A multisite longitudinal evaluation of patient characteristics associated with a poor response to non-surgical multidisciplinary management of low back pain in an advanced practice physiotherapist-led tertiary service

Abstract

Background Non-surgical multidisciplinary management is often the first pathway of care for patients with chronic low back pain (LBP). This study explores if patient characteristics recorded at the initial service examination have an association with a poor response to this pathway of care in an advanced practice physiotherapist-led tertiary service. Methods Two hundred and forty nine patients undergoing non-surgical multidisciplinary management for their LBP across 8 tertiary public hospitals in Queensland, Australia participated in this prospective longitudinal study. Generalised linear models (logistic family) examined the relationship between patient characteristics and a poor response at 6 months follow-up using a Global Rating of Change measure. Results Overall 79 of the 178 (44%) patients completing the Global Rating of Change measure (28.5% loss to follow-up) reported a poor outcome. Patient characteristics retained in the final model associated with a poor response included lower Formal Education Level (ie did not complete school) (Odds Ratio (OR (95% confidence interval)) (2.67 (1.17–6.09), p = 0.02) and higher self-reported back disability (measured with the Oswestry Disability Index) (OR 1.33 (1.01–1.77) per 10/100 point score increase, p = 0.046). Conclusions A low level of formal education and high level of self-reported back disability may be associated with a poor response to non-surgical multidisciplinary management of LBP in tertiary care. Patients with these characteristics may need greater assistance with regard to their comprehension of health information, and judicious monitoring of their response to facilitate timely alternative care if no benefits are attained.

Understanding social determinants of health and physical therapy outcomes in patients with low back pain: A scoping review

“…One study specifically evaluated the number of children living at home specifically (Dhondt et al., 2020). Number of children had no effect in all studies (Abu et al., 2017; Dhondt et al., 2020; Jensen et al., 2013; O’Leary et al., 2020; Stapelfeldt et al., 2011).…”

“…Outcome measures for pain and function were collected most frequently (Table 3). Marital status/partner had no effect on outcomes in eight studies (Beneciuk et al., 2013; Cougot et al., 2015; Jensen et al., 2013; Nava‐Bringas et al., 2016; Neyaz et al., 2019; O’Leary et al., 2020; Preuper et al., 2011; Stapelfeldt et al., 2011). One study demonstrated that having a partner or spouse was associated with better outcomes (Bath & Lovo Grona, 2015) and one study controlled for marital status/partner in the analysis (Sisco‐Taylor et al., 2021).…”

“…The majority of studies evaluated the effect of age on function ( n = 35), pain ( n = 23), and psychological well‐being ( n = 11; Table 3). No effect of age was found in 31 studies (Abu et al., 2017; Anderson et al., 2011; Beissner et al., 2012; Beneciuk et al., 2013; Beneciuk & George, 2021; Berglund et al., 2015; Brennan et al., 2021; Burns et al., 2018; Cougot et al., 2015; Feitosa et al., 2016; Fritz et al., 2019, 2011; George & Stryker, 2011; Glattacker et al., 2012, 2018, Görge et al., 2017; Hügli et al., 2015; Kaljic et al., 2018; Murphy et al., 2014; Nava‐Bringas et al., 2016; Neyaz et al., 2019; O’Leary et al., 2020; Oliveira et al., 2019; Pak et al., 2021; Rajamani et al., 2020; Rasmussen‐Barr et al., 2012; Schaller et al., 2017; Stapelfeldt et al., 2011; Van Hooff et al., 2014; Van Koppen et al., 2016; Walston & McLester, 2020), while 16 studies demonstrated that younger age was associated with better outcomes (Adnan et al., 2017; Alodaibi et al., 2021; Bath & Lovo Grona, 2015; de Heer & Warren, 2016; Fritz et al., 2013; Gregg et al., 2014; Harsted et al., 2021; Heidari et al., 2017; Jensen et al., 2013; Lutz et al., 2020; Preuper et al., 2011; Schwind et al., 2013; Verkerk et al., 2015; Werneke, Hart, George, et al., 2011; Wilson et al., 2011; Yağcı et al., 2020). Older age and better outcomes were demonstrated in four studies (Dhondt et al., 2020; Farin, 2015; Fehrmann et al., 2022; George & Stryker, 2011), one study demonstrate...…”

“…Number of children had no effect in all studies (Abu et al, 2017;Dhondt et al, 2020;Jensen et al, 2013;O'Leary et al, 2020;Stapelfeldt et al, 2011).…”

Intra-Articular Facet Joint Injection of Normal Saline for Chronic Low Back Pain: A Systematic Review and Meta-Analysis

“…In 2019, LBP remained the major cause of years lived with disability (YLDs) worldwide despite a slight decline in the age-standardized prevalence, incidence, and YLDs rate from 1990 to 2019. In 2019, the highest prevalence rates were observed in the 80–84-year-old age bracket for both sexes globally, with the number of cases increasing with age and peaking between the ages of 45 and 54 years [ 2 ].…”