School of Kinesiology and Rehabilitation Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, Florida, United States of America.
Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida, United States of America.
PLoS One. 2023 Feb 14;18(2):e0281517. doi: 10.1371/journal.pone.0281517. eCollection 2023.
Phenotypes have been proposed as a method of characterizing subgroups based on biopsychosocial factors to identify responders to analgesic treatments. This study aimed to, first, confirm phenotypes in patients with low back pain receiving physical therapy based on an a priori set of factors used to derive subgroups in other pain populations. Second, an exploratory analysis examined if phenotypes differentiated pain and disability outcomes at four weeks of physical therapy. Fifty-five participants completed psychological questionnaires and pressure pain threshold (PPT). Somatization, anxiety, and depression domains of the Symptom-Checklist-90-Revised, and PPT, were entered into a hierarchical agglomerative cluster analysis with Ward's method to identify phenotypes. Repeated measures ANOVAs assessed pain ratings and disability by phenotype at four weeks. Three clusters emerged: 1) high emotional distress and pain sensitivity (n = 10), 2) low emotional distress (n = 34), 3) low pain sensitivity (n = 11). As an exploratory study, clusters did not differentiate pain ratings or disability after four weeks of physical therapy (p's>0.05). However, trends were observed as magnitude of change for pain varied by phenotype. This supports the characterization of homogenous subgroups based on a protocol conducted in the clinical setting with varying effect sizes noted by phenotype for short-term changes in pain. As an exploratory study, future studies should aim to repeat this trial in a larger sample of patients.
表型已被提议作为一种基于生物心理社会因素对亚组进行特征描述的方法，以确定对镇痛治疗有反应的人群。本研究旨在，首先，基于先前用于衍生其他疼痛人群亚组的因素，确认接受物理治疗的腰痛患者的表型。其次，探索性分析检查表型是否在物理治疗四周时区分疼痛和残疾结局。55 名参与者完成了心理问卷和压力疼痛阈值（PPT）的测量。症状清单-90 修订版的躯体化、焦虑和抑郁领域，以及 PPT，被输入到一个层次聚类分析中，采用 Ward 方法识别表型。重复测量方差分析评估了四个星期时按表型划分的疼痛评分和残疾程度。三个聚类出现：1）高情绪困扰和疼痛敏感性（n = 10），2）低情绪困扰（n = 34），3）低疼痛敏感性（n = 11）。作为一项探索性研究，聚类在物理治疗四周后没有区分疼痛评分或残疾（p>0.05）。然而，观察到的趋势是，由于疼痛的变化幅度因表型而异。这支持了根据在临床环境中进行的方案对同质亚组进行特征描述的观点，并且表型注意到疼痛的短期变化的效果大小不同。作为一项探索性研究，未来的研究应旨在在更大的患者样本中重复这项试验。
