Department of Orthopaedic Surgery, University of California, San Francisco, CA, USA.
Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
J Back Musculoskelet Rehabil. 2024;37(4):909-920. doi: 10.3233/BMR-230067.
Tools, such as the STarTBack Screening Tool (SBT), have been developed to identify risks of progressing to chronic disability in low back pain (LBP) patients in the primary care population. However, less is known about predictors of change in function after treatment in the specialty care population.
We pursued a retrospective observational cohort study involving LBP patients seen in a multidisciplinary specialty clinic to assess which features can predict change in function at follow-up.
The SBT was administered at initial visit, and a variety of patient characteristics were available in the chart including the presence of chronic overlapping pain conditions (COPCs). Patient Reported Outcomes Measurement Information System-10 (PROMIS-10) global physical health (PH) and global mental health (MH) were measured at baseline and at pragmatic time points during follow-up. Linear regression was used to estimate adjusted associations between available features and changes in PROMIS scores.
241 patients were followed for a mean of 17.0 ± 7.5 months. Mean baseline pain was 6.7 (SD 2.1), PROMIS-10 global MH score was 44.8 (SD 9.3), and PH score was 39.4 (SD 8.6). 29.7% were low-risk on the SBT, 41.8% were medium-risk, and 28.5% were high-risk. Mean change in MH and PH scores from baseline to the follow-up questionnaire were 0.86 (SD 8.11) and 2.39 (SD 7.52), respectively. Compared to low-risk patients, high-risk patients had a mean 4.35 points greater improvement in their MH score (p= 0.004) and a mean 3.54 points greater improvement in PH score (p= 0.006). Fewer COPCs also predicted greater improvement in MH and PH.
SBT and the presence of COPC, which can be assessed at initial presentation to a specialty clinic, can predict change in PROMIS following treatment. Effort is needed to identify other factors that can help predict change in function after treatment in the specialty care setting.
为了识别初级保健人群中慢性腰痛（LBP）患者进展为慢性残疾的风险，已经开发了一些工具，例如 STarTBack 筛查工具（SBT）。然而，在专业护理人群中，关于治疗后功能变化的预测因素知之甚少。
我们进行了一项回顾性观察队列研究，涉及在多学科专业诊所就诊的 LBP 患者，以评估哪些特征可以预测随访时的功能变化。
在初次就诊时进行 SBT 评估，并且图表中提供了各种患者特征，包括慢性重叠疼痛状况（COPCs）的存在。在基线和随访期间的实用时间点测量患者报告的结果测量信息系统-10（PROMIS-10）的整体身体健康（PH）和整体心理健康（MH）。使用线性回归来估计可用特征与 PROMIS 评分变化之间的调整关联。
241 例患者平均随访 17.0 ± 7.5 个月。基线时的平均疼痛为 6.7（SD 2.1），PROMIS-10 整体 MH 得分为 44.8（SD 9.3），PH 得分为 39.4（SD 8.6）。29.7%的患者在 SBT 中属于低风险，41.8%的患者属于中风险，28.5%的患者属于高风险。从基线到随访问卷，MH 和 PH 评分的平均变化分别为 0.86（SD 8.11）和 2.39（SD 7.52）。与低风险患者相比，高风险患者的 MH 评分平均提高了 4.35 分（p=0.004），PH 评分平均提高了 3.54 分（p=0.006）。COPC 较少的患者 MH 和 PH 的改善程度也更大。
SBT 和 COPC 的存在（可在专业诊所就诊时评估）可以预测治疗后的 PROMIS 变化。需要努力确定其他有助于预测专业护理环境中治疗后功能变化的因素。
