IF 2.2 3区 医学 Q1 REHABILITATION
Nicole Baker, Alexa Edwards, Sean Harris, J Craig Garrison, Zachery Schindler, Wescott Lu, Geoffrey Zubay, Jacob D Jelmini
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引用次数: 0

摘要

背景:颈部疼痛是美国致残的主要原因之一。然而,颈椎手术的性质是多因素的,而且往往基于临床意见,因此临床适应症仍有待明确界定:目的:预测哪些临床变量对颈部疼痛患者的手术或保守治疗趋势影响最大:设计:对前瞻性收集的数据进行回顾性分析:方法:2700 名患者参与了研究。研究人员对病历进行了回顾性分析,以确定符合条件的参与者。数据收集过程中采集的变量包括:患者人口统计学信息、体格检查(如神经系统检查)、体能测量、患者报告的结果测量(数值疼痛评分量表和颈部残疾指数)以及症状的慢性化程度。组别分配由转诊医生的医疗诊断决定。采用前向分步多元逻辑回归分析建立了最终的预测模型,并得出了 p 结果:模型显示年龄较大(beta = 0.022;Exp(beta) = 1.022;p = 0.037)、症状慢性化时间较长(beta = 0.000;Exp(beta) = 1.000;p = 0.012)、颈部残疾程度较高(beta = 0.027;Exp(beta) = 1.028;p 结论:在普通颈痛患者中,年龄越大、症状慢性化时间越长、残疾程度越严重以及神经检查阳性是手术选择的临床预测因素,其中神经检查阳性会使手术可能性增加四倍。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Clinical predictors of surgical selection for individuals with neck pain.

Background: Neck pain is one of the leading causes of disability in the United States. However, the nature of cervical spine surgery is multi-factorial and often based upon clinical opinions, leaving clinical indications still to be clearly defined.

Objective: To predict which clinical variables most influenced trends toward surgical or conservative management for individuals with neck pain.

Design: Retrospective analysis on prospectively collected data.

Methods: Two-hundred seventy individuals participated in the study. A retrospective chart review was performed to identify qualifying participants. Variables captured during data collection included the following: patient demographic information, physical examination (e.g., neurologic examination), physical performance measures, patient-reported outcome measures (Numeric Pain Rating Scale and Neck Disability Index), and chronicity of symptoms. Group allocation was determined by referring physician's medical diagnosis. A forward step-wise multiple logistic regression analysis was used to develop a final predictor model with p < 0.05 considered significant.

Results: The model showed older age (beta = 0.022; Exp(beta) = 1.022; p = 0.037), longer chronicity of symptoms (beta = 0.000; Exp(beta) = 1.000; p = 0.012), and greater neck disability (beta = 0.027; Exp(beta) = 1.028; p < 0.001) were significant predictors of the operative group. Most notably, patients with a positive neurologic examination were almost four times more likely to be referred to surgery (beta = 1.368; Exp(beta) = 3.927; p < 0.001).

Conclusion: In general neck pain patients, older age, longer chronicity of symptoms, greater disability, and a positive neuro exam are clinical predictors of surgical selection, with positive neuro exam increasing the likelihood of surgery four-fold.

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来源期刊
Musculoskeletal Science and Practice
Musculoskeletal Science and Practice Health Professions-Physical Therapy, Sports Therapy and Rehabilitation
CiteScore
4.10
自引率
8.70%
发文量
152
审稿时长
48 days
期刊介绍: Musculoskeletal Science & Practice, international journal of musculoskeletal physiotherapy, is a peer-reviewed international journal (previously Manual Therapy), publishing high quality original research, review and Masterclass articles that contribute to improving the clinical understanding of appropriate care processes for musculoskeletal disorders. The journal publishes articles that influence or add to the body of evidence on diagnostic and therapeutic processes, patient centered care, guidelines for musculoskeletal therapeutics and theoretical models that support developments in assessment, diagnosis, clinical reasoning and interventions.
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