腰背痛分类系统研究进展与评价
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摘要
腰背痛是一种常见的职业疾病或工作相关疾患,具有患病率高、疾病负担重、治疗效果不佳等特点。腰背痛防治效果受样本异质性影响而导致混杂,其更详尽的亚组分类在一定程度上可以解决这个问题。本文介绍了分类的意义,分类系统的发展,并对3种经典分类系统(McKenzie分类系统、魁北克工作组分类系统. O’Sullivan分类系统)和2种新开发的分类系统(BiIIis分类系统、Nielsen分类系统)的开发过程及结果进行了综述。并根据Buchbinder评价标准,从研究目的、内容有效性、表面效度、可行性、结构有效性、可靠性和普遍性7个方面对这5种分类系统进行了评价。评价结果显示:经典分类系统总体评分较高,新开发的分类系统在结构有效性、可靠性和普遍性得分均较低。根据评价结果提出今后腰背痛亚组分类系统的发展方向,对经典分类系统进行更新完善,而新开发的分类系统需要更多的临床应用以验证和改善其有效性,从而促进腰背痛机制研究以及相关的预防和治疗指导。
Low back pain(LBP) is a common occupational disorder or work-related disorder, which has the characteristics of high prevalence, heavy disease burden, and poor treatment effect. The confounding caused by sample heterogeneity can affect the effectiveness of prevention and treatment of LBP, and more detailed subgroup classification can partly solve this problem. The article introduced the significance of LBP classification and the development of classification system, and summarized the development process and results of three classic classification systems(McKenzie's classification, Quebec task force classification, and O'Sullivan's classification) and two new classification systems(BiIIis' s classification and Nielsen's classification). According to the Buchbinder evaluation criteria, these five classification systems were evaluated from seven aspects including purpose, content validity, face validity, feasibility, construct validity, reliability, and generalizability. The evaluation results showed that the overall scores of the classic classification systems were higher, and the scores of the new systems in construct validity, reliability and generalizability were lower. According to the evaluation results, further improvement direction for classifying LBP subgroups was proposed. The classic classification systems require substantial improvement, and the new classification systems need more clinical applications to verify and improve its validity, so as to facilitate the studies on mechanism of LBP and the prevention and treatment of LBP.
Low back pain(LBP) is a common occupational disorder or work-related disorder, which has the characteristics of high prevalence, heavy disease burden, and poor treatment effect. The confounding caused by sample heterogeneity can affect the effectiveness of prevention and treatment of LBP, and more detailed subgroup classification can partly solve this problem. The article introduced the significance of LBP classification and the development of classification system, and summarized the development process and results of three classic classification systems(McKenzie's classification, Quebec task force classification, and O'Sullivan's classification) and two new classification systems(BiIIis' s classification and Nielsen's classification). According to the Buchbinder evaluation criteria, these five classification systems were evaluated from seven aspects including purpose, content validity, face validity, feasibility, construct validity, reliability, and generalizability. The evaluation results showed that the overall scores of the classic classification systems were higher, and the scores of the new systems in construct validity, reliability and generalizability were lower. According to the evaluation results, further improvement direction for classifying LBP subgroups was proposed. The classic classification systems require substantial improvement, and the new classification systems need more clinical applications to verify and improve its validity, so as to facilitate the studies on mechanism of LBP and the prevention and treatment of LBP.
引文
[1]MAHER C,UNDERWOOD M,BUCHBINDER R.Non-specific low back pain[J].Lancet,2017,389(10070):736-747.
[2]HESTBAEK L,LEBOEUF-YDE C,MANNICHE C.Low back pain:what is the long-term course?A review of studies of general patient populations[J].Eur Spine J,2003,12(2):149-165.
[3]COLLE F,RANNOU F,REVEL M,et al.Impact of quality scales on levels of evidence inferred from a systematic review of exercise therapy and low back pain[J].Arch Phys Med Rehabil,2002,83(12):1745-1752.
[4]BUCHBINDER R,GOEL V,BOMBARDIER C,et al.Classification systems of soft tissue disorders of the neck and upper limb:do they satisfy methodological guidelines?[J].J Clin Epidemiol,1996,49(2):141-149.
[5]AIRAKSINEN O,BROX J I,CEDRASCHI C,et al.Chapter 4European guidelines for the management of chronic nonspecific low back pain[J].Eur Spine J,2006,15(S2):s192-s300.
[6]ANDERSSON G B.Epidemiological features of chronic lowback pain[J].Lancet,1999,354(9178):581-585.
[7]HOY D,BROOKS P,BLYTH F,et al.The Epidemiology of low back pain[J].Best Pract Res Clin Rheumatol,2010,24(6):769-781.
[8]刘延青,郑拥军.中国居民慢性腰背痛流行病学调查[J].中华医学信息导报,2017,32(21):12.
[9]GBD 2016 DALYs and HALE Collaborators.Global,regional,and national disability-adjusted life-years(DALYs)for 333diseases and injuries and healthy life expectancy(HALE)for 195 countries and territories,1990-2016:a systematic analysis for the Global Burden of Disease Study 2016[J].Lancet,2017,390(10100):1260-1344.
[10]白璐,王建新,岳朋朋.职业性肌肉骨骼疾患研究现状[J].中国工业医学杂志,2009,22(5):356-359.
[11]KARAYANNIS N V,JULL G A,HODGES P W.Movement-based subgrouping in low back pain:synergy and divergence in approaches[J].Physiotherapy,2016,102(2):159-169.
[12]BORKAN J M,CHERKIN D C.An agenda for primary care research on low back pain[J].Spine,1996,21(24):2880-2884.
[13]BORKAN J M,KOES B,REIS S,et al.A report from the second international forum for primary care research on low back pain[J].Spine,1998,23(18):1992-1996.
[14]SLATER S L,FORD J J,RICHARDS M C,et al.The effectiveness of sub-group specific manual therapy for low back pain:Asystematic review[J].Man Ther,2012,17(3):201-212.
[15]FEINSTEIN A R.Clinimetrics[M].New Haven,Conn:Yale University Press,1987.
[16]RIDDLE D L.Classification and low back pain:a review of the literature and critical analysis of selected systems[J].Phys Ther,1998,78(7):708-737.
[17]RA M.The Lumbar Spine:Mechanical Diagnosis and Therapy[M].Waikanae,New Zealand:Spinal Publications,1981.
[18]MCCARTHY C J,ARNALL F A,STRIMPAKOS N,et al.The biopsychosocial classification of non-specific low back pain:a systematic review[J].Phys Ther Rev,2004,9(1):17-30.
[19]PETERSEN T,THORSEN H,MANNICHE C,et al.Classification of non-specific low back pain:a review of the literature on classifications systems relevant to physiotherapy[J].Phys Ther Rev,1999,4(4):265-281.
[20]BILLIS E V,MCCARTHY C J,OLDHAM J A.Subclassification of low back pain:a cross-country comparison[J].Eur Spine J,2007,16(7):865-879.
[21]徐军.麦肯基力学诊断治疗技术(续一):对腰痛的基本观点[J].中国临床康复,2002,6(14):2029-2030.
[22]Scientific approach to the assessment and management of activity-related spinal disorders.A monograph for clinicians.Report of the quebec task force on spinal disorders[J].Spine,1987,12(S7):S1-S59.
[23]O'SULLIVAN P.Diagnosis and classification of chronic low back pain disorders:Maladaptive movement and motor control impairments as underlying mechanism[J].Man Ther,2005,10(4):242-255.
[24]BILLIS E,MCCARTHY C,ROBERTS C,et al.Sub-grouping patients with non-specific low back pain based on cluster analysis of discriminatory clinical items[J].J Rehabilitat Med,2013,45(2):177-185.
[25]NIELSEN A M,KENT P,HESTBAEK L,et al.Identifying subgroups of patients using latent class analysis:should we use a single-stage or a two-stage approach?A methodological study using a cohort of patients with low back pain[J].BMC Musculoskelet Disord,2017,18(1):57.
[26]FERSUM K V,O'SULLIVAN P B,KV?LE A,et al.Inter-examiner reliability of a classification system for patients with nonspecific low back pain[J].Man Ther,2009,14(5):555-561.
[27]O'SULLIVAN P B.Masterclass.Lumbar segmental‘instability’:clinical presentation and specific stabilizing exercise management[J].Man Ther,2000,5(1):2-12.
[28]BILLIS E,MCCARTHY C,GLIATIS J,et al.Inter-tester reliability of discriminatory examination items for subclassifying non-specific low back pain[J].J Rehabil Med,2012,44(10):851-857.
[29]LAM O T,STRENGER D M,CHAN-FEE M,et al.Effectiveness of the mckenzie method of mechanical diagnosis and therapy for treating low back pain:literature review with meta-analysis[J].J Orthop Sports Phys Ther,2018,48(6):476-490.
[30]GARCIA A N,DA CUNHA MENEZES COSTA L,HANCOCK M J,et al.McKenzie Method of Mechanical Diagnosis and Therapy was slightly more effective than placebo for pain,but not for disability,in patients with chronic non-specific low back pain:a randomised placebo controlled trial with short and longer term follow-up[J].Br J Sports Med,2018,52(9):594-600.
[31]FRANK A O,DE SOUZA L H,MCAULEY J H,et al.A crosssectional survey of the clinical and psychological features of low back pain and consequent work handicap:use of the Quebec Task Force classification[J].Int J Clin Pract,2000,54(10):639-644.
[32]WERNEKE M W,HART D L.Categorizing patients with occupational low back pain by use of the Quebec Task Force Classification system versus pain pattern classification procedures:discriminant and predictive validity[J].Phys Ther,2004,84(3):243-254.
[33]LOISEL P,VACHON B,LEMAIRE J,et al.Discriminative and predictive validity assessment of the quebec task force classification[J].Spine,2002,27(8):851-857.
[34]KONGSTED A,KENT P,JENSEN T S,et al.Prognostic implications of the Quebec Task Force classification of backrelated leg pain:an analysis of longitudinal routine clinical data[J].BMC Musculoskelet Disord,2013,14:171.
[35]ATLAS S J,DEYO R A,PATRICK D L,et al.The quebec task force classification for spinal disorders and the severity,treatment,and outcomes of sciatica and lumbar spinal stenosis[J].Spine,1996,21(24):2885-2892.
[36]SCHENK R,LAWRENCE H,LORENZETTI J,et al.The relationship between Quebec Task Force Classification and outcome in patients with low back pain treated through mechanical diagnosis and therapy[J].J Man Manip Ther,2016,24(1):21-25.
[37]MOLGAARD NIELSEN A,HESTBAEK L,VACH W,et al.Latent class analysis derived subgroups of low back pain patientsdo they have prognostic capacity?[J].BMC Musculoskelet Disord,2017,18(1):345.
[38]RAZMJOU H,KRAMER J F,YAMADA R.Intertester reliability of the McKenzie evaluation in assessing patients with mechanical low back pain[J].J Orthop Sports Phys Ther,2000,30(7):368-389.
[39]WILLIS S,ROSEDALE R,RASTOGI R,et al.Inter-rater reliability of the mckenzie system of mechanical diagnosis and therapy in the examination of the knee[J].J Man Manip Ther,2016,25(2):83-90.
[40]KILPIKOSKI S,AIRAKSINEN O,KANKAANP??M,et al.Interexaminer reliability of low back pain assessment using the McKenzie method[J].Spine,2002,27(8):E207-E214.
[41]DANKAERTS W,O'SULLIVAN P B,STRAKER L M,et al.The inter-examiner reliability of a classification method for nonspecific chronic low back pain patients with motor control impairment[J].Man Ther,2006,11(1):28-39.
[42]KJELLMAN G,?BERG B.A randomized clinical trial comparing general exercise,McKenzie treatment and a control group in patients with neck pain[J].J Rehabil Med,2002,34(4):183-190.
[43]MAY S,GARDINER E,YOUNG S,et al.Predictor variables for a positive long-term functional outcome in patients with acute and chronic neck and back pain treated with a mckenzie approach:a secondary analysis[J].J Man Manip Ther,2008,16(3):155-160.
[44]CLARE H A,ADAMS R,MAHER C G.Reliability of McKenzie classification of patients with cervical or lumbar pain[J].JManipulative Physiol Ther,2005,28(2):122-127.
[45]SPITZER W O,SKOVRON M L,SALMI L R,et al.Scientific monograph of the Quebec task force on whiplash-associated disorders:redefining“whiplash”and its management[J].Spine,1995,20(S8):1S-73S.
[46]SHEERAN L,COALES P,SPARKES V.Clinical challenges of classification based targeted therapies for non-specific low back pain:What do physiotherapy practitioners and managers think?[J].Man Ther,2015,20(3):456-462.
[2]HESTBAEK L,LEBOEUF-YDE C,MANNICHE C.Low back pain:what is the long-term course?A review of studies of general patient populations[J].Eur Spine J,2003,12(2):149-165.
[3]COLLE F,RANNOU F,REVEL M,et al.Impact of quality scales on levels of evidence inferred from a systematic review of exercise therapy and low back pain[J].Arch Phys Med Rehabil,2002,83(12):1745-1752.
[4]BUCHBINDER R,GOEL V,BOMBARDIER C,et al.Classification systems of soft tissue disorders of the neck and upper limb:do they satisfy methodological guidelines?[J].J Clin Epidemiol,1996,49(2):141-149.
[5]AIRAKSINEN O,BROX J I,CEDRASCHI C,et al.Chapter 4European guidelines for the management of chronic nonspecific low back pain[J].Eur Spine J,2006,15(S2):s192-s300.
[6]ANDERSSON G B.Epidemiological features of chronic lowback pain[J].Lancet,1999,354(9178):581-585.
[7]HOY D,BROOKS P,BLYTH F,et al.The Epidemiology of low back pain[J].Best Pract Res Clin Rheumatol,2010,24(6):769-781.
[8]刘延青,郑拥军.中国居民慢性腰背痛流行病学调查[J].中华医学信息导报,2017,32(21):12.
[9]GBD 2016 DALYs and HALE Collaborators.Global,regional,and national disability-adjusted life-years(DALYs)for 333diseases and injuries and healthy life expectancy(HALE)for 195 countries and territories,1990-2016:a systematic analysis for the Global Burden of Disease Study 2016[J].Lancet,2017,390(10100):1260-1344.
[10]白璐,王建新,岳朋朋.职业性肌肉骨骼疾患研究现状[J].中国工业医学杂志,2009,22(5):356-359.
[11]KARAYANNIS N V,JULL G A,HODGES P W.Movement-based subgrouping in low back pain:synergy and divergence in approaches[J].Physiotherapy,2016,102(2):159-169.
[12]BORKAN J M,CHERKIN D C.An agenda for primary care research on low back pain[J].Spine,1996,21(24):2880-2884.
[13]BORKAN J M,KOES B,REIS S,et al.A report from the second international forum for primary care research on low back pain[J].Spine,1998,23(18):1992-1996.
[14]SLATER S L,FORD J J,RICHARDS M C,et al.The effectiveness of sub-group specific manual therapy for low back pain:Asystematic review[J].Man Ther,2012,17(3):201-212.
[15]FEINSTEIN A R.Clinimetrics[M].New Haven,Conn:Yale University Press,1987.
[16]RIDDLE D L.Classification and low back pain:a review of the literature and critical analysis of selected systems[J].Phys Ther,1998,78(7):708-737.
[17]RA M.The Lumbar Spine:Mechanical Diagnosis and Therapy[M].Waikanae,New Zealand:Spinal Publications,1981.
[18]MCCARTHY C J,ARNALL F A,STRIMPAKOS N,et al.The biopsychosocial classification of non-specific low back pain:a systematic review[J].Phys Ther Rev,2004,9(1):17-30.
[19]PETERSEN T,THORSEN H,MANNICHE C,et al.Classification of non-specific low back pain:a review of the literature on classifications systems relevant to physiotherapy[J].Phys Ther Rev,1999,4(4):265-281.
[20]BILLIS E V,MCCARTHY C J,OLDHAM J A.Subclassification of low back pain:a cross-country comparison[J].Eur Spine J,2007,16(7):865-879.
[21]徐军.麦肯基力学诊断治疗技术(续一):对腰痛的基本观点[J].中国临床康复,2002,6(14):2029-2030.
[22]Scientific approach to the assessment and management of activity-related spinal disorders.A monograph for clinicians.Report of the quebec task force on spinal disorders[J].Spine,1987,12(S7):S1-S59.
[23]O'SULLIVAN P.Diagnosis and classification of chronic low back pain disorders:Maladaptive movement and motor control impairments as underlying mechanism[J].Man Ther,2005,10(4):242-255.
[24]BILLIS E,MCCARTHY C,ROBERTS C,et al.Sub-grouping patients with non-specific low back pain based on cluster analysis of discriminatory clinical items[J].J Rehabilitat Med,2013,45(2):177-185.
[25]NIELSEN A M,KENT P,HESTBAEK L,et al.Identifying subgroups of patients using latent class analysis:should we use a single-stage or a two-stage approach?A methodological study using a cohort of patients with low back pain[J].BMC Musculoskelet Disord,2017,18(1):57.
[26]FERSUM K V,O'SULLIVAN P B,KV?LE A,et al.Inter-examiner reliability of a classification system for patients with nonspecific low back pain[J].Man Ther,2009,14(5):555-561.
[27]O'SULLIVAN P B.Masterclass.Lumbar segmental‘instability’:clinical presentation and specific stabilizing exercise management[J].Man Ther,2000,5(1):2-12.
[28]BILLIS E,MCCARTHY C,GLIATIS J,et al.Inter-tester reliability of discriminatory examination items for subclassifying non-specific low back pain[J].J Rehabil Med,2012,44(10):851-857.
[29]LAM O T,STRENGER D M,CHAN-FEE M,et al.Effectiveness of the mckenzie method of mechanical diagnosis and therapy for treating low back pain:literature review with meta-analysis[J].J Orthop Sports Phys Ther,2018,48(6):476-490.
[30]GARCIA A N,DA CUNHA MENEZES COSTA L,HANCOCK M J,et al.McKenzie Method of Mechanical Diagnosis and Therapy was slightly more effective than placebo for pain,but not for disability,in patients with chronic non-specific low back pain:a randomised placebo controlled trial with short and longer term follow-up[J].Br J Sports Med,2018,52(9):594-600.
[31]FRANK A O,DE SOUZA L H,MCAULEY J H,et al.A crosssectional survey of the clinical and psychological features of low back pain and consequent work handicap:use of the Quebec Task Force classification[J].Int J Clin Pract,2000,54(10):639-644.
[32]WERNEKE M W,HART D L.Categorizing patients with occupational low back pain by use of the Quebec Task Force Classification system versus pain pattern classification procedures:discriminant and predictive validity[J].Phys Ther,2004,84(3):243-254.
[33]LOISEL P,VACHON B,LEMAIRE J,et al.Discriminative and predictive validity assessment of the quebec task force classification[J].Spine,2002,27(8):851-857.
[34]KONGSTED A,KENT P,JENSEN T S,et al.Prognostic implications of the Quebec Task Force classification of backrelated leg pain:an analysis of longitudinal routine clinical data[J].BMC Musculoskelet Disord,2013,14:171.
[35]ATLAS S J,DEYO R A,PATRICK D L,et al.The quebec task force classification for spinal disorders and the severity,treatment,and outcomes of sciatica and lumbar spinal stenosis[J].Spine,1996,21(24):2885-2892.
[36]SCHENK R,LAWRENCE H,LORENZETTI J,et al.The relationship between Quebec Task Force Classification and outcome in patients with low back pain treated through mechanical diagnosis and therapy[J].J Man Manip Ther,2016,24(1):21-25.
[37]MOLGAARD NIELSEN A,HESTBAEK L,VACH W,et al.Latent class analysis derived subgroups of low back pain patientsdo they have prognostic capacity?[J].BMC Musculoskelet Disord,2017,18(1):345.
[38]RAZMJOU H,KRAMER J F,YAMADA R.Intertester reliability of the McKenzie evaluation in assessing patients with mechanical low back pain[J].J Orthop Sports Phys Ther,2000,30(7):368-389.
[39]WILLIS S,ROSEDALE R,RASTOGI R,et al.Inter-rater reliability of the mckenzie system of mechanical diagnosis and therapy in the examination of the knee[J].J Man Manip Ther,2016,25(2):83-90.
[40]KILPIKOSKI S,AIRAKSINEN O,KANKAANP??M,et al.Interexaminer reliability of low back pain assessment using the McKenzie method[J].Spine,2002,27(8):E207-E214.
[41]DANKAERTS W,O'SULLIVAN P B,STRAKER L M,et al.The inter-examiner reliability of a classification method for nonspecific chronic low back pain patients with motor control impairment[J].Man Ther,2006,11(1):28-39.
[42]KJELLMAN G,?BERG B.A randomized clinical trial comparing general exercise,McKenzie treatment and a control group in patients with neck pain[J].J Rehabil Med,2002,34(4):183-190.
[43]MAY S,GARDINER E,YOUNG S,et al.Predictor variables for a positive long-term functional outcome in patients with acute and chronic neck and back pain treated with a mckenzie approach:a secondary analysis[J].J Man Manip Ther,2008,16(3):155-160.
[44]CLARE H A,ADAMS R,MAHER C G.Reliability of McKenzie classification of patients with cervical or lumbar pain[J].JManipulative Physiol Ther,2005,28(2):122-127.
[45]SPITZER W O,SKOVRON M L,SALMI L R,et al.Scientific monograph of the Quebec task force on whiplash-associated disorders:redefining“whiplash”and its management[J].Spine,1995,20(S8):1S-73S.
[46]SHEERAN L,COALES P,SPARKES V.Clinical challenges of classification based targeted therapies for non-specific low back pain:What do physiotherapy practitioners and managers think?[J].Man Ther,2015,20(3):456-462.