慢性下背痛：一项多学科生物心理社会康复计划后 4 至 15 年随访的前瞻性研究。
Chronic low back pain: a prospective study with 4 to 15 years follow-up after a multidisciplinary biopsychosocial rehabilitation program.
机构信息
Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany.
Klinik Für Anästhesiologie, Caritas-Krankenhaus St. Josef, Regensburg, Germany.
出版信息
BMC Musculoskelet Disord. 2022 Nov 11;23(1):977. doi: 10.1186/s12891-022-05963-w.
BACKGROUND
Multidisciplinary biopsychosocial rehabilitation (MBR) in patients with chronic low back pain (CLBP) is superior to less intensive treatments for at least one year, but the long-term course of the disease is largely unknown. The primary aim of this study was to describe the long-term course of an MBR in relation to pain, disability, and quality of life from the beginning of an MBR to between 4 to 15 years after participation. The secondary aim was to explore the long-term course of an MBR in relation to physiological outcomes of functioning.
METHODS
This was a observational study conducted at a university hospital. The cohort consisted of participants of a 3-week, CLBP-specific MBR program between August 2001 and January 2013. The North American Spine Society questionnaire (NASS) pain and disability scale was the primary patient -reported outcome measure (PROM). The NASS neurogenic symptoms scale and the Short-Form 36 (SF-36) health survey were secondary PROMs. Patients were assessed before entry to the MBR (T0), at entry (T1), at discharge (T2) and 4 to 15 years after discharge (T3). Effects were quantified by effect size (ES). Score differences were tested for significance using parametric or non-parametric tests and linear mixed models.
RESULTS
Of 299 consecutive patients from the MBR program, 229 could be contacted. Of these, 84 declined participation, five did not meet the inclusion criteria, and 26 had incomplete data. Thus, 114 patients were included. The mean follow-up time was 9.2 years. At T3, patients exhibited beneficial effects for NASS pain and disability with a moderate ES (ES = 0.63; p < 0.001). The NASS neurogenic symptoms scale was stable. The SF-36 scales showed an improvement in the bodily pain domain (ES = 1.02; p < 0.001), but no significant changes for physical functioning, physical role, general health, vitality, social functioning, emotional role, or mental health. The physical health component summary was improved (ES = 0.40, p = 0.002), and the mental health summary was unchanged. The linear mixed model analysis confirmed improvements in pain and disability between T1 and T3 (p = 0.010).
CONCLUSIONS
The results of this study suggest that there is a long-term benefit of MBR participation in patients with CLBP.
背景
慢性下腰痛（CLBP）患者的多学科生物心理社会康复（MBR）至少在一年以上优于不太密集的治疗，但疾病的长期病程在很大程度上尚不清楚。本研究的主要目的是描述 MBR 的长期病程，从 MBR 开始到参与后 4 至 15 年之间，与疼痛、残疾和生活质量有关。次要目的是探讨 MBR 的长期病程与功能的生理结果有关。
方法
这是一项在大学医院进行的观察性研究。该队列由 2001 年 8 月至 2013 年 1 月期间参加为期 3 周的 CLBP 特定 MBR 计划的参与者组成。北美脊柱协会问卷（NASS）疼痛和残疾量表是主要的患者报告结局测量（PROM）。NASS 神经症状量表和简明健康调查问卷（SF-36）是次要的 PROM。患者在进入 MBR 之前（T0）、进入时（T1）、出院时（T2）和出院后 4 至 15 年（T3）进行评估。通过效应大小（ES）量化效果。使用参数或非参数检验和线性混合模型测试分数差异的显著性。
结果
从 MBR 计划中连续 299 例患者中，有 229 例可联系。其中，84 例拒绝参加，5 例不符合纳入标准，26 例数据不完整。因此，114 例患者被纳入。平均随访时间为 9.2 年。在 T3 时，患者的 NASS 疼痛和残疾具有中度 ES（ES=0.63；p<0.001）的有益效果。NASS 神经症状量表稳定。SF-36 量表在身体疼痛领域有所改善（ES=1.02；p<0.001），但身体功能、身体角色、一般健康、活力、社会功能、情绪角色或心理健康没有显著变化。身体健康成分摘要有所改善（ES=0.40，p=0.002），心理健康摘要不变。线性混合模型分析证实了 T1 至 T3 之间疼痛和残疾的改善（p=0.010）。
结论
本研究结果表明，CLBP 患者参与 MBR 具有长期获益。
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