PHYSICAL THERAPY & REHAB
Expectations, perceptions, and physiotherapy predict prolonged sick leave in subacute low back pain
This report has been verified
by one or more authors of the
original publication.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(1):26 BMC Musculoskelet Disord. 2009 Nov 13;10:139.246 patients suffering from low back pain, who have been sick listed for 8-12 weeks, were randomized to receive a brief intervention program alone or a brief intervention in combination with physical exercise. The objective of this trial was to identify predictors for not returning to work (i.e. secondary analysis). At 3, 12 and 24 months, there were no differences in return to work between participants in each group. As such, both arms were pooled for analysis of predictors of not returning to work. Significant predictors included pain intensity while resting and during activity, negative expectations for return to work, perceived reduced ability to walk long distances, and having prior treatment from a physiotherapist before the trial.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
はい = 1
不確実＝0.5
無関係 = 0
いいえ = 0
報告基準評価では、著者が出版物内で試験の方法論的特徴や試験特性を報告する際の透明性を評価します。評価は以下の5つのカテゴリーに分類されます。
1/4
Randomization
1/4
Outcome Measurements
2/4
Inclusion / Exclusion
4/4
Therapy Description
3/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
Fragility Indexは、重要な所見の解釈を助けるツールで、結果の強さの尺度を提供します。Fragility Indexは、その所見が有意でなくなるために、二項対立の結果に追加する必要がある連続した事象の数を表します。数値が小さいほど弱い所見を表し、数値が大きいほど強い所見を表します。
なぜ今この研究が必要なのですか？
Low back pain is one of the most common causes for loss of work and is a large economic burden. Brief intervention (BI) programs, consisting of consultations and a short follow up, have been demonstrated to significantly reduce sick leave; however, a large proportion of patients still do not return to work. This study identified predictors of non-return to work in patients who participated in a BI program alone or in combination with exercise.
主な研究課題は何ですか？
What predictors for not returning to work are present in patients suffering from sub-acute low back pain undergoing a brief intervention program or a brief intervention program in combination with physical exercise?
重要な知見は？
- No significant differences in return to work were observed between group 1 and group 2 at 3, 12, or 24 months
- Both groups were combined for regression analysis of predictors for non-return to work
- At 3 months, pain intensity while resting (OR= 5.6 95%CI= 1.7-19.0), perception of constant back strain while working (OR= 4.1; 95% CI= 1.5-11.5), negative expectations of return to work (OR=4.2; 95% CI= 1.7-10.2), and physical therapy prior to study participation (OR=3.3; 95% CI=1.3-8.3) predicted non-return to work
- At 12 months, perceived reduced ability to walk far due to complaints (OR= 2.6; 95% CI= 1.3-5.4), pain during activities (OR=2.4;95% CI= 1.1-5.1), and physical therapy prior to participation in the trial (OR 2.1; 95% CI=1.1-4.3) predicted non-return to work at 12 months
- At 24 months, age below 41 years was the only predictor of non-return to work (OR= 2.9; 95% CI= 1.4-6.0)
最も覚えておくべきことは？
The addition of an exercise program to a brief intervention provided no significant improvements in patient return to work. Pooled regression analysis identified a number of predictors for non-return to work at different follow-up points. These included the pain intensity at rest, perception of constant back strain negative expectations of return to work, pain during activities, perceived reduced ability to walk, and age less than 41, and previous treatment by a physiotherapist.
それが私の患者ケアにどのように影響するか？
Return to work for patients suffering from sub-acute low back pain is dependent on a number of individual and cognitive factors, including negative expectations and perceptions of pain and disability. Previous physiotherapy treatment was also identified as a novel predictor for non return to work, an unexpected finding that deserves further investigation.
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