van den Hoogen H J, Koes B W, van Eijk J T, Bouter L M, Devillé W
Institute for Research in Extramural Medicine, Faculty of Medicine, Vrije Universiteit, Amsterdam, The Netherlands.
Ann Rheum Dis. 1998 Jan;57(1):13-9. doi: 10.1136/ard.57.1.13.
Knowledge on the clinical course of low back pain presented in general practice is poor. Preceding studies offer a fragmentary view only, whereas further knowledge is important to enable the assessment of the prognosis. The object of this study is to investigate the course of low back pain presented in general practice to enable the assessment of the prognosis.
A one year follow up study on the clinical course of low back pain in consecutive cases receiving usual care in general practice. During a period of two years 15 general practitioners from Amsterdam and surrounding areas included consecutive patients with both chronic and recent onset low back pain. After the initial visit, each patient was monitored for a period of 12 months. The follow up consisted of monthly postal questionnaires on the course of the low back pain and the related disability.
A total of 443 of 605 patients identified were included in the follow up, which was fully completed by 269 patients. In general, patients with less serious low back pain participated less often or did not complete the follow up. At 12 weeks 35% and at the end of the follow up 10% of the population, respectively, still suffered from low back pain. Both the pain and the disability seemed to diminish quickly after the initial visit, and both seemed to stabilise at a lower level if the low back pain did not disappear completely. About three of four patients, whose pain disappeared before the end of the follow up, endured one or more relapses within a year. The median time to a relapse was about seven weeks, and its median duration about six weeks. Both the pain and the disability turned out to be less severe during relapses. The median time to recovery for patients whose low back pain developed more than seven weeks before the initial visit, was four weeks longer than for patients with more recently developed low back pain at the initial visit.
The clinical course of low back pain presented in general practice, for the most patients, clearly is less favourable than expected. It takes more than just a few weeks to recover, and relapses occur within a year in most cases. Fortunately, both the pain and the disability quickly diminish, even if the low back pain does not resolve within a few weeks.
对于全科医疗中出现的腰痛临床病程，人们了解甚少。以往的研究仅提供了片面的观点，而更多的了解对于评估预后很重要。本研究的目的是调查全科医疗中出现的腰痛病程，以便评估预后。
对全科医疗中接受常规治疗的连续病例的腰痛临床病程进行为期一年的随访研究。在两年时间里，来自阿姆斯特丹及周边地区的15名全科医生纳入了连续的慢性和近期发作腰痛患者。初诊后，对每位患者进行为期12个月的监测。随访包括每月邮寄关于腰痛病程及相关残疾情况的问卷。
在确定的605名患者中，共有443名纳入随访，其中269名患者完全完成了随访。一般来说，腰痛不太严重的患者参与随访的频率较低或未完成随访。在12周时，分别有35%的人群仍患有腰痛，随访结束时这一比例为10%。疼痛和残疾在初诊后似乎都迅速减轻，如果腰痛没有完全消失，两者似乎都稳定在较低水平。在随访结束前疼痛消失的患者中，约四分之三在一年内经历了一次或多次复发。复发的中位时间约为7周，中位持续时间约为6周。复发期间疼痛和残疾的严重程度均较低。初诊前腰痛发作超过7周的患者的中位恢复时间比初诊时近期发作腰痛的患者长4周。
对于大多数患者而言，全科医疗中出现的腰痛临床病程显然比预期的更不理想。恢复需要不止几周的时间，而且大多数情况下一年内会复发。幸运的是，即使腰痛在几周内没有缓解，疼痛和残疾也会迅速减轻。
