The RealHealth Institute, Sint Maartenskliniek, Zevenheuvelenweg 48a, 6571 CK, Berg en Dal, The Netherlands.
Department of Orthopedics, Sint Maartenskliniek, P.O. Box 9011, 6500 GM, Nijmegen, The Netherlands.
Eur Spine J. 2022 May;31(5):1189-1196. doi: 10.1007/s00586-022-07156-4. Epub 2022 Mar 24.
No evidence-based treatment exists for adult spinal deformity (ASD) patients with chronic low back pain (CLBP).
evaluate a combined physical and psychological programme (CPPP) for ASD patients with CLBP and to compare this with a non-ASD-cohort with CLBP.
Data were extracted from the database of CLBP-patients for whom surgery is not an option and completed CPPP. Two cohorts were selected: an ASD-cohort (n = 80) based on a Cobb angle of > 10° and a consecutive age- and gender-matched non-ASD-cohort (n = 240).
functional status (Oswestry Disability Index; ODI).
pain intensity, self-efficacy and quality of life.
pre and post treatment, one-month and one-year follow-up (FU).
minimal important clinical change (MCIC; ODI 10 points), patient acceptable symptom state (PASS; ODI ≤ 22).
Demographics ASD-cohort: 79% female, mean age 50.9 (± 14.1) years, mean CLBP duration 15.5 (± 12.5) years, mean Cobb angle 21.4 (± 9.4)°. Non-ASD-cohort: not significantly different. Both cohorts improved in functional status (F[1,318] = 142.982, p < .001; r = 0.31). The ASD-cohort improved from mean ODI 39.5(± 12.0) at baseline to mean ODI 31.8(± 16.5) at one-year FU.
51% of the ASD patients reached MCIC and 33% reached a PASS. An interaction effect is shown between time and both cohorts (F[1,318] = 8.2, p = .004; r = 0.03); however, not clinically relevant. All secondary outcomes: improvement at one-year FU.
This is the first study showing beneficial outcomes of a non-surgical treatment in selected ASD patients with longstanding CLBP. Improvement is shown in functional status, and appeared equivalent to the non-ASD cohort. LEVEL OF EVIDENCE 1: Diagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding.
目前尚无针对慢性下腰痛（CLBP）成年脊柱畸形（ASD）患者的循证治疗方法。
评估针对 ASD 合并 CLBP 患者的综合身体和心理治疗方案（CPPP），并将其与无 ASD 的 CLBP 患者进行比较。
从 CLBP 患者数据库中提取不适合手术且已完成 CPPP 的患者数据。选择了两个队列：一个是基于 Cobb 角>10°的 ASD 队列（n=80），另一个是年龄和性别匹配的连续无 ASD 队列（n=240）。
功能状态（Oswestry 残疾指数；ODI）。
疼痛强度、自我效能和生活质量。
治疗前、治疗后、一个月和一年随访（FU）。
最小重要临床变化（ODI 10 分），可接受的症状状态（ODI≤22）。
ASD 队列的人口统计学数据：79%为女性，平均年龄 50.9（±14.1）岁，CLBP 持续时间平均为 15.5（±12.5）年，Cobb 角平均为 21.4（±9.4）°。非 ASD 队列无显著差异。两个队列的功能状态均得到改善（F[1,318]=142.982，p<.001；r=0.31）。ASD 队列从基线时的平均 ODI 39.5（±12.0）改善到一年 FU 时的平均 ODI 31.8（±16.5）。
51%的 ASD 患者达到了 MCIC，33%达到了 PASS。时间和两个队列之间存在交互效应（F[1,318]=8.2，p=.004；r=0.03），但无临床意义。所有次要结局在一年 FU 时均有改善。
这是第一项表明针对长期慢性下腰痛的特定 ASD 患者的非手术治疗有获益的研究。在功能状态方面有改善，且与非 ASD 队列相当。
证据水平 1：诊断：应用一致的参考标准和盲法的个体横断面研究。
