Karas R, McIntosh G, Hall H, Wilson L, Melles T
Clinical Services-Eastern Ontario, Canadian Back Institute, Ottawa, Canada.
Phys Ther. 1997 Apr;77(4):354-60; discussion 361-9. doi: 10.1093/ptj/77.4.354.
The purpose of this study was to assess the relationship between the nonorganic signs (Waddell scores) of patients with low back pain, their response to repetitive end-range lumbar spine test movements (centralization of symptoms), and the rate of return to work at a 6-month follow-up.
Patients were assessed at five locations of the Canadian Back Institute. A consecutive sample of 126 patients with low back pain, with or without referred leg pain, was selected and reviewed.
Physical therapists assessed patients' responses to repetitive test movements (centralization), as described by McKenzie, and tested the patients for nonorganic signs (Waddell scores). Therapists completed a data sheet that classified patients as either those who centralize their symptoms or those who do not centralize their symptoms and recorded their Waddell scores. Although the patients were classified at assessment, they remained in treatment. All patients followed a structured Canadian Back Institute protocol of active exercise, regardless of centralization status or Waddell score.
The inability to centralize symptoms indicated a decreased likelihood of returning to work, regardless of the Waddell score. A high Waddell score predicted a poor chance of returning to work, regardless of the patients' ability to centralize symptoms.
A high Waddell score appears to be the best predictor of outcome, as indicated by return to work.
本研究旨在评估腰痛患者的非器质性体征（瓦德尔评分）、其对腰椎重复终末范围测试动作的反应（症状集中化）以及6个月随访时的重返工作率之间的关系。
在加拿大背部研究所的五个地点对患者进行评估。选取并审查了126例有或无下肢牵涉痛的腰痛患者的连续样本。
物理治疗师按照麦肯齐的描述评估患者对重复测试动作的反应（症状集中化），并对患者进行非器质性体征测试（瓦德尔评分）。治疗师完成一份数据表，将患者分为症状集中化患者和症状未集中化患者，并记录他们的瓦德尔评分。尽管患者在评估时进行了分类，但他们仍继续接受治疗。所有患者均遵循加拿大背部研究所制定的结构化主动运动方案，无论症状集中化状态或瓦德尔评分如何。
无论瓦德尔评分如何，症状无法集中化均表明重返工作的可能性降低。无论患者症状能否集中化，高瓦德尔评分预示着重返工作的机会渺茫。
如重返工作情况所示，高瓦德尔评分似乎是结果的最佳预测指标。
