Sub-grouping patients with non-specific low back pain based on cluster analysis of discriminatory clinical items

Abstract

Objective: To identify potential subgroups amongst patients with non-specific low back pain based on a consensus list of potentially discriminatory examination items. Design: Exploratory study. Participants: A convenience sample of 106 patients with nonspecific low back pain (43 males, 63 females, mean age 36 years, standard deviation 15.9 years) and 7 physiotherapists. Methods: Based on 3 focus groups and a two-round Delphi involving 23 health professionals and a random stratified sample of 150 physiotherapists, respectively, a comprehensive examination list comprising the most "discriminatory" items was compiled. Following reliability analysis, the most reliable clinical items were assessed with a sample of patients with non-specific low back pain. K-means cluster analysis was conducted for 2-, 3-and 4-cluster options to explore for meaningful homogenous subgroups. Results: The most clinically meaningful cluster was a twosubgroup option, comprising a small group (n = 24) with more severe clinical presentation (i.e. more widespread pain, functional and sleeping problems, other symptoms, increased investigations undertaken, more severe clinical signs, etc.) and a larger less dysfunctional group (n = 80). Conclusion: A number of potentially discriminatory clinical items were identified by health professionals and sub-classified, based on a sample of patients with non-specific low back pain, into two subgroups. However, further work is needed to validate this classification process.

Association of low back pain on physical, sociodemographic and lifestyle factors across a general population sample within Greece

“…), which according to the literature have been found to be strongly associated with LBP [3,4,15,32]. The majority of the questions were taken from an assessment sheet (Greek proforma), which has previously been tested for its reliability and has already been utilised among Greek LBP samples [33,34] In addition, three reliable, validate and extensively used self-administered questionnaires were added in the Greek survey form: i) The Roland-Morris Disability Questionnaire, which is one of the most popular questionnaires (entailing 24 questions), assessing mild to moderate physical disability caused by LBP, ii) Tthe Hospital Anxiety and Depression (HAD) scale, which is a 14-item scale detecting anxiety (7 items) and depression (7 items) in people with physical health problems, and finally iii), the SF-12 Health Survey, often reported as a QoL measure. It is a shorter version of the SF-36 Health Survey (version 2), entailing 12 questions for measuring physical health and well-being (mental health).…”

“…It is a shorter version of the SF-36 Health Survey (version 2), entailing 12 questions for measuring physical health and well-being (mental health). All three questionnaires have previously been cross-culturally validated within the Greek setting and have been utilised across similar populations [34,[36][37][38].…”

Low back pain and associated disability in Swedish adolescents

“…In China, a 3‐month LBP prevalence of about 40% in subjects 14 years of age was found, and in Norway, in the same age group, in a 3‐year follow‐up study, an odds ratio of 4.7 for LBP was found . Some authors have tried to clinically subclassify low back pain in adults into more severe and less severe LBP . Adolescent competitive athletes seem to have more LBP than nonathletes.…”

Identifying Subgroups of Patients With Chronic Nonspecific Low Back Pain Based on a Multifactorial Approach: Protocol For a Prospective Study

“…The poor efficiency of the available treatments is attributed to the heterogeneity of nonspecific chronic LBP patients [ 17 ]. Therefore, identifying nonspecific chronic LBP patient subgroups is essential [ 18 ] and will help optimize therapeutic management [ 19 - 22 ]. The need for nonspecific chronic LBP patient subgroups was highlighted by 84% of primary care clinicians on a large-scale survey [ 18 ].…”