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急性腰痛症(治療含む)

著者: 松平 浩 東京大学医学部附属病院22世紀医療センター

監修: 酒井昭典 産業医科大学 整形外科学教室

著者校正/監修レビュー済:2020/07/09
参考ガイドライン:
  1. 日本整形外科学会/日本腰痛学会:腰痛診療ガイドライン2019(改訂第2版)
  1. 米国内科学会(ACP):Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians.
  1. 英国国立医療技術評価機構(NICE):Managing low back pain and sciatica. NICE Pathway last updated: 29 October 2018
  1. 英国国立医療技術評価機構(NICE):Non-specific low back pain and sciatica: management. 2016
患者向け説明資料

概要・推奨   

  1. 癌の脊椎転移、化膿性椎間板炎、椎体骨折、急性大動脈症候群といった重篤な特異的腰痛を見逃さない意識を常に念頭に置く。
  1. 重篤な病理のない急性腰痛は、無治療であっても予後良好であり、不安を持たず通常通りの生活を維持することを指導することが強く推奨される。
  1. 腰痛は再発率が高く、その予防にはエクササイズ習慣を主軸とするセルフマネジメントが強く推奨されるが、その一手段として「[https://www.youtube.com/watch?v=DD_GxxFH1y8&t=32s これだけ体操] の習慣化が有用である。
薬剤監修について:
オーダー内の薬剤用量は日本医科大学付属病院 薬剤部 部長 伊勢雄也 以下、林太祐、渡邉裕次、井ノ口岳洋、梅田将光による疑義照会のプロセスを実施、疑義照会の対象については著者の方による再確認を実施しております。
※薬剤中分類、用法、同効薬、診療報酬は、エルゼビアが独自に作成した薬剤情報であり、
著者により作成された情報ではありません。
尚、用法は添付文書より、同効薬は、薬剤師監修のもとで作成しております。
※薬剤情報の(適外/適内/⽤量内/⽤量外/㊜)等の表記は、エルゼビアジャパン編集部によって記載日時にレセプトチェックソフトなどで確認し作成しております。ただし、これらの記載は、実際の保険適用の査定において保険適用及び保険適用外と判断されることを保証するものではありません。また、検査薬、輸液、血液製剤、全身麻酔薬、抗癌剤等の薬剤は保険適用の記載の一部を割愛させていただいています。
(詳細はこちらを参照)
著者のCOI(Conflicts of Interest)開示:
松平 浩 : 講演料(ファイザー(株)),原稿料((株)宝島社),研究費・助成金など((一財)第一生命財団,帝人フロンティア(株),国際疼痛学会,日本疼痛学会,ファイザー(株)),企業などが提供する寄付講座(日本臓器製薬(株),あゆみ製薬(株),SOMPOホールディングス(株),中外製薬(株),小野薬品工業(株),MS&ADインターリスク総研(株),(一財)日本予防医学協会,(株)MTG,塩野義製薬(株))[2021年]
監修:酒井昭典 : 講演料(旭化成ファーマ(株),第一三共(株),中外製薬(株)),奨学(奨励)寄付など(旭化成ファーマ(株),第一三共(株),中外製薬(株))[2021年]

改訂のポイント:
  1. 疾患情報に関し、2019年に改訂された本邦の腰痛診療ガイドライン2019の情報を参照し改訂した。

病態・疫学・診察

疾患情報(疫学・病態)  
  1. 急性腰痛症とは、現在の世界標準の分類では、急性非特異的腰痛のことを指す。いわゆるぎっくり腰(産業医学的用語では災害性腰痛)もこれに含まれる。
  1. 非特異的腰痛とは、特異的腰痛が除外された腰痛という意味である。
  1. 特異的腰痛とは、腫瘍、感染、骨折、神経症状を伴う 腰椎椎間板ヘルニア や 脊柱管狭窄症 に加え、動脈瘤や尿路結石といった他科疾患を含む原因疾患が明確化できるものを指す。(それぞれのコンテンツ参照)
  1. 腰部への身体的負荷が大きい作業は発症の危険因子である。加えて、職場における精神的ストレスといった心理社会的要因も発症の危険因子である。
  1. 非特異的腰痛は、不安を持たず普段の活動を制限することなく過ごせば予後良好であり、エクササイズ習慣をはじめとするセルフマネジメント(自己管理)が重要である。
  1. 予後規定因子として重要視されているのは、恐怖回避思考をはじめとする心理社会的要因である。 >詳細情報 
 
  1. 主に2019年に改訂された日本の腰痛診療ガイドライン[1]における関連要約(主にエビデンスレベルおよび推奨度の強い主な項目の抜粋
  1. 腰痛の定義と病態
  1. 腰痛の定義で確立されたものはない。しかし、主に疼痛部位、発症からの有症期間、原因などにより定義される。
  1. 一般的には、第12肋骨と殿溝下端の間の領域に位置する疼痛と定義される。
  1. 少なくとも1日以上継続する痛み、片側、または両側の下肢に放散する痛みを伴う場合も、伴わない場合もある。
  1. 有症期間別では、急性腰痛は発症からの期間が4週間未満と定義される。
  1. 原因としては、脊椎由来、神経由来、内臓由来、血管由来、心因性(ただし心因性というtermは患者に用いることは勧められない)、その他に定義され、重篤な基礎疾患(悪性腫瘍、感染、骨折など)、下肢の神経症状を併発する疾患(腰椎椎間板ヘルニア、腰部脊柱管狭窄症など)、および各種脊椎構成体(椎間板、椎間関節、仙腸関節、付着部を含む筋・筋膜など)に発痛源があることが疑われるものの重篤な病理はなく、不安を与えなければ予後良好な腰痛に大別される。前者2つを特異的腰痛、最後を非特異的と総称することがグローバルには一般的である。
  1. 一方、腰痛は腰椎から脳にいたるまで、言い換えれば末梢から中枢(中枢性感作、下行性疼痛制御系の機能不全など)まで様々な病態が関与しうるため、非特異的腰痛は未確立の疾患群を詰め込んだ症候群であるともいえ、いまだ検討の余地は残っている。
  1. 疫学(自然経過、生活習慣との関連を含む)
  1. 急性腰痛患者の自然経過は、自然軽快を示すことが多く、おおむね良好である。なお、ここでの急性腰痛は前述した脊椎構成体に起源があると想定される非特異的腰痛の範疇のものを指す。
  1. 一方、腰痛は一度発症すると繰り返しやすく、腰痛既往は腰痛再発のbest predictorであるといえる。
  1. 心理社会的要因(症状回復に対するマイナス思考など)は、腰痛を遷延させる。
  1. 身体的・精神的に健康な生活習慣は、腰痛の予後によい。
  1. 標準体重(BMI:18.5~25.0)より肥満、あるいは低体重の両者とも腰痛発症リスクと弱い関連があり、健康的な体重管理は腰痛予防に役立つ可能性がある。
  1. 喫煙と飲酒は、腰痛発症リスクや有病率に関連が指摘されている。
  1. 日常的な運動実施群に比べ、普段運動していない群に腰痛発症リスクは増大する。
  1. 腰痛の予防には健康的な生活習慣と穏やかで心理的ストレスが強まらない生活スタイルが推奨される。
  1. 腰部への身体的負荷が大きい作業(重労働)は、腰痛発症の危険因子であるとともに、仕事や職場における心理社会的因子(人間関係のストレス、仕事の不満足度など)は、腰痛発症や予後に関連する。
 
  1. 診断:
  1. 注意深い問診と身体検査により、red flags(危険信号)を示し、腫瘍、炎症、骨折などの重篤な脊椎疾患が疑われる腰痛、神経症状を伴う腰痛、それ以外の心配な病理のない腰痛(非特異的腰痛)をトリアージとする。
  1. 非特異的腰痛と考えられる患者に対する受診後早期の段階でのX線撮影検査は、疼痛起源の同定に役立つ場合もあるが予後に好影響を与えるとはいえず、必ずしも必要とされない。一方、高齢者や低学歴者は、単純X線検査を必要と考える傾向にあることに留意する必要がある。
  1. 危険信号の合併が疑われる腰痛、神経症状を伴う腰痛、または保存的治療にもかかわらず腰痛が軽快しない場合には、画像検査を推奨する。
  1. 神経症状がある持続性の腰痛に対しては、MRIでの評価を推奨する。
  1. 危険信号を持つ腰痛患者および神経根症状を合併する腰痛患者の画像検査としてMRIは推奨される。
  1. 治療:
  1. 急性腰痛に対して、痛みに応じた活動性維持は、ベッド上安静よりも疼痛を軽減し、機能を回復させるのに有用である。
  1. 職業性腰痛に対しても、痛みに応じた活動性維持は、より早い痛みの改善につながり、休業期間の短縮とその後の再発予防にも効果的である。
  1. 強く推奨される薬物は、非ステロイド性抗炎症薬(NSAIDs)である。一方、特に消化管潰瘍や腎不全への配慮から、筋弛緩薬(特に筋緊張が強い患者)、アセトアミノフェン(特に高齢患者)、弱オピオイド、さらにはワクシニアウイルス接種家兎炎症皮膚抽出液が、2019年に改訂された本邦のガイドラインでは推奨薬である。
打撲を主とした外傷を伴う腰痛には、治打撲一方が役立つ場合がある。
  1. 温熱療法は急性および亜急性腰痛に対して短期的に有効である。
  1. 米国内科学会(ACP)ガイドライン(2017)[2]では、温熱療法のみならず鍼灸治療、脊椎マニュピレーションといった非薬物療法を先に試すことを推奨している。
  1. 英国NICEガイドライン(2018)[3]では、適切な情報提供と患者のニーズ・能力に応じたセルフマネジメントのサポートを重要視している。
問診・診察のポイント  
  1. 特異的腰痛を除外する。注意深い問診と身体検査により、red flags(危険信号)があり、腫瘍、感染、骨折などの重篤な疾患が疑われる腰痛、神経症状を伴う腰痛、そして除外的な非特異的腰痛(心配する病理のない青信号:green lightの腰痛)をトリアージとする。

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文献 

著者: Amir Qaseem, Timothy J Wilt, Robert M McLean, Mary Ann Forciea, Clinical Guidelines Committee of the American College of Physicians
雑誌名: Ann Intern Med. 2017 Apr 4;166(7):514-530. doi: 10.7326/M16-2367. Epub 2017 Feb 14.
Abstract/Text Description: The American College of Physicians (ACP) developed this guideline to present the evidence and provide clinical recommendations on noninvasive treatment of low back pain.
Methods: Using the ACP grading system, the committee based these recommendations on a systematic review of randomized, controlled trials and systematic reviews published through April 2015 on noninvasive pharmacologic and nonpharmacologic treatments for low back pain. Updated searches were performed through November 2016. Clinical outcomes evaluated included reduction or elimination of low back pain, improvement in back-specific and overall function, improvement in health-related quality of life, reduction in work disability and return to work, global improvement, number of back pain episodes or time between episodes, patient satisfaction, and adverse effects.
Target Audience and Patient Population: The target audience for this guideline includes all clinicians, and the target patient population includes adults with acute, subacute, or chronic low back pain.
Recommendation 1: Given that most patients with acute or subacute low back pain improve over time regardless of treatment, clinicians and patients should select nonpharmacologic treatment with superficial heat (moderate-quality evidence), massage, acupuncture, or spinal manipulation (low-quality evidence). If pharmacologic treatment is desired, clinicians and patients should select nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants (moderate-quality evidence). (Grade: strong recommendation).
Recommendation 2: For patients with chronic low back pain, clinicians and patients should initially select nonpharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction (moderate-quality evidence), tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation (low-quality evidence). (Grade: strong recommendation).
Recommendation 3: In patients with chronic low back pain who have had an inadequate response to nonpharmacologic therapy, clinicians and patients should consider pharmacologic treatment with nonsteroidal anti-inflammatory drugs as first-line therapy, or tramadol or duloxetine as second-line therapy. Clinicians should only consider opioids as an option in patients who have failed the aforementioned treatments and only if the potential benefits outweigh the risks for individual patients and after a discussion of known risks and realistic benefits with patients. (Grade: weak recommendation, moderate-quality evidence).

PMID 28192789  Ann Intern Med. 2017 Apr 4;166(7):514-530. doi: 10.7326・・・
著者: Nicholas Henschke, Christopher G Maher, Kathryn M Refshauge, Robert D Herbert, Robert G Cumming, Jane Bleasel, John York, Anurina Das, James H McAuley
雑誌名: Arthritis Rheum. 2009 Oct;60(10):3072-80. doi: 10.1002/art.24853.
Abstract/Text OBJECTIVE: To determine the prevalence of serious pathology in patients presenting to primary care settings with acute low back pain, and to evaluate the diagnostic accuracy of recommended "red flag" screening questions.
METHODS: An inception cohort of 1,172 consecutive patients receiving primary care for acute low back pain was recruited from primary care clinics in Sydney, Australia. At the initial consultation, clinicians recorded responses to 25 red flag questions and then provided an initial diagnosis. The reference standard was a 12-month followup supplemented with a specialist review of a random subsample of participants.
RESULTS: There were 11 cases (0.9%) of serious pathology, including 8 cases of fracture. Despite the low prevalence of serious pathology, most patients (80.4%) had at least 1 red flag (median 2, interquartile range 1-3). Only 3 of the red flags for fracture recommended for use in clinical guidelines were informative: prolonged use of corticosteroids, age >70 years, and significant trauma. Clinicians identified 5 of the 11 cases of serious pathology at the initial consultation and made 6 false-positive diagnoses. The status of a diagnostic prediction rule containing 4 features (female sex, age >70 years, significant trauma, and prolonged use of corticosteroids) was moderately associated with the presence of fracture (the area under the curve for the rule score was 0.834 [95% confidence interval 0.654-1.014]; P = 0.001).
CONCLUSION: In patients presenting to a primary care provider with back pain, previously undiagnosed serious pathology is rare. The most common serious pathology observed was vertebral fracture. Approximately half of the cases of serious pathology were identified at the initial consultation. Some red flags have very high false-positive rates, indicating that, when used in isolation, they have little diagnostic value in the primary care setting.

PMID 19790051  Arthritis Rheum. 2009 Oct;60(10):3072-80. doi: 10.1002/・・・
著者: Ajay Premkumar, William Godfrey, Michael B Gottschalk, Scott D Boden
雑誌名: J Bone Joint Surg Am. 2018 Mar 7;100(5):368-374. doi: 10.2106/JBJS.17.00134.
Abstract/Text BACKGROUND: Low back pain has a high prevalence and morbidity, and is a source of substantial health-care spending. Numerous published guidelines support the use of so-called red flag questions to screen for serious pathology in patients with low back pain. This paper examines the effectiveness of red flag questions as a screening tool for patients presenting with low back pain to a multidisciplinary academic spine center.
METHODS: We conducted a retrospective review of the cases of 9,940 patients with a chief complaint of low back pain. The patients completed a questionnaire that included several red flag questions during their first physician visit. Diagnostic data for the same clinical episode were collected from medical records and were corroborated with imaging reports. Patients who were diagnosed as having a vertebral fracture, malignancy, infection, or cauda equina syndrome were classified as having a red flag diagnosis.
RESULTS: Specific individual red flags and combinations of red flags were associated with an increased probability of underlying serious spinal pathology, e.g., recent trauma and an age of >50 years were associated with vertebral fracture. The presence or absence of other red flags, such as night pain, was unrelated to any particular diagnosis. For instance, for patients with no recent history of infection and no fever, chills, or sweating, the presence of night pain was a false-positive finding for infection >96% of the time. In general, the absence of red flag responses did not meaningfully decrease the likelihood of a red flag diagnosis; 64% of patients with spinal malignancy had no associated red flags.
CONCLUSIONS: While a positive response to a red flag question may indicate the presence of serious disease, a negative response to 1 or 2 red flag questions does not meaningfully decrease the likelihood of a red flag diagnosis. Clinicians should use caution when utilizing red flag questions as screening tools.

PMID 29509613  J Bone Joint Surg Am. 2018 Mar 7;100(5):368-374. doi: 1・・・
著者: T P van Staa, H G M Leufkens, C Cooper
雑誌名: Osteoporos Int. 2002 Oct;13(10):777-87. doi: 10.1007/s001980200108.
Abstract/Text Studies of oral corticosteroid dose and loss of bone mineral density have reported inconsistent results. In this meta-analysis, we used information from 66 papers on bone density and 23 papers on fractures to examine the effects of oral corticosteroids on bone mineral density and risk of fracture. Strong correlations were found between cumulative dose and loss of bone mineral density and between daily dose and risk of fracture. The risk of fracture was found to increase rapidly after the start of oral corticosteroid therapy (within 3 to 6 months) and decrease after stopping therapy. The risk remained independent of underlying disease, age and gender. We conclude that oral corticosteroid treatment using more than 5 mg (of prednisolone or equivalent) daily leads to a reduction in bone mineral density and a rapid increase in the risk of fracture during the treatment period. Early use of preventive measures against corticosteroid-induced osteoporosis is recommended.

PMID 12378366  Osteoporos Int. 2002 Oct;13(10):777-87. doi: 10.1007/s0・・・
著者: Tetsuya Hasegawa, Junji Katsuhira, Ko Matsudaira, Kazuyuki Iwakiri, Hitoshi Maruyama
雑誌名: Gait Posture. 2014 Sep;40(4):670-5. doi: 10.1016/j.gaitpost.2014.07.020. Epub 2014 Aug 1.
Abstract/Text BACKGROUND: Although sneezing is known to induce low back pain, there is no objective data of the load generated when sneezing. Moreover, the approaches often recommended for reducing low back pain, such as leaning with both hands against a wall, are not supported by objective evidence.
METHODS: Participants were 12 healthy young men (mean age 23.25 ± 1.54 years) with no history of spinal column pain or low back pain. Measurements were taken using a three-dimensional motion capture system and surface electromyograms in three experimental conditions: normal for sneezing, characterized by forward trunk inclination; stand, in which the body was deliberately maintained in an upright posture when sneezing; and table, in which the participants leaned with both hands on a table when sneezing. We analyzed and compared the intervertebral disk compressive force, low back moment, ground reaction force, trunk inclination angle, and co-contraction of the rectus abdominis and erector spinae muscles in the three conditions.
FINDINGS: The intervertebral disk compressive force and ground reaction force were significantly lower in the stand and table conditions than in the normal condition. The co-contraction index value was significantly higher in the stand condition than in the normal and table conditions.
INTERPRETATION: When sneezing, body posture in the stand or table condition can reduce load on the low back compared with body posture in the normal sneezing condition. Thus, placing both hands on a table or otherwise maintaining an upright body posture appears to be beneficial for reducing low back load when sneezing.

Copyright © 2014 Elsevier B.V. All rights reserved.
PMID 25149901  Gait Posture. 2014 Sep;40(4):670-5. doi: 10.1016/j.gait・・・
著者: Ko Matsudaira, Miho Hiroe, Masatomo Kikkawa, Takayuki Sawada, Mari Suzuki, Tatsuya Isomura, Hiroyuki Oka, Kou Hiroe, Ken Hiroe
雑誌名: J Man Manip Ther. 2015 Sep;23(4):205-9. doi: 10.1179/2042618614Y.0000000100.
Abstract/Text BACKGROUND: We suggested a standing back extension exercise 'One Stretch' based on the McKenzie method, to examine the ability to improve or prevent low back pain (LBP) in Japanese care workers.
METHODS: We conducted a single-center, non-randomized, controlled study in Japan. Care workers in an intervention group received an exercise manual and a 30-minute seminar on LBP and were encouraged with a group approach, while care workers in a control group were given only the manual. All care workers answered questionnaires at the baseline and end of a 1-year study period. The subjective improvement of LBP and compliance with the exercise were evaluated.
RESULTS: In all, 64 workers in the intervention group and 72 in the control group participated in this study. More care workers in the intervention group exercised regularly and improved or prevented LBP than in the control group (P = 0·003 and P<0·0001, respectively). In the intervention group, none had a first medical consultation or were absent from disability for LBP by the end of the study period.
CONCLUSION: The exercise 'One Stretch' would be effective to improve or prevent LBP in care workers. Our group approach would lead to better compliance with the exercise.

PMID 26917938  J Man Manip Ther. 2015 Sep;23(4):205-9. doi: 10.1179/20・・・
著者: Juichi Tonosu, Ko Matsudaira, Hiroyuki Oka, Hiroshi Okazaki, Takuya Oshio, Izumi Hanaoka, Yutaka Muraoka, Masahiro Midorikawa, Kikuo Wakabayashi, Sakae Tanaka
雑誌名: J Orthop Sci. 2016 Jul;21(4):414-418. doi: 10.1016/j.jos.2016.03.002. Epub 2016 Apr 2.
Abstract/Text BACKGROUND: We examined the effectiveness of an intervention using a standing back extension exercise called "One Stretch", based on the McKenzie method, in improving or preventing low back pain and disability in Japanese care workers.
METHODS: We conducted a non-randomized controlled trial in Japan. Care workers in the intervention group received an exercise manual and a 30-minute seminar on low back pain and were encouraged to exercise in groups, while care workers in a control group were given only the manual. All care workers answered questionnaires at baseline and after one year on the subjective improvement in low back pain, whether they had had a medical consultation for low back pain, and the exercise compliance. Low back pain with disability was assessed by the Oswestry Disability Index.
RESULTS: Participants included 89 workers in the intervention group and 78 in the control group. Background characteristics did not differ significantly between the two groups. Compared to the control group, a greater number of care workers in the intervention group showed improvements in low back pain or prevented it, did not have a medical consultation for low back pain, and exercised regularly. Furthermore, significantly fewer care workers in the intervention group suffered from low back pain with disability by the end of the study period than in the control group.
CONCLUSION: The population approach about the exercise "One Stretch" led to better compliance with the exercise, and was effective for improving or preventing low back pain and in decreasing the likelihood of having a medical consultation for low back pain.

Copyright © 2016 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.
PMID 27053155  J Orthop Sci. 2016 Jul;21(4):414-418. doi: 10.1016/j.jo・・・
著者: Hiroyuki Oka, Takuo Nomura, Fuminari Asada, Kenichiro Takano, Yasuhiko Nitta, Yasutomo Uchima, Tomonori Sato, Masafumi Kawase, Sayoko Sawada, Kazushi Sakamoto, Makoto Yasue, Satoshi Arima, Junji Katsuhira, Kayo Kawamata, Tomoko Fujii, Sakae Tanaka, Hiroaki Konishi, Hiroshi Okazaki, Kota Miyoshi, Junko Watanabe, Ko Matsudaira
雑誌名: Mod Rheumatol. 2019 Sep;29(5):861-866. doi: 10.1080/14397595.2018.1514998. Epub 2019 Jan 3.
Abstract/Text Objectives: To evaluate the 'One Stretch' exercise's effect on improvements in low back pain (LBP), psychological factors, and fear avoidance in a large number of nurses. Methods: Between July 2015 and June 2016, we performed a prospective, randomized, parallel-group, multi-center study with central evaluations. Eligible patients were randomly assigned (1:1:1 ratio) to either the control group (Group A) or an intervention group (Group B: 30-min seminar about the 'One Stretch' exercise, Group C: B + physical and psychological approaches to LBP treatment). The primary outcome was subjective improvement from baseline to 6 months (improved/unchanged/worsened) and overall exercise habits (good/poor). Results: There were 4767 participants: 1799, 1430, and 1548 in Groups A, B, and C, respectively. We collected data on 3439 participants (949, 706, and 751 in Groups A, B, and C, respectively) at the 6-month follow-up. The improvement rates in Groups A, B, and C were 13.3%, 23.5%, and 22.6%, respectively. The worsened pain rates were 13.0%, 9.6%, and 8.1%, which decreased as the intervention degree increased (the Cochran-Armitage trend test: p < .0001). In Groups A, B, and C, 15.6%, 64.9%, 48.8% of the patients, respectively, exhibited exercise habits. Conclusion: The 'One Stretch' exercise is useful for improving LBP.

PMID 30130991  Mod Rheumatol. 2019 Sep;29(5):861-866. doi: 10.1080/143・・・
著者: Jonathan C Hill, Kate M Dunn, Martyn Lewis, Ricky Mullis, Chris J Main, Nadine E Foster, Elaine M Hay
雑誌名: Arthritis Rheum. 2008 May 15;59(5):632-41. doi: 10.1002/art.23563.
Abstract/Text OBJECTIVE: To develop and validate a tool that screens for back pain prognostic indicators relevant to initial decision making in primary care.
METHODS: The setting was UK primary care adults with nonspecific back pain. Constructs that were independent prognostic indicators for persistence were identified from secondary analysis of 2 existing cohorts and published literature. Receiver operating characteristic curve analysis identified single screening questions for relevant constructs. Psychometric properties of the tool, including concurrent and discriminant validity, internal consistency, and repeatability, were assessed within a new development sample (n = 131) and tool score cutoffs were established to enable allocation to 3 subgroups (low, medium, and high risk). Predictive and external validity were evaluated within an independent external sample (n = 500).
RESULTS: The tool included 9 items: referred leg pain, comorbid pain, disability (2 items), bothersomeness, catastrophizing, fear, anxiety, and depression. The latter 5 items were identified as a psychosocial subscale. The tool demonstrated good reliability and validity and was acceptable to patients and clinicians. Patients scoring 0-3 were classified as low risk, and those scoring 4 or 5 on a psychosocial subscale were classified as high risk. The remainder were classified as medium risk.
CONCLUSION: We validated a brief screening tool, which is a promising instrument for identifying subgroups of patients to guide the provision of early secondary prevention in primary care. Further work will establish whether allocation to treatment subgroups using the tool, linked with targeting treatment appropriately, improves patient outcomes.

PMID 18438893  Arthritis Rheum. 2008 May 15;59(5):632-41. doi: 10.1002・・・
著者: Tarcisio Folly de Campos
雑誌名: J Physiother. 2017 Apr;63(2):120. doi: 10.1016/j.jphys.2017.02.012. Epub 2017 Mar 7.
Abstract/Text
PMID 28325480  J Physiother. 2017 Apr;63(2):120. doi: 10.1016/j.jphys.・・・
著者: Ian A Bernstein, Qudsia Malik, Serena Carville, Stephen Ward
雑誌名: BMJ. 2017 Jan 6;356:i6748. doi: 10.1136/bmj.i6748. Epub 2017 Jan 6.
Abstract/Text
PMID 28062522  BMJ. 2017 Jan 6;356:i6748. doi: 10.1136/bmj.i6748. Epub・・・

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