School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, Essex, United Kingdom.
Discipline of Physiotherapy, School of Allied Health, Human Services & Sport, La Trobe University, Melbourne, Australia.
PLoS One. 2021 Oct 11;16(10):e0258515. doi: 10.1371/journal.pone.0258515. eCollection 2021.
Individualised physiotherapy is an effective treatment for low back pain. We sought to determine how this treatment works by using randomised controlled trial data to develop a Bayesian Network model.
300 randomised controlled trial participants (153 male, 147 female, mean age 44.1) with low back pain (of duration 6-26 weeks) received either individualised physiotherapy or advice. Variables with potential to explain how individualised physiotherapy works were included in a multivariate Bayesian Network model. Modelling incorporated the intervention period (0-10 weeks after study commencement-"early" changes) and the follow-up period (10-52 weeks after study commencement-"late" changes). Sequences of variables in the Bayesian Network showed the most common direct and indirect recovery pathways followed by participants with low back pain receiving individualised physiotherapy versus advice.
Individualised physiotherapy directly reduced early disability in people with low back pain. Individualised physiotherapy exerted indirect effects on pain intensity, recovery expectations, sleep, fear, anxiety, and depression via its ability to facilitate early improvement in disability. Early improvement in disability, led to an early reduction in depression both directly and via more complex pathways involving fear, recovery expectations, anxiety, and pain intensity. Individualised physiotherapy had its greatest influence on early change variables (during the intervention period).
Individualised physiotherapy for low back pain appears to work predominately by facilitating an early reduction in disability, which in turn leads to improvements in other biopsychosocial outcomes. The current study cannot rule out that unmeasured mechanisms (such as tissue healing or reduced inflammation) may mediate the relationship between individualised physiotherapy treatment and improvement in disability. Further data-driven analyses involving a broad range of plausible biopsychosocial variables are recommended to fully understand how treatments work for people with low back pain.
ACTRN12609000834257.
个体化物理治疗是治疗腰痛的有效方法。我们试图通过使用随机对照试验数据来开发贝叶斯网络模型，确定这种治疗方法的作用机制。
300 名随机对照试验参与者（153 名男性，147 名女性，平均年龄 44.1 岁）患有腰痛（持续时间 6-26 周），接受个体化物理治疗或建议。具有解释个体化物理治疗作用机制潜力的变量被纳入多变量贝叶斯网络模型。模型纳入了干预期（研究开始后 0-10 周-“早期”变化）和随访期（研究开始后 10-52 周-“晚期”变化）。贝叶斯网络中的变量序列显示了接受个体化物理治疗与建议的腰痛患者最常见的直接和间接恢复途径。
个体化物理治疗可直接减轻腰痛患者的早期残疾。个体化物理治疗通过促进早期残疾改善，对疼痛强度、恢复期望、睡眠、恐惧、焦虑和抑郁产生间接影响。早期残疾的改善直接和通过更复杂的途径（涉及恐惧、恢复期望、焦虑和疼痛强度）导致早期抑郁的减少。个体化物理治疗对早期变化变量（干预期间）的影响最大。
个体化物理治疗腰痛主要通过促进早期残疾的减轻来发挥作用，进而改善其他生物心理社会结局。本研究不能排除未测量的机制（如组织愈合或炎症减轻）可能介导个体化物理治疗与残疾改善之间的关系。建议进一步进行涉及广泛生物心理社会变量的数据驱动分析，以充分了解治疗方法如何对腰痛患者起作用。
ACTRN12609000834257。
