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. 2022 Feb 10;17(2):e0263574. doi: 10.1371/journal.pone.0263574. eCollection 2022.
The Oswestry Disability Index (ODI) is a common aggregate measure of disability for people with Low Back Pain (LBP). Scores on individual items and the relationship between items of the ODI may help understand the complexity of low back disorders and their response to treatment. In this study, we present a network analysis to explore how individualised physiotherapy or advice might influence individual items of the ODI, and the relationship between those items, at different time points for people with LBP.
Data from a randomised controlled trial (n = 300) comparing individualised physiotherapy versus advice for low back pain were used. A network analysis was performed at baseline, 5, 10, 26 and 52 weeks, with the 10 items of the Oswestry Disability Index modelled as continuous variables and treatment group (Individualised Physiotherapy or Advice) modelled as a dichotomous variable. A Mixed Graphical Model was used to estimate associations between variables in the network, while centrality indices (Strength, Closeness and Betweenness) were calculated to determine the importance of each variable.
Individualised Physiotherapy was directly related to lower Sleep and Pain scores at all follow-up time points relative to advice, as well as a lower Standing score at 10-weeks, and higher Lifting and Travelling scores at 5-weeks. The strongest associations in the network were between Sitting and Travelling at weeks 5 and 26, between Walking and Standing at week 10, and between Sitting and Standing scores at week 52. ODI items with the highest centrality measures were consistently found to be Pain, Work and Social Life.
This study represents the first to understand how individualised physiotherapy or advice differentially altered disability in people with LBP. Individualised Physiotherapy directly reduced Pain and Sleep more effectively than advice, which in turn may have facilitated improvements in other disability items. Through their high centrality measures, Pain may be considered as a candidate therapeutic target for optimising LBP management, while Work and Socialising may need to be addressed via intermediary improvements in lifting, standing, walking, travelling or sleep. Slower (5-week follow-up) improvements in Lifting and Travelling as an intended element of the Individualised Physiotherapy approach did not negatively impact any longer-term outcomes.
ACTRN12609000834257.
Oswestry 残疾指数（ODI）是一种常见的腰痛（LBP）患者残疾综合衡量指标。个别项目的分数以及 ODI 项目之间的关系有助于理解下腰痛的复杂性及其对治疗的反应。在这项研究中，我们进行了网络分析，以探讨个体化物理治疗或建议如何在不同时间点影响腰痛患者的 ODI 个别项目以及这些项目之间的关系。
使用比较个体化物理治疗与腰痛建议的随机对照试验（n=300）的数据。在基线、5、10、26 和 52 周时进行网络分析，将 Oswestry 残疾指数的 10 个项目建模为连续变量，将治疗组（个体化物理治疗或建议）建模为二分类变量。使用混合图形模型来估计网络中变量之间的关联，同时计算中心性指数（强度、接近度和中间度）以确定每个变量的重要性。
与建议相比，个体化物理治疗在所有随访时间点均与较低的睡眠和疼痛评分直接相关，在 10 周时与较低的站立评分相关，在 5 周时与较高的提举和旅行评分相关。网络中最强的关联是在第 5 和 26 周时的坐姿和旅行之间，在第 10 周时的步行和站立之间，以及在第 52 周时的坐姿和站立评分之间。中心性测量最高的 ODI 项目始终是疼痛、工作和社会生活。
这项研究代表了首次了解个体化物理治疗或建议如何在腰痛患者中不同程度地改变残疾。与建议相比，个体化物理治疗更直接地减轻疼痛和睡眠，这反过来可能促进了其他残疾项目的改善。通过其高中心性测量，疼痛可能被视为优化腰痛管理的候选治疗靶点，而工作和社交则可能需要通过中间改善举重、站立、行走、旅行或睡眠来解决。作为个体化物理治疗方法的预期要素，提升和旅行在 5 周的随访中较慢的改善并没有对任何长期结果产生负面影响。
ACTRN12609000834257。
