摘要
目的估计初级保健诊所内新发腰背痛患者的1年预后，并确定其预后因素。设计1年随访队列研究。地点澳大利亚悉尼的初级保健诊所。参试者初级保健诊所接诊的973例非特异性腰背痛连续患者（平均年龄43.3岁，男性54.8％）。该起始队列患者腰背痛时间不足两周，征集自170名全科医生、理疗师或按摩师诊所。主要评估指标参试者完成基线调查问卷后，分别于初次就诊后6周、3个月和21个月时复查评估。评估内容包括：工作恢复情况、功能恢复情况和疼痛消失情况。潜在预后因素与恢复所需时间的关联性用Cox回归建模分析。结果12个月随访率〉97％。基线时工作能力下降的患者半数在14天内恢复了以前的工作状态（95％可信区间11-17天），83％在3个月内恢复。残疾（中位恢复时间31天，25-37天）和疼痛（中位58天，52-63天）则需要较长的时间才能恢复。只有72％的受试者于基线访问后12个月获得完全康复。高龄、赔偿诉讼、疼痛较重、就诊前腰背痛时间较长、就诊前因疼痛活动减少天数较多、抑郁情绪以及预期危险持续与所需恢复时问较长相关。结论在这个急性腰背痛初级保健患者队列，患者的预后并不像临床指南声称的那样乐观。多数患者的恢复缓慢。近三分之一的患者在腰背痛发作后1年尚未恢复。
Objective To estimate the one year prognosis and identify prognostic factors in cases of recent onset low back pain managed in primary care. Design Cohort study with one year follow-up. Setting Primary care clinics in Sydney, Australia. Participants An inception cohort of 973 consecutive primary care patients （mean age 43.3, 54.8% men） with non-specific low back pain of less than two weeks＇ duration recruited from the clinics of 170 general practitioners, physiotherapists, and chiropractors. Main outcome measures Participants completed a baseline questionnaire and were contacted six weeks, three months, and 12 months after the initial consultation. Recovery was assessed in terms of return to work, return to function, and resolution of pain. The association between potential prognostic factors and time to recovery was modelled with Cox regression. Results The follow-up rate over the 12 months was more than 97%. Half of those who reduced their work status at baseline had returned to previous work status within 14 days （95% confidence interval 11 to 17 days） and 83% had returned to previous work status by three months. Disability （median recovery time 31 days, 25 to 37 days） and pain （median 58 days, 52 to 63 days） took much longer to resolve. Only 72% of participants had completely recovered 12 months after the baseline consultation. Older age, compensation cases, higher pain intensity, longer duration of low back pain before consultation, more days of reduced activity because of lower back pain before consultation, feelings of depression, and a perceived risk of persistence were each associated with a longer time to recovery. Conclusions In this cohort of patients with acute low back pain in primary care, prognosis was not as favourable as claimed in clinical practice guidelines. Recovery was slow for most patients. Nearly a third of patients did not recover from the presenting episode within a year.
出处
《英国医学杂志中文版》
2008年第6期339-342,共4页
The BMJ Chinese Edition
基金
关于作者（Contributors） ： CGM, KMR, RDH, RGC, and JB were the chief investigators on the NHMRC project grant that funded the study. All authors contributed to the design of the study. NH, AD, JHMc, CGM, KMR, JB, and JY trained the recruiting clinicians. NH, AD, and JHMc conducted the follow-up assessments and entered and double checked the data. All authors contributed to the analysis and interpretation of the data and reviewed and approved the final version of the manuscript. CGM is guarantor. 资助（Funding）： National Health and Medical Research Council of Australia
