对颈背部挥鞭伤相关障碍患者的康复预期是否能改善风险评估？一项前瞻性队列研究的二次分析。

Do expectations of recovery improve risk assessment for people with whiplash-associated disorders? Secondary analysis of a prospective cohort study.

机构信息

Faculty of Medicine and Health, The University of Sydney, D18 Susan Wakil Health Building, Western Ave, Camperdown, NSW, 2050, Australia.

John Walsh Centre for Rehabilitation Research, Faculty and Medicine and Health, The University of Sydney, St Leonards, NSW, Australia.

出版信息

BMC Musculoskelet Disord. 2022 Apr 27;23(1):395. doi: 10.1186/s12891-022-05242-8.

DOI:10.1186/s12891-022-05242-8

PMID:35477438

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9044895/

Abstract

BACKGROUND

WhipPredict, which includes prognostic factors of pain-related disability, age and hyperarousal symptoms, was developed and validated for prediction of outcome in people with whiplash associated disorders (WAD). Patient expectations of recovery was not an included factor, though is known to mediate outcomes. The aim of this study was to determine whether the addition of expectations of recovery could improve the accuracy of WhipPredict.

METHODS

Two hundred twenty-eight participants with acute WAD completed questionnaires (WhipPredict and expectations of recovery) at baseline. Health outcomes (neck disability index (NDI) and Global Perceived Recovery (GPR)) were assessed at 6- and 12-months post injury. Cut-off points for expectations of recovery predictive of both full recovery (NDI ≤10 % , GPR ≥ 4) and poor outcome (NDI ≥30 % , GPR ≤ - 3) were determined, and multivariate logistic regression analyses were used to compare models with and without this variable.

RESULTS

Expectations of recovery improved or maintained the accuracy of predictions of poor outcome (6-months: sensitivity 78 to 83%, specificity maintained at 79.5%; 12-months: sensitivity maintained at 80%, specificity 69 to 73%). The sensitivity of predictions of full recovery improved (6-months: 68 to 76%; 12-months: 57 to 81%), though specificity did not change appreciably at 6 months (80 to 81%) and declined at 12 (83 to 76%). ROC curves indicated a larger and more consistent improvement in model performance when expectations of recovery were added to the pathway predictive of full recovery.

CONCLUSIONS

The addition of expectations of recovery may improve the accuracy of WhipPredict, though further validation is required.

摘要

背景

WhipPredict 包含与疼痛相关残疾、年龄和过度唤醒症状相关的预后因素，专为预测与挥鞭样损伤相关的疾病（WAD）患者的结局而开发和验证。尽管患者对康复的期望已知会影响结局，但它不是纳入因素。本研究旨在确定添加对康复的期望是否可以提高 WhipPredict 的准确性。

方法

228 名急性 WAD 患者在基线时完成了问卷（WhipPredict 和对康复的期望）。在受伤后 6 个月和 12 个月评估健康结局（颈部残疾指数（NDI）和总体感知恢复（GPR））。确定了对康复的期望的预测值的截定点，可预测完全恢复（NDI≤10%，GPR≥4）和不良结局（NDI≥30%，GPR≤-3），并使用多元逻辑回归分析比较了包含和不包含此变量的模型。

结果

对康复的期望提高或维持了不良结局预测的准确性（6 个月：敏感性从 78%提高至 83%，特异性维持在 79.5%；12 个月：敏感性维持在 80%，特异性为 69%至 73%）。完全恢复预测的敏感性提高（6 个月：68%至 76%；12 个月：57%至 81%），但特异性在 6 个月时变化不大（80%至 81%），而在 12 个月时下降（83%至 76%）。ROC 曲线表明，当将对完全恢复有预测作用的途径中添加对康复的期望时，模型性能的改善更大且更一致。