No abstract

The total score of the PDI as well as the subscale of voluntary activities is responsive. Partly because of floor effects, the subscale obligatory activities are not sufficiently responsive in patients with CBP. However, the responsiveness of this subscale in other patient groups should be further tested. In patients with CBP, change can be considered clinically important when PDI score has decreased 8.5 to 9.5 points.

Study Design. Cross-sectional study. Objective. The aim of this study was to study the personal and societal impact of low back pain (LBP) in patients admitted to a multidisciplinary spine center. Summary of Background Data. The socioeconomic burden of LBP is very high. A minority of patients visit secondary or tertiary care because of severe and long-lasting complaints. This subgroup may account for a major part of disability and costs, yet could potentially gain most from treatment. Currently, little is known about the personal and societal burden in patients with chronic complex LBP visiting secondary/tertiary care. Methods. Baseline data were acquired through patient-reported questionnaires and health insurance claims. Primary outcomes were LBP impact (Impact Stratification, range 8–50), functioning (Pain Disability Index, PDI; 0–70), quality of life (EuroQol-5D, EQ5D; −0.33 to 1.00), work ability (Work Ability Score, WAS; 0–10), work participation, productivity costs (Productivity Cost Questionnaire), and healthcare costs 1 year before baseline. Healthcare costs were compared with matched primary and secondary care LBP samples. Descriptive and inferential statistics were applied. Results. In total, 1502 patients (age 46.3 ± 12.8 years, 57% female) were included. Impact Stratification was 35.2 ± 7.5 with severe impact (≥35) for 58% of patients. PDI was 38.2 ± 14.1, EQ5D 0.39 (interquartile range, IQR: 0.17–0.72); WAS 4.0 (IQR: 1.0–6.0) and 17% were permanently work-disabled. Mean total health care costs (€4875, 95% confidence interval [CI]: 4309–5498) were higher compared to the matched primary care sample (n = 4995) (€2365, 95% CI: 2219–2526, P < 0.001), and similar to the matched secondary care sample (n = 4993) (€4379, 95% CI: 4180–4590). Productivity loss was estimated at €4315 per patient (95% CI: 3898–4688) during 6 months. Conclusion. In patients seeking multidisciplinary spine care, the personal and societal impact of LBP is very high. Specifically, quality of life and work ability are poor and health care costs are twice as high compared to patients seeking primary LBP care. Level of Evidence: 3