Department of Rehabilitation and Sport Sciences, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, England.
AECC University College, Bournemouth, England.
Chiropr Man Therap. 2022 Apr 21;30(1):20. doi: 10.1186/s12998-022-00430-8.
Chronic low back pain is pervasive, societally impactful, and current treatments only provide moderate relief. Exploring whether therapeutic elements, either unrecognised or perceived as implicit within clinical encounters, are acknowledged and deliberately targeted may improve treatment efficacy. Contextual factors (specifically, patient's and practitioner's beliefs/characteristics; patient-practitioner relationships; the therapeutic setting/environment; and treatment characteristics) could be important, but there is limited evidence regarding their influence. This research aims to review the impact of interventions modifying contextual factors during conservative care on patient's pain and physical functioning.
Four electronic databases (Medline, CINAHL, PsycINFO and AMED) were searched from 2009 until 15th February 2022, using tailored search strategies, and resulted in 3476 unique citations. After initial screening, 170 full-text records were potentially eligible and assessed against the inclusion-exclusion criteria. Thereafter, studies were assessed for methodological quality using a modified Downs and Black scale, data extracted, and synthesised using a narrative approach.
Twenty-one primary studies (N = 3075 participants), were included in this review. Eight studies reported significant improvements in pain intensity, and seven in physical functioning, in favour of the contextual factor intervention(s). Notable contextual factors included: addressing maladaptive illness beliefs; verbal suggestions to influence symptom change expectations; visual or physical cues to suggest pain-relieving treatment properties; and positive communication such as empathy to enhance the therapeutic alliance.
This review identified influential contextual factors which may augment conservative chronic low back pain care. The heterogeneity of interventions suggests modifying more than one contextual factor may be more impactful on patients' clinical outcomes, although these findings require judicious interpretation.
慢性下背痛普遍存在，对社会有影响，而目前的治疗方法只能提供中度缓解。探索治疗元素，无论是未被认识到的还是被认为是临床接触中隐含的，是否被承认并被有意针对，可能会提高治疗效果。背景因素（特别是患者和医生的信念/特征；医患关系；治疗环境；和治疗特点）可能很重要，但关于它们的影响的证据有限。这项研究旨在回顾在保守治疗过程中干预改变背景因素对患者疼痛和身体功能的影响。
从 2009 年到 2022 年 2 月 15 日，使用定制的搜索策略，在四个电子数据库（Medline、CINAHL、PsycINFO 和 AMED）中进行了搜索，共产生了 3476 条独特的引用。经过初步筛选，有 170 篇全文记录可能符合纳入标准，并根据纳入和排除标准进行评估。此后，使用改良的 Downs 和 Black 量表评估研究的方法学质量，提取数据，并使用叙述性方法进行综合。
这项综述共纳入了 21 项初级研究（N=3075 名参与者）。八项研究报告疼痛强度显著改善，七项研究报告身体功能改善，有利于背景因素干预。值得注意的背景因素包括：解决适应不良的疾病信念；口头建议影响症状改变的期望；视觉或物理线索暗示有缓解疼痛的治疗特性；以及积极的沟通，如同理心，以增强治疗联盟。
这项综述确定了一些有影响力的背景因素，这些因素可能会增强慢性下背痛的保守治疗效果。干预措施的异质性表明，改变一个以上的背景因素可能对患者的临床结局更有影响，但这些发现需要谨慎解释。
