Skargren Elisabeth I, Öberg Birgitta E
Department of Neuroscience and Locomotion, Physiotherapy, Faculty of Health Sciences, Linköping University, 58185 Linköping, Sweden.
Pain. 1998 Aug;77(2):201-207. doi: 10.1016/S0304-3959(98)00101-8.
The inability to predict outcome in patients with low back/neck pain leads to inappropriate or unnecessary treatment. The aims of the study were to identify prognostic factors for disability at 1-year follow-up in patients with back pain visiting primary care, and to compare the effect of these in two treatment strategies--chiropractic and physiotherapy. Data were taken from a randomised trial on patients with back/neck pain visiting the general practitioner, in which patients were allocated to chiropractic and physiotherapy as primary management. Three hundred and twenty-three patients, aged 18-60 years, who had no contraindications to manipulation and who had not been treated within the previous month were included in the study. Multiple regression analysis was used to identify prognostic factors. Dependent variables were mean Oswestry score and mean change in Oswestry score at 12-month follow-up. The multiple regression analysis revealed five significant (P < 0.001-0.01) prognostic factors; duration of current episode, Oswestry score at entry, expectations of treatment, number of localisations, and well-being. Besides, the regression coefficients for the significant factors were compared between the two treatment strategies. No significant difference in effect or regression coefficients for the prognostic factors were seen between the two treatment strategies. Twelve per cent of the patients had poor prognostic factors (duration > or = 1 month, more than one localisation, low expectations of treatment and low well-being) at entry. These patients had a mean Oswestry score above 20% at 1-year follow-up. Clinical decision models for the management of patients with back pain visiting primary care that consider prognostic factors need to be implemented and prospectively evaluated.
无法预测腰/颈痛患者的预后会导致不适当或不必要的治疗。本研究的目的是确定在基层医疗就诊的背痛患者1年随访时残疾的预后因素，并比较两种治疗策略——整脊疗法和物理疗法——的效果。数据取自一项针对到全科医生处就诊的腰/颈痛患者的随机试验，其中患者被分配接受整脊疗法和物理疗法作为主要治疗。纳入研究的患者为323名，年龄在18至60岁之间，无手法治疗禁忌证且前一个月内未接受过治疗。采用多元回归分析确定预后因素。因变量为12个月随访时的平均奥斯威斯功能障碍指数（Oswestry）评分及该评分的平均变化。多元回归分析揭示了5个显著（P<0.001 - 0.01）的预后因素：当前发作持续时间、入组时的Oswestry评分、对治疗的期望、疼痛部位数量和健康状况。此外，还比较了两种治疗策略中显著因素的回归系数。两种治疗策略在效果或预后因素的回归系数方面未见显著差异。12%的患者在入组时具有不良预后因素（持续时间≥1个月、疼痛部位多于一处、对治疗期望低和健康状况差）。这些患者在1年随访时的平均Oswestry评分高于20%。需要实施并前瞻性评估考虑预后因素的基层医疗中背痛患者管理的临床决策模型。
