在慢性疼痛康复计划之后，患者报告的基线结局指标能否预测自我报告功能的变化？
Do baseline patient reported outcome measures predict changes in self-reported function, following a chronic pain rehabilitation programme?
作者信息
Heelas L, Soni A, Barker Karen
机构信息
Physio Research Unit ouh and NDORMs, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK.
出版信息
Br J Pain. 2023 Dec;17(6):532-545. doi: 10.1177/20494637231190190. Epub 2023 Jul 31.
BACKGROUND
Interdisciplinary pain management programmes, based on cognitive-behavioural principles, aim to improve physical and psychological functioning and enhance self-management in people living with chronic pain. Currently there is insufficient evidence about whether psychological, biological or social factors are predictive of positive outcomes following pain rehabilitation. This study aims to evaluate predictors of change in Brief Pain Inventory - pain interference score (BPI) in a clinical data set to determine whether age, sex and baseline outcome measures are predictive of improvement in pain interference following pain rehabilitation.
METHODS
A retrospective, pragmatic observational analysis of routinely collected clinical data in two pain rehabilitation programmes, Balanced Life Programme (BLP) and Get Back Active (GBA) was conducted. Standard regression and hierarchical regression analyses were used to identify predictors of change to assess temporal changes in BPI. Responder analysis was also conducted.
RESULTS
Standard regression analyses of 208 (BLP) and 310 (GBA) patients showed that higher baseline BPI and better physical performance measures predicted better improvement in BPI across both programmes. Hierarchical regression showed that age and sex accounted for 2.7% (BLP) and 0.002% (GBA) of the variance in change in BPI. After controlling for age and sex, the other measures explained an additional 23% (BLP) and 19% (GBA) of the variance, = < .001 where BPI and physical performance measures were consistently statistically significant predictors, < .05. Responder analysis also showed that pain interference and physical performance were significantly associated with improvement ( = < .0005).
CONCLUSIONS
The combination of high self-reported pain interference and better physical performance measures may be a useful indicator of who would benefit from interdisciplinary rehabilitation. Further validation of the results is required.
背景
基于认知行为原则的跨学科疼痛管理项目旨在改善慢性疼痛患者的身体和心理功能，并增强自我管理能力。目前，关于心理、生物或社会因素是否能预测疼痛康复后的积极结果，证据尚不充分。本研究旨在评估一个临床数据集中简明疼痛量表 - 疼痛干扰评分（BPI）变化的预测因素，以确定年龄、性别和基线结果指标是否能预测疼痛康复后疼痛干扰的改善情况。
方法
对两个疼痛康复项目——平衡生活计划（BLP）和恢复活力（GBA）中常规收集的临床数据进行回顾性、实用性观察分析。使用标准回归和分层回归分析来确定变化的预测因素，以评估BPI的时间变化。还进行了反应者分析。
结果
对208名（BLP）和310名（GBA）患者的标准回归分析表明，较高的基线BPI和较好的身体表现指标预测了两个项目中BPI的更好改善。分层回归显示，年龄和性别分别占BPI变化方差的2.7%（BLP）和0.002%（GBA）。在控制年龄和性别后，其他指标又解释了另外23%（BLP）和19%（GBA）的方差，P <=.001，其中BPI和身体表现指标始终是具有统计学意义的显著预测因素，P <.05。反应者分析还表明，疼痛干扰和身体表现与改善显著相关（P <=.0005）。
结论
自我报告的高疼痛干扰与较好的身体表现指标相结合，可能是判断谁将从跨学科康复中受益的有用指标。需要对结果进行进一步验证。
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