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首页> 外文期刊>Statistical modeling: applications in contemporary issues >Non-compliance in surgical patients with herniated lumbar discs: An application of an extended latent class model as selection model
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Non-compliance in surgical patients with herniated lumbar discs: An application of an extended latent class model as selection model

机译：腰椎间盘突出症手术患者的不依从性：扩展潜伏类模型作为选择模型的应用

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摘要

In a recent observational study on a sample of patients with herniated lumbar discs who underwent physiotherapy, the recovery rate of those who chose physiotherapy rather than surgery, as recommended, was not appreciably different from that of the other patients, although their prognosis was worse. To investigate whether this finding was due to a confounding effect induced by unobserved features of the patients, we fit a latent class model for the joint distribution of compliance, participation rate and recovery, given the individual attitude (modelled as latent variable) and a set of covariates. The usual assumption of local independence is relaxed in favour of conditional association between the observed variables given the latent one. The results indicate that the latent classes may be interpreted as dividing the patients according to whether they are highly versus moderately motivated towards physiotherapy: conditionally on the covariates, the more motivated subjects attend a larger number of therapy sessions and benefit much more from the therapy. In addition, the fact that the proportion of less motivated patients among non-compliers is very small may be due to a self-selection mechanism, which may explain the surprisingly good performance of physiotherapy for these patients.
机译：在最近的一项对接受物理疗法的腰椎间盘突出症患者样本的观察性研究中，尽管推荐的物理疗法的患者的预后较差，但按推荐的方法选择物理疗法而不是手术的患者的康复率与其他患者没有明显差异。为了研究这一发现是否是由于患者未观察到的特征引起的混杂效应，我们针对个体的态度（建模为潜伏变量）和一组拟合拟合了潜伏类模型，用于依从性，参与率和恢复的联合分布协变量放宽对局部独立性的通常假设，以便在给定潜在变量的情况下观察变量之间的条件关联。结果表明，潜在类别可以解释为根据患者对物理治疗的动机是高度动机还是中等动机：按协变量为条件，动机更强的受试者参加更大量的治疗课程，并从治疗中受益更多。此外，非适应症患者中动力不足的患者比例很小的事实可能归因于自我选择机制，这可能解释了对这些患者而言理疗效果惊人。

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