Rainville J, Sobel J B, Hartigan C, Wright A
New England Spine Care Center, Chestnut Hill, Massachusetts, USA.
Spine (Phila Pa 1976). 1997 Sep 1;22(17):2016-24. doi: 10.1097/00007632-199709010-00016.
In this prospective, observational, cohort study of 192 individuals with chronic low back pain, the group of individuals was divided based on compensation involvement, and their presentation pain and disability, treatment recommendations, and compliance were compared. For 85 of these individuals who completed a spine rehabilitation program, their pain and disability at 3 and 12 months were compared.
To test the theory that individuals with compensation involvement presented with greater pain and disability and would report less change of pain and disability after rehabilitation efforts.
Previous studies have produced conflicting results concerning this issue.
Individuals were recruited as consecutive patients referred for consultation at a spine rehabilitation center. Pain, depression, and disability were assessed using self-report questionnaires at evaluation and at 3 and 12 months. Rehabilitation services consisted of aggressive, quota-based exercises aimed at correcting impairments in flexibility, strength, endurance, and lifting capacity, identified through quantification of back function. Multifactoral analysis of variance models were used to control for baseline differences between compensation and noncompensation patients during analysis of target variables.
The compensation group included 96 patients; these patients reported more pain, depression, and disability than the 96 patients without compensation involvement. These differences persisted when baseline differences were controlled for with multifactoral analysis of variance models. Treatment recommendations and compliance were not affected by compensation. For patients completing the spine rehabilitation program, length of treatment, flexibility, strength, lifting ability, and lower extremity work performance before and after treatment and patient satisfaction ratings were similar for the compensation and noncompensation groups. At 3 and 12 months, improvements in depression and disability were noted for both groups, but were statistically and clinically less substantial for the compensation group. At the 12 month follow-up visit, pain scores improved for the noncompensation group, but not for the compensation group.
In chronic low back pain, compensation involvement may have an adverse effect on self-reported pain, depression, and disability before and after rehabilitation interventions.
在这项针对192例慢性腰痛患者的前瞻性观察性队列研究中，根据是否涉及赔偿将患者分组，并比较他们的疼痛表现、残疾情况、治疗建议及依从性。对其中85例完成脊柱康复计划的患者，比较他们在3个月和12个月时的疼痛及残疾情况。
验证以下理论，即涉及赔偿的患者疼痛和残疾程度更高，且康复治疗后疼痛和残疾的改善程度较小。
以往关于此问题的研究结果相互矛盾。
连续招募脊柱康复中心转诊咨询的患者。在评估时以及3个月和12个月时，使用自我报告问卷评估疼痛、抑郁和残疾情况。康复服务包括积极的、基于配额的锻炼，旨在纠正通过量化背部功能确定的灵活性、力量、耐力和举重能力方面的损伤。在分析目标变量时，使用多因素方差分析模型控制赔偿患者和非赔偿患者之间的基线差异。
赔偿组包括96例患者；这些患者报告的疼痛、抑郁和残疾程度高于96例未涉及赔偿的患者。在使用多因素方差分析模型控制基线差异后，这些差异仍然存在。治疗建议和依从性不受赔偿影响。对于完成脊柱康复计划的患者，赔偿组和非赔偿组在治疗时长、灵活性、力量、举重能力、治疗前后下肢工作表现以及患者满意度评分方面相似。在3个月和12个月时，两组的抑郁和残疾情况均有改善，但赔偿组在统计学和临床上的改善程度较小。在12个月随访时，非赔偿组的疼痛评分有所改善，而赔偿组则没有。
在慢性腰痛中，赔偿因素可能对康复干预前后自我报告的疼痛、抑郁和残疾产生不利影响。
