School of Health and Life Sciences, Teesside University, Middlesbrough, UK.
South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK.
Spine (Phila Pa 1976). 2021 Feb 1;46(3):191-197. doi: 10.1097/BRS.0000000000003760.
Nonrandomized longitudinal observational study.
The aim of this study was to evaluate the association between baseline pain duration and medium-to-long term clinical outcomes, in low back pain (LBP) patients enrolled on the North East of England Regional Back Pain and Radicular Pain Pathway (NERBPP).
The NERBPP is based upon National Institute for Health and Care Excellence (NICE) guidelines. These guidelines no longer differentiate management of LBP patients based on pain duration. Medium-to-long term data from the NERBPP is lacking.
Between May 2015 and December 2019, 786 and 552 LBP patients from the NERBPP returned 6-month and 12-month follow-up outcome measures, respectively. Outcomes included pain (Numerical rating scale), function (Oswestry Disability Index) and quality-of-life (EuroQol five-dimension, five-level questionnaire), analyzed using a series of covariate-adjusted models. Patients were categorized into four groups based upon baseline pain duration: <3 months, ≥3 to <6 months, ≥6 months to <12 months, ≥12 months.
Patients with <3 months duration demonstrated clinically important improvements on all outcomes, at both follow-ups. The improvements in outcomes from this group were larger than those in the ≥12 month's duration group (P < 0.05), these group differences in change, in some cases surpassed our threshold for clinical relevance. Functional improvements in those with ≥12 month's duration were not clinically relevant at either follow-up. All patients, regardless of baseline pain duration, reported similar levels of readiness to self-manage at the 12-month follow-up.
Baseline pain duration would appear to be of clinical importance. Patients with shorter baseline pain duration demonstrated better outcomes. Those with ≥12 month's duration of pain may need additional support during their management to achieve clinically relevant functional improvements in the medium-to-long term. These findings raise questions about the decision by NICE to move away from duration of pain to differentiate management of LBP patients.Level of Evidence: 3.
非随机纵向观察研究。
本研究旨在评估东北英格兰地区腰痛和神经根痛通道（NERBPP）纳入的腰痛（LBP）患者基线疼痛持续时间与中远期临床结果之间的关联。
NERBPP 基于英国国家卫生与保健优化研究所（NICE）指南。这些指南不再根据疼痛持续时间来区分 LBP 患者的管理。NERBPP 缺乏中远期数据。
2015 年 5 月至 2019 年 12 月，NERBPP 中 786 名和 552 名 LBP 患者分别在 6 个月和 12 个月时返回了随访结果测量值。结果包括疼痛（数字评分量表）、功能（Oswestry 残疾指数）和生活质量（EuroQol 五维，五水平问卷），使用一系列协变量调整模型进行分析。患者根据基线疼痛持续时间分为四组：<3 个月、≥3 至<6 个月、≥6 至<12 个月、≥12 个月。
疼痛持续时间<3 个月的患者在两次随访中所有结果均显示出临床重要的改善。与疼痛持续时间≥12 个月的组相比，该组的结果改善更大（P<0.05），在某些情况下，这些组间变化超过了我们对临床相关性的阈值。在≥12 个月的组中，功能改善在两次随访中均无临床相关性。所有患者，无论基线疼痛持续时间如何，在 12 个月随访时都报告了类似的自我管理准备水平。
基线疼痛持续时间似乎具有临床重要性。基线疼痛持续时间较短的患者表现出更好的结果。疼痛持续时间≥12 个月的患者可能需要在管理过程中获得额外支持，以在中远期实现具有临床相关性的功能改善。这些发现引发了对 NICE 决定不再根据疼痛持续时间来区分 LBP 患者管理的质疑。
3 级。
