丹麦整脊实践中腰痛患者的多病共存：一项队列研究。
Multimorbidity in patients with low back pain in Danish chiropractic practice: a cohort study.
机构信息
Research Unit for General Practice and Section of General Practice, Department of Public Health, Copenhagen University, Copenhagen, Denmark.
Chiropractic Knowledge Hub, Odense, Denmark.
出版信息
Chiropr Man Therap. 2023 Feb 10;31(1):8. doi: 10.1186/s12998-023-00475-3.
BACKGROUND
People with multimorbidity, defined as the co-existence of two or more chronic conditions in an individual, often suffer from pain and functional limitations caused by musculoskeletal disorders and the chronic conditions. In chiropractic practice, two thirds of patients are treated for low back pain (LBP). It is unknown to what extent LBP is accompanied with chronic conditions in chiropractic practice. The objective was to determine the prevalence of multimorbidity among patients with LBP in chiropractric practice and to investigate if multimorbidity affects pain intensity, self-rated health, physical and mental health. Finally, to explore if individuals with multimorbidity have a different recovery for the LBP.
METHODS
Patients presenting with a new episode of LBP were recruited from 10 chiropractic clinics in 2016-2018. Patient-reported data concerning socio-demographics, self-rated health, pain intensity, history of LBP, mental health and chronic conditions were collected at baseline. The prevalence of multimorbidity was determined. To evaluate differences in recovery from the LBP, we estimated changes in the Roland Morris Disability Questionnaire (RMDQ) score and use of pain medication at baseline, 2 weeks, 3 months and 12 months. The analyses were adjusted using regression models.
RESULTS
2083 patients were included at baseline and 71%, 68% and 64% responded to follow-up questionnaires at 2 weeks, 3 and 12 months. 1024 (49%) participants reported to have at least one chronic condition and 421 (20%) had multimorbidity (≥ 2 chronic conditions). The presence of multimorbidity was associated with increased odds of poor self-rated health (OR 2.13), physical fitness (OR 1.79), poor muscular strength (OR 1.52), poor endurance (OR 1.51), and poor balance (OR 1.33). Patients with high LBP intensity combined with multimorbidity showed a poorer recovery than patients without chronic diseases (mean difference in RMDQ score 3.53 at 12 months follow-up). More patients with multimorbidity used pain medication for LBP at 12 months follow-up compared to those without chronic disease (OR 2.36).
CONCLUSIONS
Chiropractors should be aware that patients with LBP may suffer from multimorbidity with poor general health. Patients with multimorbidity also have poorer recovery from LBP than people without chronic disease and clinical follow-up may be indicated.
背景
患有多种疾病的人（定义为个体同时存在两种或多种慢性疾病）通常会因肌肉骨骼疾病和慢性疾病而遭受疼痛和功能受限。在整脊实践中，三分之二的患者因腰痛（LBP）接受治疗。目前尚不清楚在整脊实践中，LBP 伴发慢性疾病的程度如何。目的是确定整脊治疗中 LBP 患者的多种疾病患病率，并探讨多种疾病是否会影响疼痛强度、自我报告的健康状况、身体和心理健康。最后，探讨患有多种疾病的个体对 LBP 的恢复是否有不同的反应。
方法
2016-2018 年，从 10 家脊骨神经科诊所招募了出现新的腰痛发作的患者。在基线时收集了有关社会人口统计学、自我报告的健康状况、疼痛强度、腰痛病史、心理健康和慢性疾病的患者报告数据。确定了多种疾病的患病率。为了评估 LBP 恢复情况的差异，我们估计了 Roland Morris 残疾问卷（RMDQ）评分和基线、2 周、3 个月和 12 个月时使用止痛药的变化。使用回归模型进行分析调整。
结果
2083 名患者在基线时入组，71%、68%和 64%的患者在 2 周、3 个月和 12 个月时回复了随访问卷。1024 名（49%）参与者报告至少有一种慢性疾病，421 名（20%）患有多种疾病（≥2 种慢性疾病）。患有多种疾病与较差的自我报告健康状况（OR 2.13）、身体适应性（OR 1.79）、较差的肌肉力量（OR 1.52）、较差的耐力（OR 1.51）和较差的平衡（OR 1.33）的可能性增加相关。高 LBP 强度合并多种疾病的患者的恢复情况比没有慢性疾病的患者差（12 个月随访时 RMDQ 评分的平均差异为 3.53）。与没有慢性疾病的患者相比，更多患有多种疾病的患者在 12 个月随访时使用止痛药治疗 LBP（OR 2.36）。
结论
脊骨神经科医生应该意识到，患有 LBP 的患者可能患有多种疾病，且整体健康状况较差。患有多种疾病的患者从 LBP 中恢复的情况也比没有慢性疾病的患者差，可能需要进行临床随访。
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