背景:尽管患有肩部不适的患者经常接受物理治疗,预后的推定预测因素仍不清楚.在这方面,肩峰下疼痛综合征患者的科学数据有限,结果不一致。对基线变量预测结果的能力的改进知识可以帮助患者做出明智的治疗决定。防止他们接受无效的治疗,并将发展为慢性疼痛的风险降至最低。
目的:二次纵向分析的目的有三方面:第一,调查有和没有成功的长期治疗结果的患者之间的基线差异。第二,为了比较两组推定的预测变量对结果的预测能力,一个基于文献,一个基于原始试验的数据。第三,探讨短期随访数据对预测模型的贡献。
方法:计算应答者和非应答者之间的差异。分析了通过文献定义的变量和基于Akaike信息标准(AIC)的变量的预测能力,这些变量来自原始试验数据集的肩痛和残疾指数以及一年随访时患者的总体变化印象。为了测试结果的稳健性,使用不同的统计模型。为了研究后续数据对预测的贡献,短期数据纳入分析.
结果:分析了87例肩峰下疼痛综合征患者的样本。这些参与者中有77%(n=67)被归类为应答者。较高的预期和短期变化分数为正,和更高的恐惧回避信念,较高的基线残疾和疼痛水平是肩峰下疼痛综合征患者长期结局的阴性预测因子.
结论:尽管我们的结果与先前的研究一致,并支持使用临床因素进行预测,我们的研究结果表明心理因素,尤其是病人的期望和避免恐惧的信念,也有助于长期结局,因此应在临床和进一步研究中加以考虑.然而,从我们的研究结果中产生的假设和建议需要在进一步的研究中得到证实,因为它们具有探索性.
背景:原始试验于2010年3月17日在当前对照试验中注册,试验注册号为ISRCTN86900354。
BACKGROUND: Although patients with shoulder complaints are frequently referred to physiotherapy, putative predictive factors for outcomes are still unclear. In this regard, only a limited amount of scientific data for patients with subacromial pain syndrome exist, with inconsistent results. An improved knowledge about the ability of baseline variables to predict outcomes could help patients make informed treatment decisions, prevent them from receiving ineffective treatments, and minimize the risk of developing chronic pain.
OBJECTIVE: The aims of this secondary longitudinal analysis are threefold: First, to investigate baseline differences between patients with and without successful long-term outcomes following physiotherapy. Second, to compare the predictive ability of two sets of putative predictive variables on outcomes, one based on the literature and one based on the data of the original trial. Third, to explore the contribution of short-term follow-up data to predictive models.
METHODS: Differences between responders and nonresponders were calculated. The predictive ability of variables defined through literature and of variables based on the Akaike Information Criterion (AIC) from the original trial dataset on the Shoulder Pain and Disability Index and the Patients\' Global Impression of Change at the one-year follow-up were analyzed. To test the robustness of the results, different statistical models were used. To investigate the contribution of follow-up data to prediction, short-term data were included in the analyses.
RESULTS: A sample of 87 patients with subacromial pain syndrome was analyzed. 77% (n = 67) of these participants were classified as responders. Higher expectations and short-term change scores were positive, and higher fear avoidance beliefs, greater baseline disability and pain levels were negative predictors of long-term outcomes in patients with subacromial pain syndrome.
CONCLUSIONS: Although our results are in line with previous research and support the use of clinical factors for prediction, our findings suggest that psychological factors, especially patient expectations and fear avoidance beliefs, also contribute to long-term outcomes and should therefore be considered in the clinical context and further research. However, the hypotheses and recommendations generated from our results need to be confirmed in further studies due to their explorative nature.
BACKGROUND: The original trial was registered at Current Controlled Trials under the trial registration number ISRCTN86900354 on March 17, 2010.