Atlas S J, Singer D E, Keller R B, Patrick D L, Deyo R A
Medical Practices Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA.
Am J Ind Med. 1996 Jun;29(6):584-9. doi: 10.1002/(SICI)1097-0274(199606)29:6<584::AID-AJIM2>3.0.CO;2-K.
Outcomes research represents an expansion of traditional clinical research to include issues of cost and quality of care in usual clinical practice, emphasizing outcomes that matter most to patients. In low back disorders, outcomes research has focused on the lack of reliable information to support much of clinical practice and has demonstrated marked variability in the treatment of these common problems. The Maine Lumbar Spine Study represents an example of an outcomes research study to investigate the treatment of patients with sciatica in usual clinical practice. Because low back symptoms are a frequent cause of occupational disability, Workers' Compensation patients were explicitly oversampled. Baseline features were significantly different in those patients who were receiving Workers' Compensation versus those who were not. Efforts to compare outcomes by disability status need to control for these differences. Whereas most Workers' Compensation patients were still receiving disability compensation regardless of treatment at 6 months, patients who were treated surgically were more likely to have come off disability and returned to work than nonsurgically treated patients. Long-term follow-up is necessary to determine whether these differences persist.
结果研究是传统临床研究的扩展，将常规临床实践中的成本和护理质量问题纳入其中，强调对患者最重要的结果。在腰椎疾病方面，结果研究聚焦于缺乏可靠信息来支持大部分临床实践，并表明这些常见问题的治疗存在显著差异。缅因州腰椎研究是一项结果研究的实例，旨在调查常规临床实践中坐骨神经痛患者的治疗情况。由于腰背部症状是职业残疾的常见原因，工人赔偿患者被明确过度抽样。接受工人赔偿的患者与未接受赔偿的患者在基线特征上存在显著差异。按残疾状况比较结果时，需要控制这些差异。尽管大多数工人赔偿患者在6个月时无论接受何种治疗仍在领取残疾赔偿金，但接受手术治疗的患者比未接受手术治疗的患者更有可能摆脱残疾并重返工作岗位。需要进行长期随访以确定这些差异是否持续存在。
