Association Between Centralization, Depression, Somatization, and Disability Among Patients With Nonspecific Low Back Pain

Edmond, Susan L.; Werneke, Mark W.; Hart, Dennis L.

doi:10.2519/jospt.2010.3334

Cited by 28 publications

(21 citation statements)

References 38 publications

(57 reference statements)

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“…In addition, when classification data are used to direct treatment, treatment confounds outcomes assessment, which affects regression models. 9 Another concern to consider is that predictive models are dependent on the dependent and independent variables used. Previous authors who have reported fear-avoidance beliefs as predictive have used different measures of FS.…”

Section: Discussionmentioning

confidence: 99%

Effect of Fear-Avoidance Beliefs of Physical Activities on a Model That Predicts Risk-Adjusted Functional Status Outcomes in Patients Treated for a Lumbar Spine Dysfunction

Hart¹,

Werneke²,

Deutscher³

et al. 2011

J Orthop Sports Phys Ther

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Functional status (FS) outcomes of patients with lumbar spine dysfunctions managed in outpatient rehabilitation clinics are affected by many variables, including patient demographic variables. 35 Before clinicians can interpret associations between treatments and outcomes in a meaningful way, FS outcomes must be statistically risk-adjusted to control the effect of variables that may or may not be related to clinical care. 8,23,33,35,52 Although statistical risk adjustment models can appear complicated, 53,54 results of these models tend to be clinically logical. For example, it is clinically logical that patients who are older or patients whose symptoms are more chronic should report less FS change compared to patients who are younger or have more acute symptoms, and, indeed, results support this inverse relationship (ie, as patients age, or symptoms become chronic, FS T T STUDY DESIGN: Retrospective analysis of a prospective, longitudinal cohort study of 30 858 patients being treated for a lumbar spine dysfunction in outpatient physical therapy. T T OBJECTIVES:To determine effect of adding a single-item screening variable classifying patients with elevated versus not-elevated scores of fearavoidance beliefs of physical activities at intake, on a model predicting risk-adjusted functional status (FS) outcomes. T T BACKGROUND:Outcomes must be risk-adjusted before making meaningful interpretations. Elevated fear-avoidance beliefs scores have been predictive of poor outcomes. But the importance of elevated fear-avoidance scores in a multivariable model predicting FS outcomes needs further study. T T METHODS:Using retrospective analyses, predictive ability (R 2 ) of multivariable linear regression models of discharge FS with and without classification by elevated versus not-elevated fearavoidance scores were compared, while controlling for intake FS, age, symptom acuity, surgical history, gender, number of comorbidities, and payer. Percent variance controlled and beta coefficients (95% confidence intervals) of each variable in both models were compared. A split-half design was used for model cross-validation. Predictive ratios (predicted FS, divided by actual discharge FS) were assessed. T T RESULTS:Adding fear-avoidance beliefs classification to the discharge FS model improved (P<.001) model predictive ability but only slightly (R 2 without, and with, fear-avoidance classification, 0.2997 and 0.3010, respectively). Variables impacted models similarly (95% confidence intervals not different). Fear-avoidance classification added 0.2% data variance control to the existing model. Cross-validation was supported. Predictive ratios were 1.09 and 1.10, without and with fearavoidance, respectively. T T CONCLUSION:Although screening for elevated fear-avoidance beliefs of physical activities significantly improves the FS outcomes predictive model, the amount of additional meaningful interpretation of FS outcomes was minimal. Exploration of other clinically relevant variables designed to improve outcomes prediction is warranted...

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Section: Discussionmentioning

confidence: 99%

Effect of Fear-Avoidance Beliefs of Physical Activities on a Model That Predicts Risk-Adjusted Functional Status Outcomes in Patients Treated for a Lumbar Spine Dysfunction

Hart¹,

Werneke²,

Deutscher³

et al. 2011

J Orthop Sports Phys Ther

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“…Overinterpretation of elevated intake PD scores should be avoided if PD symptoms are treatment mediators. To our knowledge, only 1 study has explored the association between intake PD and physical therapy classification-based interventions on disability in patients with acute low back pain, which was Edmond et al's 15 analyses to determine whether physical therapy treatment acted as a confounder or effect measure modifier to better interpret the associations observed between PD and disability outcomes. The data supported classification-based treatment as a confounder that mediated the effect of intake PD on patient outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…The data supported classification-based treatment as a confounder that mediated the effect of intake PD on patient outcomes. 15 Further research examining whether PD is best interpreted as a treatment mediator, modifier, or a prognostic factor is warranted.…”

Section: Discussionmentioning

confidence: 99%

“…However, previous data suggest that independent assessment of individual psychosocial characteristics versus the SCL BPPM decision rules does not change disability outcome results. 15 The SCL BPPM was developed and validated in primary-care settings, and further testing in physical therapy settings is required. In addition, though the validity of the SCL prediction rules has been previously reported, 11 the SCL BPPM used in this paper has not yet been validated to detect change across repeated measures.…”

Section: Limitationsmentioning

confidence: 99%

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Change in Psychosocial Distress Associated With Pain and Functional Status Outcomes in Patients With Lumbar Impairments Referred to Physical Therapy Services

Werneke

Hart²,

George³

et al. 2011

J Orthop Sports Phys Ther

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“…The correlation between spinal stenosis associated LBP and depression is not easy to establish due to ambiguous cause and result relationship.Depression symptoms may be caused by pain; however, in some cases depression increases the existing pain and gives way to anxiety associated with depression [6,7]. Lautenbacher et al [8] have presented that women are more sensitive to pain however, medical treratment is more effective in female patients [9].…”

Section: Introductionmentioning

confidence: 98%

Correlation of low back pain caused by lumbar spinal stenosis and depression in women: a clinical study

Kaptan

Yalçin²,

Kasımcan

2012

Arch Orthop Trauma Surg

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Association Between Centralization, Depression, Somatization, and Disability Among Patients With Nonspecific Low Back Pain

Cited by 28 publications

References 38 publications

Effect of Fear-Avoidance Beliefs of Physical Activities on a Model That Predicts Risk-Adjusted Functional Status Outcomes in Patients Treated for a Lumbar Spine Dysfunction

Effect of Fear-Avoidance Beliefs of Physical Activities on a Model That Predicts Risk-Adjusted Functional Status Outcomes in Patients Treated for a Lumbar Spine Dysfunction

Change in Psychosocial Distress Associated With Pain and Functional Status Outcomes in Patients With Lumbar Impairments Referred to Physical Therapy Services

Correlation of low back pain caused by lumbar spinal stenosis and depression in women: a clinical study

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