BACKGROUND According to clinical guidelines, advice to stay active despite experiencing pain is recommended to patients with non-specific low back pain (LBP). However, not all patients receive guideline-concordant information and advice, and some patients still believe that activity avoidance will help them recover. The purpose was to study whether guideline-concordant beliefs among patients and other explanatory variables were associated with recovery. The main aim was to investigate whether believing staying active despite having pain is associated with a better functional outcome. METHODS This was a prospective cohort study involving adults with non-specific LBP referred from general practices to the Spine Centre at Silkeborg Regional Hospital, Denmark. Patients reported on their beliefs about the importance of finding the cause, the importance of diagnostic imaging, perceiving to have received advice to stay active, pain duration, pain intensity, and STarT Back Tool. Agreeing to: 'An increase in pain is an indication that I should stop what I'm doing until the pain decreases' adjusted for age, gender, and education level was the primary explanatory analysis. A 30% improvement in the Roland Morris Disability Questionnaire (RMDQ) score after 52 weeks was the outcome. RESULTS 816 patients were included and 596 (73.0%) agreed that pain is a warning signal to stop being active. Among patients not considering pain as a warning signal, 80 (43.2%) had a favourable functional improvement of ≥30% on the RMDQ compared to 201 (41.2%) among patients considering pain a warning signal. No difference was found between the two groups (adjusted P = 0.542 and unadjusted P = 0.629). However, STarT Back Tool high-risk patients had a less favourable functional outcome (adjusted P = 0.003 and unadjusted P = 0.002). Chronic pain was associated with less favourable functional outcome (adjusted P < 0.001 and unadjusted P < 0.001), whereas beliefs about finding the cause, diagnostic imaging, perceiving to have received advice to stay active, or pain intensity were not significantly associated with outcome. CONCLUSIONS Holding the single belief that pain is a warning signal to stop being active was not associated with functional outcome. However, patients characterised by having multiple psychological barriers (high-risk according to the STarT Back Tool) had a less favourable functional outcome. TRIAL REGISTRATION Registered at ClinicalTrials.gov (registration number: NCT03058315), 20 February 2017.

中文翻译：

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相信保持活跃有益与 52 周后实现临床相关功能改善之间的关联：一项针对二级护理中的慢性腰痛患者的前瞻性队列研究。


背景 根据临床指南，建议患有非特异性腰痛 (LBP) 的患者尽管经历疼痛，仍要保持活跃。然而，并非所有患者都会收到符合指南的信息和建议，一些患者仍然认为避免活动将有助于他们康复。目的是研究患者之间符合指南的信念和其他解释变量是否与康复相关。主要目的是调查相信在疼痛的情况下保持活跃是否与更好的功能结果相关。方法 这是一项前瞻性队列研究，涉及从全科诊所转诊至丹麦锡尔克堡地区医院脊柱中心的非特异性腰痛成人患者。患者报告了他们对查找原因的重要性、诊断成像的重要性、认为已收到保持活跃的建议、疼痛持续时间、疼痛强度和 STarT 背部工具的信念。同意：“疼痛加剧表明我应该停止正在做的事情，直到疼痛减轻”，并根据年龄、性别和教育水平进行调整，这是主要的解释性分析。 52 周后，罗兰·莫里斯残疾问卷 (RMDQ) 评分提高了 30%。结果 纳入 816 名患者，其中 596 名患者 (73.0%) 同意疼痛是停止活动的警告信号。在不将疼痛视为警告信号的患者中，80 名 (43.2%) 的 RMDQ 功能改善≥30%，而将疼痛视为警告信号的患者中有 201 名 (41.2%)。两组之间没有发现差异（调整后的 P = 0.542 和未调整的 P = 0.629）。然而，STarT Back Tool 高风险患者的功能结果较差（调整后的 P = 0.003 和未调整的 P = 0.002）。慢性疼痛与较差的功能结果相关（调整后的 P < 0.001 和未调整的 P < 0.001），而关于寻找原因、诊断成像、感知已收到保持活跃的建议或疼痛强度的信念与结果没有显着相关。结论 认为疼痛是停止活动的警告信号这一单一信念与功能结果无关。然而，具有多种心理障碍（根据 STarT Back Tool 为高风险）的患者的功能结果较差。试验注册 2017 年 2 月 20 日在 ClinicalTrials.gov 注册（注册号：NCT03058315）。