Zhao Zhenni, Li Jiawei, Zhang Rui, Feng Yun, He Yanyan, Sun Zhiling
School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China.
Int J Rehabil Res. 2023 Mar 1;46(1):3-13. doi: 10.1097/MRR.0000000000000567. Epub 2023 Jan 19.
The study aimed to explore the prognostic value of fear-avoidance beliefs (FABs) on postoperative pain and back-specific function for patients with lumbar degenerative disk disease (LDDD). FABs have been proven to be a predictorof pain and disability for patients with low back pain. However, whether FABs are a predictor of surgical outcomes for LDDD is a matter of debate. PubMed, Cochrane library, EMBASE, and EBSCO were searched for eligible cohort studies or secondary analyses of randomized controlled trials. Fixed-effect meta-analysis models were used to estimate odds ratios (OR) because of absent or low heterogeneity ( I ² < 50%). Subgroup analyses were conducted according to different follow-up durations. Forest plots were used for graphical representation. Six studies with a total of 829 participants were included in the meta-analyses. Risk of bias was high for three studies and moderate for the other three studies. For patients with LDDD, meta-analyses showed that FABs were a predictor of postoperative pain intensity [OR 2.88; 95% confidence interval (CI), 2.76-3.00] and back-specific function (OR 3.13; 95% CI, 3.02-3.24). Patients with FABs are less likely to report improvement in pain (OR 2.56; 95% CI, 1.73-3.86) and function (OR 2.81; 95% CI, 2.57-3.07). In conclusion, FABs were a predictor of postoperative pain and back-specific function for patients with LDDD. This prognostic value is sustained for a long period after surgery (>12 months). Clinicians are advised to initiate targeted interventions for patients with FABs at different stages after surgery. Due to the limited number and low quality of included studies, the results of this meta-analysis should be interpreted with caution.
该研究旨在探讨恐惧回避信念（FABs）对腰椎退行性椎间盘疾病（LDDD）患者术后疼痛和腰部特定功能的预后价值。FABs已被证明是腰痛患者疼痛和残疾的预测指标。然而，FABs是否是LDDD手术结果的预测指标仍存在争议。检索了PubMed、Cochrane图书馆、EMBASE和EBSCO，以查找符合条件的队列研究或随机对照试验的二次分析。由于异质性缺失或较低（I²<50%），使用固定效应荟萃分析模型来估计优势比（OR）。根据不同的随访时间进行亚组分析。森林图用于图形表示。荟萃分析纳入了6项研究，共829名参与者。3项研究的偏倚风险较高，另外3项研究的偏倚风险为中等。对于LDDD患者，荟萃分析表明，FABs是术后疼痛强度[OR 2.88；95%置信区间（CI），2.76 - 3.00]和腰部特定功能（OR 3.13；95%CI，3.02 - 3.24）的预测指标。有FABs的患者报告疼痛改善（OR 2.56；95%CI，1.73 - 3.86）和功能改善（OR 2.8l；95%CI，2.57 - 3.07）的可能性较小。总之，FABs是LDDD患者术后疼痛和腰部特定功能的预测指标。这种预后价值在术后很长一段时间（>12个月）内持续存在。建议临床医生在术后不同阶段对有FABs的患者启动针对性干预措施。由于纳入研究的数量有限且质量较低，本荟萃分析的结果应谨慎解释。
