catastrophization, depression, fear of movement, and anxiety and persistent, severe LBP, and disability.
STUDY DESIGN/ SETTING: One-year prospective cohort study.
Participants were selected from the SpineData registry (Denmark), which enrolls individuals with LBP of 2 to 12 months duration without radiculopathy and without satisfactory response to primary intervention.
Psychological characteristics, including catastrophization, depression, fear of movement, and anxiety, were examined at baseline using a validated screening questionnaire. Current, typical, and worst pain in the past 2 weeks were assessed by 11-point numeric rating scales and an average pain score was calculated. Disability was measured using the 23-item Roland-Morris Disability Questionnaire.
Participants completed baseline questionnaires on initial presentation to the Spine Center (Middelfart, Denmark), and follow-up questionnaires were sent and returned electronically. Statistical analysis involved multivariable Poisson regression to investigate the association between psychological factors and the number of episodes of severe pain or disability. This study received no direct funding.
Of the 952 participants at baseline, 633 (63.4%) provided data 1 year later. Approximately half of the participants reported severe LBP (n=299, 47.2%, 95% confidence interval [CI] 43.3%-51.2%) or disability (n=315, 57.6%, 95% CI 53.3%-61.8%) at a minimum of one time point, and 14.9% (n=94, 95% CI 12.2%-17.9%) and 24.3% (n=133, 95% CI 20.8%-28.1%) experienced severe LBP or disability at two time points, respectively. Multivariable Poisson regression showed a relationship between catastrophization, depression, fear of movement, and anxiety and a greater number of time points with severe LBP and disability, after adjusting for age, gender, body mass index, and duration of symptoms. However, when all psychological factors were added to the regression model, only catastrophization and depression remained significantly associated.
This study showed that persistent, severe LBP, and disability is common in a secondary care population with LBP and is associated with a variety of psychological risk factors, in particular catastrophization and depression, highlighting the importance of considering these factors in the design and evaluation of outcomes studies for LBP.
心理特征在腰痛（LBP）的发展和进展中很重要；然而，它们在持续性、严重的 LBP 中的作用尚不清楚。
研究灾难化、抑郁、运动恐惧和焦虑与持续性、严重 LBP 和残疾之间的关系。
研究设计/地点：为期一年的前瞻性队列研究。
参与者从 SpineData 登记处（丹麦）中选出，该登记处招募了持续 2 至 12 个月、无神经根病且对初级干预无满意反应的 LBP 患者。
使用经过验证的筛选问卷在基线时评估心理特征，包括灾难化、抑郁、运动恐惧和焦虑。过去 2 周的当前、典型和最剧烈疼痛通过 11 点数字评分量表进行评估，并计算平均疼痛评分。使用 23 项 Roland-Morris 残疾问卷测量残疾。
参与者在向 SpineCenter（丹麦 Middelfart）初次就诊时完成基线问卷，然后通过电子方式发送和返回随访问卷。统计分析采用多变量泊松回归，以调查心理因素与严重疼痛或残疾发作次数之间的关联。本研究未获得直接资金支持。
在基线时的 952 名参与者中，有 633 名（63.4%）在 1 年后提供了数据。大约一半的参与者报告在至少一个时间点有严重的 LBP（n=299，47.2%，95%置信区间[CI]43.3%-51.2%）或残疾（n=315，57.6%，95%CI 53.3%-61.8%），14.9%（n=94，95%CI 12.2%-17.9%）和 24.3%（n=133，95%CI 20.8%-28.1%）分别在两个时间点经历了严重的 LBP 或残疾。多变量泊松回归显示，在调整年龄、性别、体重指数和症状持续时间后，灾难化、抑郁、运动恐惧和焦虑与更多的严重 LBP 和残疾时间点之间存在关联。然而，当将所有心理因素纳入回归模型时，只有灾难化和抑郁仍然与严重的 LBP 和残疾显著相关。
本研究表明，在 LBP 的二级护理人群中，持续性、严重的 LBP 和残疾很常见，与多种心理危险因素相关，特别是灾难化和抑郁，这凸显了在 LBP 的设计和结局研究中考虑这些因素的重要性。
