Predictors for Half-Year Outcome of Impairment in Daily Life for Back Pain Patients Referred for Physiotherapy: A Prospective Observational Study

Abstract

Background and ObjectiveFrom observational studies, there is only sparse information available on the predictors of development of impairment in daily life for patients receiving physiotherapy. Therefore, our aim was to identify factors which predict impairment in daily life for patients with back pain 6 months after receiving physiotherapy.MethodsWe conducted a prospective cohort study with 6-month follow-up. Patients were enrolled for treatment in private physiotherapy practices. Patients with a first physiotherapy referral because of thoracic or low back pain, aged 18 to 65 years were included. Primary outcome impairment was measured utilising the 16-item version of the Musculoskeletal Function Assessment Questionnaire. Therapy was documented on a standardized form. Baseline scores for impairment in daily life, symptom characteristics, sociodemographic and psychosocial factors, physical activity, nicotine consumption, intake of analgesics, comorbidity and delivered primary therapy approach were investigated as possible predictors. Univariate and multiple linear regression analyses were performed.ResultsA total of 792 patients participated in the study (59% female, mean age 44.4 (SD 11.4), with 6-month follow-up results available from 391 patients. In univariate analysis 17 variables reached significance. In multiple linear regression identified predictors were: impairment in daily life before therapy, mental disorders, duration of the complaints, self-prognosis on work ability, rheumatoid arthritis, age, form of stress at work and physical activity. The variables explain 34% of variance (adjusted R2, p<0.001).ConclusionsWith minimal information available from observational studies on the predictors of development of back problems for physiotherapy patients, this study adds new knowledge for forming appropriate referral guidelines. Impairment in daily life before therapy, mental disorder as comorbidity and the duration of the complaints can be named as outstanding factors. The results of this study can be used to facilitate comparison of patient therapy goals with the prognosis in everyday practice.

Physiotherapists’ views of implementing a stratified treatment approach for patients with low back pain in Germany: a qualitative study

“…The German physiotherapy caseload consists predominantly of patients with LBP [ 5 , 6 ], in which a key challenge is to identify patients at risk of an unfavourable prognosis [ 7 ]. Early assessment and treatment of those at high risk is not only important in terms of improving clinical outcomes and cost effectiveness, but also in reducing the impact of LBP, including individuals’ health, physical and social activities and local and global participation [ 8 , 9 ].…”

Prognostic ability of the German version of the STarT Back tool: analysis of 12-month follow-up data from a randomized controlled trial

“…psychological factors) or non-modifiable (e.g. pain history) [5–7]. Despite this knowledge, and although planning of treatment on such a basis seems ineffective, prediction in clinical practice mainly relies on experience and clinical judgement [1, 8].…”

General Practitioners Views of Implementing a Stratified Treatment Approach for Low Back Pain in Germany: A Qualitative Study

“…Numerous biopsychosocial risk factors for persistent disabling LBP have been identified in the literature, [ 4 , 6 – 8 ]. Identifying LBP treatments that can effectively target those factors has become the zeitgeist for research and clinical practice over the past 10 to 15 years [ 9 ].…”