腰背痛分类系统研究进展与评价
Progress and evaluation on subgroup classification system of low back pain
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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。
Abstract: 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 (Billis'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.
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