Burton A K, Tillotson K M, Main C J, Hollis S
Spinal Research Unit, University of Huddersfield, United Kingdom.
Spine (Phila Pa 1976). 1995 Mar 15;20(6):722-8. doi: 10.1097/00007632-199503150-00014.
A prospective survey of patients seeking primary care for low back pain. Clinical and psychosocial data, available at presentation, were explored for predictors of outcome at 1 year.
To determine the relative value of clinical and psychosocial variables for early identification of patients with a poor prognosis.
Current treatment strategies for low back pain have failed to stem the rising levels of disability. Psychosocial factors have been shown to be important determinants of response to therapy in chronic patients, but the contribution from similar data in acute or subchronic patients has not been comprehensively investigated.
Two hundred fifty-two patients with low back pain, presenting to primary care, underwent a structured clinical interview and completed a battery of psychosocial instruments. Follow-up was done by mail at 1 year; outcome was measured using a back pain disability questionnaire. Predictive relationships were sought between the data at presentation and disability at follow-up.
Most patients showed improved disability and pain scores, although more than half had persisting symptoms. Eighteen percent showed significant psychological distress at presentation. Multiple regression analysis showed the level of persisting disability to depend principally on measures in the psychosocial domain; for acute cases outcome is also dependent on the absence or presence of a previous history of low back trouble. Discriminant models successfully allocated typically 76% of cases to recovered/not-recovered groups, largely on the basis of psychosocial factors evident at presentation.
Early identification of psychosocial problems is important in understanding, and hopefully preventing, the progression to chronicity in low back trouble.
对因腰痛寻求初级保健的患者进行前瞻性调查。探讨就诊时可得的临床和心理社会数据，以寻找1年时预后的预测因素。
确定临床和心理社会变量对于早期识别预后不良患者的相对价值。
当前的腰痛治疗策略未能阻止残疾水平的上升。心理社会因素已被证明是慢性患者对治疗反应的重要决定因素，但急性或亚慢性患者类似数据的贡献尚未得到全面研究。
252例因腰痛就诊于初级保健机构的患者接受了结构化临床访谈，并完成了一系列心理社会测评工具。1年后通过邮件进行随访；使用背痛残疾问卷测量结局。寻找就诊时的数据与随访时的残疾之间的预测关系。
大多数患者的残疾和疼痛评分有所改善，尽管超过一半的患者仍有持续症状。18%的患者在就诊时表现出明显的心理困扰。多元回归分析显示，持续残疾水平主要取决于心理社会领域的测量指标；对于急性病例，结局还取决于是否有既往腰痛病史。判别模型通常能成功地将76%的病例分为康复/未康复组，主要基于就诊时明显的心理社会因素。
早期识别心理社会问题对于理解并有望预防腰痛发展为慢性疾病很重要。
