Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
Spine J. 2022 Jul;22(7):1131-1138. doi: 10.1016/j.spinee.2022.02.008. Epub 2022 Feb 18.
Improving prognostic stratification for patients with low back pain (LBP) outside of a primary care setting has been identified as an important area for further research.
Our study aimed to identify clinical symptom classes of patients presenting to a spine clinic based on 4 Patient Reported Outcome Measurement Information System (PROMIS) domains and evaluate demographic and clinical differences across classes.
An observational cross-sectional study of patients seen in spine centers at a large health system.
Adult patients with LBP seen in a spine center between November 14, 2018 and May 14, 2019 who completed patient-reported outcomes as part of routine care.
PROMIS physical function, pain interference, satisfaction with social roles and activities, and fatigue.
Latent class analysis identified symptom classes based on PROMIS domain scores ≥1 standard deviation worse (meaningfully worse) than the general population. A multivariable multinomial logistic regression model was constructed to evaluate differences in symptom classes based on demographics and socioeconomic characteristics. Lastly, the ability of the profiles to discriminate across levels of disability, based on the modified Oswestry Disability Questionnaire (ODI), was evaluated.
There were 7,144 adult patients included in the study who visited spine clinics for a primary complaint of LBP and completed all 4 PROMIS domains (age 58.7±15.9, 54% female). Three distinct classes were identified. Class 1 ("Significant Symptoms," n=3238) had PROMIS scores that were meaningfully worse than the population average for all domains. Class 2 ("Mixed Symptoms," n=1366) had meaningfully worse scores on physical function and pain interference but average scores on other domains. Class 3 ("Mild Symptoms," n=2540) had average scores across all domains. Compared to patients in Class 3, those in Class 2 were more likely older, and those in Classes 1 and 2 were more likely to be divorced, have lower household income, and no employment. Level of disability was significantly different across each class (average (SD) ODI for Classes 1-3: 53.4 (14.3), 39.9 (12.5), 22.9 (12.1), p<.01).
Patients presenting to specialty clinics for LBP demonstrate distinct clinical symptom classes which could be utilized to inform specific symptom-based treatment. Future research should evaluate the ability of these classes to predict long-term disability.
在初级保健环境之外，改善腰痛（LBP）患者的预后分层已被确定为进一步研究的重要领域。
我们的研究旨在根据 4 个患者报告的结果测量信息系统（PROMIS）领域，确定在脊柱诊所就诊的患者的临床症状类别，并评估各类别之间的人口统计学和临床差异。
这是一项在大型医疗系统的脊柱中心就诊的患者的观察性横断面研究。
2018 年 11 月 14 日至 2019 年 5 月 14 日期间，在脊柱中心就诊的患有 LBP 的成年患者，他们在常规护理中完成了患者报告的结果。
PROMIS 身体功能、疼痛干扰、社会角色和活动满意度以及疲劳。
基于 PROMIS 域评分比一般人群差（有意义地差）1 个标准差，使用潜在类别分析确定症状类别。构建多变量多项逻辑回归模型，根据人口统计学和社会经济特征评估症状类别的差异。最后，根据改良 Oswestry 残疾问卷（ODI）评估各表型在残疾程度上的区分能力。
共纳入 7144 名成年患者，因 LBP 就诊脊柱诊所，并完成了所有 4 个 PROMIS 领域（年龄 58.7±15.9，54%女性）。确定了 3 个不同的类别。第 1 类（“明显症状”，n=3238）的所有领域的 PROMIS 评分均明显差于人群平均值。第 2 类（“混合症状”，n=1366）的身体功能和疼痛干扰的评分有意义地较差，但其他领域的评分平均。第 3 类（“轻度症状”，n=2540）的所有领域评分均平均。与第 3 类患者相比，第 2 类患者更可能年龄较大，而第 1 类和第 2 类患者更可能离婚、家庭收入较低且没有就业。各类别之间的残疾程度有显著差异（第 1-3 类的平均（SD）ODI：53.4（14.3）、39.9（12.5）、22.9（12.1），p<.01）。
因 LBP 就诊于专科诊所的患者表现出明显的临床症状类别，可用于为特定的基于症状的治疗提供信息。未来的研究应评估这些类别的预测长期残疾的能力。
