prognostic factors for short-term improvement in acute and persistent musculoskeletal pain consulters in primary care预后因素短期改善急性和持续性肌肉骨骼疼痛在初级保健咨询师.pdfVIP

Bolton and Hurst Chiropractic Manual Therapies 2011, 19:27 /content/19/1/27 CHIROPRACTIC MANUAL THERAPIES RESEARCH Open Access Prognostic factors for short-term improvement in acute and persistent musculoskeletal pain consulters in primary care Jennifer E Bolton 1* and Hugh C Hurst2 Abstract Background: Given the costs associated with the management of musculoskeletal pain in primary care, predicting the course of these conditions remains a research priority. Much of the research into prognostic indicators however considers musculoskeletal conditions in terms of single pain sites whereas in reality, many patients present with pain in more than one site. The aim of this study was to identify prognostic factors for early improvement in primary care consulters with acute and persistent musculoskeletal conditions across a range of pain sites. Methods: Consecutive patients with a new episode of musculoskeletal pain completed self-report questionnaires at baseline, and then again at the 4/5th treatment visit, and if they were still consulting, at the 10th visit. The outcome was defined as patient self-report improvement sufficient to make a meaningful difference. Independent predictors of outcome were identified using multivariate regression analyses. Results: Acute (7 weeks) patients, on average, had more severe conditions in terms of pain, disability, anxiety and work fear-avoidance behaviour than patients with persistent (≥7 weeks) pain, but were more likely to be better by the 4/5th visit. Several variables at baseline were associated with improvement at the 4/5th visit, but the predictive models were weak and unable to discriminate between patients who were improved and those who were not. In contrast, it was possible to elicit a p