Mannion A F, Dolan P, Adams M A
Department of Anatomy, University of Bristol, United Kingdom.
Spine (Phila Pa 1976). 1996 Nov 15;21(22):2603-11. doi: 10.1097/00007632-199611150-00010.
A prospective study of psychological risk factors for first-time low back pain with repeated use of psychological questionnaires.
To measure the reproducibility of scores from psychological questionnaires, and to compare this with changes that follow an individual's first attack of back pain. Secondly, to determine which scores predict first-time back pain.
"Abnormal" psychometric scores are associated with several aspects of back pain behavior. Little is known, however, about their reproducibility or long-term stability, and there has been no definitive answer to the question: which comes first, "abnormal" scores or low back pain?
403 volunteers with no history of "serious" low back pain (defined as pain requiring medical attention or absence from work) participated in a functional spinal assessment. At the time of initial assessment and at 6-month intervals thereafter, the volunteers completed the following questionnaires: the Health Locus of Control, which was subdivided into three sections labelled "Internal," "Powerful others," and "Chance"; the Modified Somatic Perception Questionnaire; and the Zung depression scale. Scores from the Modified Somatic Perception Questionnaire and from the Zung depression scale were added to form a measure of psychological distress. Additional questionnaires inquired about any back pain experienced in the previous 6 months. Only three volunteers had left the study at the 18-month follow-up. At that time 162 participants had reported "any" low back pain, of which 79 were "serious."
Intraclass correlation coefficients for scores repeated after 6 months ranged from 0.67-0.80, and reproducibility of scores was equally high between the 0-, 6-, 12- and 18-month assessments. None of the scores were affected by "any" low back pain, and only the Modified Somatic Perception Questionnaire scores changed after "serious" back pain was reported. In a multivariate analysis, the most significant predictor of first time "serious" or "any" back pain was a history of non-"serious" back pain (P < 0.001). Of the psychological factors, the sum of Modified Somatic Perception Questionnaire scores and Zung questionnaire scores was the best predictor of "serious" back pain (P = 0.037), and the Modified Somatic Perception Questionnaire score was the best predictor of "any" back pain (P = 0.002). The 25% of participants with the highest sum of scores from the Modified Somatic Perception Questionnaire and Zung questionnaire was 2.7 times more likely to develop "serious" back pain than the 25% with the lowest sum of these scores. Nevertheless, after accounting for the affects of a history of non-"serious" back pain, psychometric scores predicted less than an additional 3% of reported back pain.
The scores from the Modified Somatic Perception Questionnaire and Zung questionnaire were reproducible over 18 months and were affected little by first episodes of back pain; yet these scores were significant predictors of it. "Abnormal" scores from these questionnaires precede back pain in a small number of people.
一项前瞻性研究，通过重复使用心理问卷来探究首次出现下腰痛的心理风险因素。
测量心理问卷得分的可重复性，并将其与个体首次腰痛发作后的变化进行比较。其次，确定哪些得分可预测首次腰痛。
“异常”的心理测量得分与腰痛行为的多个方面相关。然而，对于它们的可重复性或长期稳定性知之甚少，并且对于“异常”得分和下腰痛哪个先出现这个问题尚无定论。
403名无“严重”下腰痛病史（定义为需要医疗关注或导致缺勤的疼痛）的志愿者参与了一项功能性脊柱评估。在初始评估时以及此后每隔6个月，志愿者们完成以下问卷：健康控制点问卷，分为“内控”“有影响力的他人”和“机遇”三个部分；改良躯体感知问卷；以及zung抑郁量表。将改良躯体感知问卷和zung抑郁量表的得分相加，形成心理困扰的一种度量。另外的问卷询问了过去6个月内经历的任何腰痛情况。在18个月的随访时，只有3名志愿者退出了研究。那时，162名参与者报告有“任何”下腰痛，其中79例为“严重”下腰痛。
6个月后重复得分的组内相关系数在0.67 - 0.80之间，并且在0个月、6个月、12个月和18个月的评估之间得分的可重复性同样很高。没有任何得分受到“任何”下腰痛的影响，只有在报告“严重”下腰痛后，改良躯体感知问卷的得分发生了变化。在多变量分析中，首次出现“严重”或“任何”下腰痛的最显著预测因素是有非“严重”下腰痛病史（P < 0.001）。在心理因素中，改良躯体感知问卷得分与zung问卷得分之和是“严重”下腰痛的最佳预测因素（P = 0.037），改良躯体感知问卷得分是“任何”下腰痛的最佳预测因素（P = 0.002）。改良躯体感知问卷和zung问卷得分总和最高的25%参与者发生“严重”下腰痛的可能性是得分总和最低的25%参与者的2.7倍。然而，在考虑了非“严重”下腰痛病史的影响后，心理测量得分对报告的下腰痛的额外预测率不到3%。
改良躯体感知问卷和zung问卷得分在18个月内具有可重复性，并且很少受到首次腰痛发作的影响；然而这些得分却是腰痛的显著预测因素。这些问卷中的 “异常” 得分在少数人身上先于腰痛出现。
