Psychosocial factors and their predictive value in chiropractic patients with low back pain: a prospective inception cohort study

Abstract

BackgroundBeing able to estimate the likelihood of poor recovery from episodes of back pain is important for care. Studies of psychosocial factors in inception cohorts in general practice and occupational populations have begun to make inroads to these problems. However, no studies have yet investigated this in chiropractic patients.MethodsA prospective inception cohort study of patients presenting to a UK chiropractic practice for new episodes of non-specific low back pain (LBP) was conducted. Baseline questionnaires asked about age, gender, occupation, work status, duration of current episode, chronicity, aggravating features and bothersomeness using Deyo's 'Core Set'. Psychological factors (fear-avoidance beliefs, inevitability, anxiety/distress and coping, and co-morbidity were also assessed at baseline. Satisfaction with care, number of attendances and pain impact were determined at 6 weeks. Predictors of poor outcome were sought by the calculation of relative risk ratios.ResultsMost patients presented within 4 weeks of onset. Of 158 eligible and willing patients, 130 completed both baseline and 6-week follow-up questionnaires. Greatest improvements at 6 weeks were in interference with normal work (ES 1.12) and LBP bothersomeness (ES 1.37). Although most patients began with moderate-high back pain bothersomeness scores, few had high psychometric ones. Co-morbidity was a risk for high-moderate interference with normal work at 6 weeks (RR 2.37; 95% C.I. 1.15–4.74). An episode duration of >4 weeks was associated with moderate to high bothersomeness at 6 weeks (RR 2.07; 95% C.I. 1.19 – 3.38) and negative outlook (inevitability) with moderate to high interference with normal work (RR 2.56; 95% C.I. 1.08 – 5.08).ConclusionPatients attending a private UK chiropractic clinic for new episodes of non-specific LBP exhibited few psychosocial predictors of poor outcome, unlike other patient populations that have been studied. Despite considerable bothersomeness at baseline, scores were low at follow-up. In this independent health sector back pain population, general health and duration of episode before consulting appeared more important to outcome than psychosocial factors.

The use of weekly text messaging over 6 months was a feasible method for monitoring the clinical course of low back pain in patients seeking chiropractic care

“…Therefore, in terms of health level, this sample seems representative, placed between a ''normally healthy'' population and those presumed to be of poorer health. However, studies have shown that depression and anxiety, predictors of chronicity [32], are relatively rare in chiropractic patients, and when present, it was unimportant for outcome [28,33]. Whether such psychological factors influence the willingness of responding frequently is not known.…”

Preliminary study into the components of the fear-avoidance model of LBP: change after an initial chiropractic visit and influence on outcome

“…It has been suggested that this may be because patients choosing to present to a chiropractor generally have lower levels of potentially adverse psychological functioning [20]. …”

“…This has been suggested to be due to the observation that patients choosing to present to a chiropractor generally have lower levels of potentially adverse psychological functioning [20]. However, although the mean level of adverse psychology may well be lower than the wider LBP population it remains possible that of those chiropractic patients that present with significant psychological distress this may still present a barrier to recovery.…”

Predicting who responds to spinal manipulative therapy using a short-time frame methodology: Results from a 238-participant study

“…Similarly, a study using a pragmatic osteopathic approach that employed SMT found two statistically significant baseline variables including depression and pain intensity as predictors of back-related disability at 4 years [22]. Other studies from other groups have achieved similar results when consideration for symptom duration was given [14,17].…”