Research Group Lifestyle and Health, HU University of Applied Sciences Utrecht, Heidelberglaan 7, CS, Utrecht, 3584, The Netherlands.
Department of Health Sciences, VU University, Amsterdam, The Netherlands.
BMC Musculoskelet Disord. 2021 Jun 7;22(1):522. doi: 10.1186/s12891-021-04366-7.
Musculoskeletal pain (MSP) is recognized worldwide as a major cause of increased years lived with disability. In addition to known generic prognostic factors, illness perceptions (IPs) may have predictive value for poor recovery in MSP. We were interested in the added predictive value of baseline IPs, over and above the known generic prognostic factors, on clinical recovery from MSP. Also, it is hypothesized there may be overlap between IPs and domains covered by the Four-Dimensional Symptom Questionnaire (4DSQ), measuring distress, depression, anxiety and somatization. The aim of this study is twofold; 1) to assess the added predictive value of IPs for poor recovery and 2) to assess differences in predictive value for poor recovery between the Brief Illness Perception Questionnaire - Dutch Language Version (Brief IPQ-DLV) and the 4DSQ.
An eligible sample of 251 patients with musculoskeletal pain attending outpatient physical therapy were included in a multi-center longitudinal cohort study. Pain intensity, physical functioning and Global Perceived Effect were the primary outcomes. Hierarchical logistic regression models were used to assess the added value of baseline IPs for predicting poor recovery. To investigate the performance of the models, the levels of calibration (Hosmer-Lemeshov test) and discrimination (Area under the Curve (AUC)) were assessed.
Baseline 'Treatment Control' added little predictive value for poor recovery in pain intensity [Odds Ratio (OR) 0.80 (Confidence Interval (CI) 0.66-0.97), increase in AUC 2%] and global perceived effect [OR 0.78 (CI 0.65-0.93), increase in AUC 3%]. Baseline 'Timeline' added little predictive value for poor recovery in physical functioning [OR 1.16 (CI 1.03-1.30), increase in AUC 2%]. There was a non-significant difference between AUCs in predictive value for poor recovery between the Brief IPQ-DLV and the 4DSQ.
Based on the findings of this explorative study, assessing baseline IPs, over and above the known generic prognostic factors, does not result in a substantial improvement in the prediction of poor recovery. Also, no recommendations can be given for preferring either the 4DSQ or the Brief IPQ-DLV to assess psychological factors.
肌肉骨骼疼痛（MSP）被全球公认为导致残疾年限增加的主要原因。除了已知的一般预后因素外，疾病认知（IPs）可能对 MSP 的康复不良具有预测价值。我们对基线 IPs 的预测价值感兴趣，即在 MSP 从已知的一般预后因素中恢复过来的基础上，是否有额外的预测价值。此外，假设 IPs 与四维度症状问卷（4DSQ）涵盖的领域之间可能存在重叠，该问卷用于衡量痛苦、抑郁、焦虑和躯体化。本研究的目的有两个；1）评估 IPs 对不良恢复的预测价值；2）评估Brief Illness Perception Questionnaire-Dutch Language Version（Brief IPQ-DLV）和 4DSQ 对不良恢复预测价值的差异。
本研究纳入了 251 名在门诊物理治疗中接受治疗的肌肉骨骼疼痛患者的样本，进行了一项多中心纵向队列研究。疼痛强度、身体功能和整体感知效果是主要结果。使用层次逻辑回归模型评估基线 IPs 对预测不良恢复的附加价值。为了研究模型的性能，评估了校准水平（Hosmer-Lemeshov 检验）和区分度（曲线下面积（AUC））。
基线“治疗控制”对疼痛强度的不良恢复预测价值不大[优势比（OR）0.80（置信区间（CI）0.66-0.97），AUC 增加 2%]和整体感知效果[OR 0.78（CI 0.65-0.93），AUC 增加 3%]。基线“时间线”对身体功能的不良恢复预测价值不大[OR 1.16（CI 1.03-1.30），AUC 增加 2%]。Brief IPQ-DLV 和 4DSQ 在预测不良恢复方面的 AUC 值差异无统计学意义。
基于这项探索性研究的结果，评估基线 IPs，在已知的一般预后因素之外，对不良恢复的预测并没有显著改善。此外，也无法推荐使用 4DSQ 或 Brief IPQ-DLV 来评估心理因素。
