Borkan J M, Koes B, Reis S, Cherkin D C
Department of Family Medicine, Faculty of the Health Sciences, Ben-Gurion, University of the Negev, Beer Sheva, Israel.
Spine (Phila Pa 1976). 1998 Sep 15;23(18):1992-6. doi: 10.1097/00007632-199809150-00016.
Consensus process.
Reexamining and redirecting the research agenda for low back pain in primary care.
Most research, publications, and funding have traditionally been directed toward specialty and biologically oriented investigations of "spinal disorders" from biomedical and biomechanical perspectives. Beginning in the mid-1980s, primary care researchers began to investigate this field in earnest, focusing on lower back pain as a pain syndrome within an individual, family, and community context. Unfortunately, more progress has been made on what should not be done in diagnosing and treating lower back pain than on what should be done.
This was a modified group process designed to reach consensus among an international group of primary care lower back pain researchers.
Nearly all of the research priorities from the initial 1995 forum are still thought to be important, although only modest progress has been made on most of them. The priorities perceived to be the most feasible to investigate and the ones in which the greatest strides have been achieved are in methodologic rather than substantive areas. Identifying subgroups of people with lower back pain is still given top ranking in 1997, but the priorities have changed dramatically. Greater emphasis is given to finding predictors and risk factors for lower back pain chronicity, improving self-care strategies, and stimulating self-reliance. New items now make up 50% of the top 10 priorities. In general, the additions reflect a greater emphasis on expanding methodologic avenues of inquiry.
Methodologic advances, the enlistment of new techniques and disciplines, and redirected research efforts may facilitate progress in the diagnosis and treatment of lower back pain.
共识达成过程。
重新审视并调整基层医疗中腰痛的研究议程。
传统上，大多数研究、出版物及资金都投向了从生物医学和生物力学角度对“脊柱疾病”进行的专科性及生物学导向的研究。从20世纪80年代中期开始，基层医疗研究人员开始认真研究这一领域，将腰痛作为个体、家庭及社区背景下的一种疼痛综合征来关注。遗憾的是，在腰痛的诊断和治疗方面，关于不应该做什么取得的进展比应该做什么更多。
这是一个经过改进的小组过程，旨在让国际基层医疗腰痛研究人员小组达成共识。
尽管在大多数方面仅取得了适度进展，但1995年初始论坛提出的几乎所有研究重点仍被认为很重要。被认为最可行去研究且取得最大进展的重点在方法学而非实质性领域。确定腰痛患者亚组在1997年仍位居首位，但重点已发生显著变化。更加强调寻找腰痛慢性化的预测因素和风险因素、改进自我护理策略以及激发自我依赖。新条目现在占前十大重点的50%。总体而言，新增内容反映出更加强调拓展研究的方法学途径。
方法学的进步、新技术和学科的引入以及重新调整的研究工作可能会促进腰痛诊断和治疗方面的进展。
