University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, The Netherlands.
University of Groningen, University Medical Center Groningen, Pain Center, The Netherlands.
Spine (Phila Pa 1976). 2020 Dec 1;45(23):1649-1660. doi: 10.1097/BRS.0000000000003647.
Prospective cohort study.
The aim of this study was to identify treatment response trajectories in patients with low back pain (LBP) during and after multidisciplinary care in a tertiary spine center, and to examine baseline patient characteristics that can distinguish trajectories.
Treatment response is often heterogeneous between patients with LBP. Knowledge on key characteristics that are associated with courses of disability could identify patients at risk for less favorable outcome. This knowledge will help improve shared decision-making.
Adult patients with LBP completed questionnaires on disability (Pain Disability Index) and LBP impact (Impact Stratification of the National Institutes of Health minimal dataset) at baseline, 6, 12, 18, and 24 months' follow-up. Latent class analyses were applied to identify trajectories of disability and LBP impact. Baseline sociodemographic and clinical patient characteristics were compared between trajectory subgroups.
Follow-up was available for 996 patients on disability and 707 patients on LBP impact. Six trajectories were identified for both outcome measures. Three disability trajectories remained stable at distinct levels of severity (68% of patients) and three trajectories showed patterns of recovery (32%). For LBP impact there was one stable trajectory (17%), two slightly improving (59%), two recovering (15%), and one with a pattern of recovery and relapse (15%). Significant differences between trajectories were observed for almost all baseline patient characteristics.
On average, patients show moderate improvements in disability and LBP impact 2 years after visiting a multidisciplinary tertiary spine center. However, latent class analyses revealed that most patients belong to subgroups experiencing stable levels of disability and LBP impact. Differences in baseline patient characteristics were mostly associated with baseline levels of functioning, instead of (un)favorable outcome during follow-up.
前瞻性队列研究。
本研究旨在确定在三级脊柱中心接受多学科治疗期间和之后患有腰痛（LBP）的患者的治疗反应轨迹，并探讨可区分轨迹的基线患者特征。
腰痛患者的治疗反应通常存在个体差异。了解与残疾病程相关的关键特征可以识别出预后较差风险较高的患者。这种知识将有助于改善共同决策。
成年腰痛患者在基线时、6 个月、12 个月、18 个月和 24 个月随访时完成了残疾（疼痛残疾指数）和腰痛影响（国家卫生研究院最小数据集的影响分层）问卷。应用潜在类别分析来确定残疾和腰痛影响的轨迹。比较轨迹亚组之间的基线社会人口学和临床患者特征。
残疾和腰痛影响的随访率分别为 996 例和 707 例。两种结局指标均确定了 6 个轨迹。三种残疾轨迹保持在明显的严重程度水平上稳定（68%的患者），三种轨迹呈现恢复模式（32%）。对于腰痛影响，有一个稳定的轨迹（17%），两个稍微改善的轨迹（59%），两个恢复的轨迹（15%），和一个恢复和复发的轨迹（15%）。几乎所有基线患者特征在轨迹之间均存在显著差异。
平均而言，在访问多学科三级脊柱中心 2 年后，患者的残疾和腰痛影响均有中度改善。然而，潜在类别分析显示，大多数患者属于经历残疾和腰痛影响稳定水平的亚组。基线患者特征的差异主要与基线功能水平相关，而不是与随访期间（不良）结局相关。
2 级。
