Predicting Outcome in Acute Low Back Pain Using Different Models of Patient Profiling

Abstract

Tel +61 8 9433 0203Fax +61 8 9433 0210Competing interest: No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subjects of this manuscript Acknowledgements: We would like to thank Christien Bird, Maureen MacDowell, Anne Golden and Mary Sexton for their initial contribution to this study. Ethical approval: Ethical approval was obtained from the Health Authorities Research Ethics Committee 3 Abstract Study DesignProspective observational study of prognostic indicators, utilising data from a randomised, controlled trial of physiotherapy care of acute low back pain (ALBP) with follow up at 6 weeks, 3 months and 6 months. ObjectiveTo evaluate which patient profile offers the most useful guide to long-term outcome in ALBP. Summary of Background DataThe evidence used to inform prognostic decision-making is derived largely from studies where baseline data is used to predict future status. Clinicians often see patients on multiple occasions so may profile patients in a variety of ways. It is worth considering if better prognostic decisions can be made from alternative profiles. MethodsClinical, psychological and demographic data were collected from a sample of 54 ALBP patients. Three clinical profiles were developed from information collected at baseline, information collected at 6 weeks, and the change in status between these two time points. A series of regression models were used to determine the independent and relative contributions of these profiles to the prediction of chronic pain and disability. 4 ResultsThe baseline profile predicted long-term pain only. The 6-week profile predicted both long-term pain and disability. The change profile only predicted long-term disability (p < 0.01). When predicting long-term pain, after the baseline profile had been added to the model, the 6-week profile did not add significantly when forced in at the second step (p>0.05). A similar result was obtained when the order of entry was reversed. When predicting long-term disability, after the 6-week profile was entered at the first step, the change profile was not significant when forced in at the second step. However, when the change profile was entered at the first step and the 6-week clinical profile was forced in at the second step, a significant contribution of the 6-week profile was found. ConclusionsThe profile derived from information collected at 6 weeks provided the best guide to long-term pain and disability. The baseline profile and change in status offered less predictive value.Key words: acute low back pain; clinical guidelines; prognosis; physiotherapy. Key points• International guidelines for ALBP use information about prognosis to shape care pathways for ALBP patients. 5• This information is derived largely from studies that have assessed patients at a single (early) time point.• The clinical situation provides a much richer source of information and potential for varying models of patient profiling.• The 6...

The perceptions of people with low back pain treated in the Spanish National Health, and their experience while undergoing a new evidence-based treatment. A focus group study

“…The experience of LBP in Spain appears to be similar to the one in the Anglo-Saxon and Northern European cultural contexts [8][9][10][11][12][13][14][15], despite differences in the relevance of fear-avoidance beliefs and catastrophizing across these settings [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. This further suggests that, although quantitative studies using validated DOI: 10.3109/09638288.2013.869625 methods may be useful for assessing the influence of psychological factors, qualitative methods are necessary to allow patients to express themselves freely over and above the questions included in closed questionnaires.…”

“…However, certain psychological variables which are important for people with LBP in these cultural contexts, such as fear-avoidance beliefs and catastrophizing [16][17][18][19][20][21][22][23], have shown to be irrelevant in Southern Europe [24][25][26][27][28][29][30][31]. These differences might suggest variations in the experiences of LBP across these cultural settings.…”

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

“…14,52,53,60,64 For example, Sullivan et al 53 examined initial depression severity and the trajectory of recovery following a Pain-Disability Prevention Program. The authors classified patients at intake and discharge as either mildly depressed or moderately severely depressed.…”

The STarT Back Screening Tool for Prediction of 6-Month Clinical Outcomes: Relevance of Change Patterns in Outpatient Physical Therapy Settings

“…Previous studies have indicated that repeated assessment 15,21,24,30 and subsequent observed changes in important variables improved prediction of LBPrelated clinical outcomes. 7,12,25,31 For example, Dunn and Croft 7 found that in primary care settings, the presence of adverse prognostic indicators at initial assessment and 4 weeks later was associated with higher risk for poor outcomes at 12 months compared to the presence of adverse prognostic indicators at either time point or none at all.…”