- Email: [email protected]
Prognostic factors for short-term improvement in acute and persistent musculoskeletal pain consulters in primary care
Chiropractic Evidence 2012
81
are amenable to modification, may have a powerful impact on the management and subsequent outcomes for these LBP patients.
References 1. Borkan JM, Koes B, Reis S, Cherkin DC. A report from the second international forum for primary care research on low back pain: reexamining priorities. Spine 1998;23:1992—6. 2. Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, et al. European guidelines for the management of chronic non-specific low back pain. Eur Spine J 2006;15:S192—300. 3. Axen I, Rosenbaum A, Robech R, Wren T, Leboeuf-Yde C. Can patient reactions to the first chiropractic treatment predict early favourable treatment outcome in persistent low back pain? J Manip Physiol Ther 2002;25:450—4. 4. Leboeuf-Yde C, Gronstvedt A, Borge JA, Magnesen E, Nilsson O, Rosok G, et al. The Nordic back subpopulation program: demographic and clinical predictors for outcome in patients receiving chiropractic treatment for low-back pain. J Manip Physiol Ther 2004;27:493—502. 5. Axen I, Rosenbaum A, Robech R, Larsen K, Leboeuf-Yde C. The Nordic back pain subpopulation program: can patient reactions to the first chiropractic treatment predict early favourable treatment outcome in non-persistent low back pain? J Manip Physiol Ther 2005;28:153—8. 6. Axen I, Jones JJ, Rosenbaum A, Lovgren PW, Halasz L, Larsen K, et al. The Nordic back pain subpopulation program: validation and improvement of a predictive model for treatment outcome in patients with low back pain receiving chiropractic treatment. J Manip Physiol Ther 2005;28:381—5. 7. Malmqvist S, Leboeuf-Yde C, Ahola T, Andersson O, Ekstro ¨m K, Pekkarinen H, et al. The Nordic back pain subpopulation program: predicting outcome among chiropractic patients in Finland. Chiropr Osteopathy 2008;16:13. 8. Langworthy JM, Breen AC. Psychosocial factors and their predictive value in chiropractic patients with low back pain: a prospective inception cohort study. Chiropr Osteopathy 2007;15:5. 9. Newell D, Field J. Who will get better? Predicting clinical outcomes in a chiropractic practice. Clin Chiropr 2007;10:179—86. http://dx.doi.org/10.1016/j.clch.2012.06.003
Prognostic factors for short-term improvement in acute and persistent musculoskeletal pain consulters in primary care Hugh Hurst a, Jennifer Bolton b a Chiropractor, Independent Practice, Bristol, UK b Research Professor, AECC, Bournemouth, UK
Introduction Given the costs associated with the management of musculoskeletal pain in primary care, predicting the course of these conditions remains a research priority. Much of the research into prognostic indicators however considers musculoskeletal conditions in terms of single pain sites, whereas in reality many patients present with pain in more than one site. The aim of this study was to identify prognostic factors for early improvement in primary care consulters with acute and persistent musculoskeletal conditions across a range pain sites.
Methods Consecutive patients with a new episode of musculoskeletal pain completed self-report questionnaires at baseline, and then again at the 4/5th treatment visit, and if still consulting, at the 10th visit. The outcome was defined as patient self-report improvement sufficient to make a meaningful difference. Independent predictors of outcome were identified using multivariate regression analyses.
E-mail address: [email protected].
82
Chiropractic Evidence 2012
Results Acute (<7 weeks) patients, on average, had more severe conditions in terms of pain, disability, anxiety and work fear avoidance behaviour than patients with persistent (7 weeks) pain, but were more likely to be better by the 4/5th visit. Several variables at baseline were associated with improvement at the 4/5th visit, but the predictive models were weak and unable to discriminate between patients who were improved and those who were not. In contrast, it was possible to elicit a predictive model for improvement later on at the 10th visit, but only in patients with persistent pain. Being employed, reporting a decline in work fear avoidance behaviour at the 4/5th visit, and being better by the 4/5th visit, were all independently associated with improvement. This model accounted for 34.3% of the variation in observed improvement, and had good discriminative ability (area under curve 0.80) and approximate balance in correctly identifying improved and non-improved cases (79.0% and 68% respectively).
Conclusions We were unable to identify baseline characteristics that predicted early outcome in musculoskeletal pain patients. However, early self-reported improvement and decline in work fear avoidance behaviour as predictors of later improvement highlighted the importance of speedy recovery in persistent musculoskeletal pain consulters. Our findings reinforce the elusive nature of baseline predictors, and the need for more emphasis on early changes as prognostic predictors in musculoskeletal conditions. http://dx.doi.org/10.1016/j.clch.2012.06.004
Predictive value of subgroups defined by the STarT Back Tool in a chiropractic population Dave Newell a, Jonathan Field b a AECC, 13-15 Parkwood Road, Bournemouth, Dorset, United Kingdom b Back2Health, 2 Charles Street, Petersfield, Hampshire, United Kingdom
Introduction The ‘Subgroups for Targeted Treatment Back Screening Tool’ (SBT) is being recommended as a decision aid to help GP’s in the UK make treatment recommendations for patients presenting with lower back pain (LBP).1 Scoring the SBT places patients into one of three categories of risk for having LBP with disability that persists at three months; Low — few risk factors, suitable for GP management without referral (e.g. advice, analgesia and education). Medium — physical risk factors for poor prognosis, appropriate for referral to physical therapy. High — psychosocial risk factors for a very unfavourable prognosis likely to respond better to care including psychological components. If the tool becomes used to influence referral decisions by GP’s in the UK it will be important for chiropractors wishing to work with NHS patients to understand how patients from the three SBT categories are likely to improve or otherwise during their care. Additionally if the SBT is able to identify groups of patients less likely to respond well to ‘standard’ treatment, its use by practitioners could help identify individuals appropriate for alternative management or onwards referral.
Methods Eight hundred and eight consecutive patients aged over 16, presenting with LBP to one of six chiropractic clinics were asked to complete the SBTand Bournemouth Questionnaire (BQ) before their first visit (52% male, mean age (47.9), median duration of 21 days (range; 1 day to 20 years), 7.8% with any leg pain). Those who
E-mail address: [email protected].
81
are amenable to modification, may have a powerful impact on the management and subsequent outcomes for these LBP patients.
References 1. Borkan JM, Koes B, Reis S, Cherkin DC. A report from the second international forum for primary care research on low back pain: reexamining priorities. Spine 1998;23:1992—6. 2. Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, et al. European guidelines for the management of chronic non-specific low back pain. Eur Spine J 2006;15:S192—300. 3. Axen I, Rosenbaum A, Robech R, Wren T, Leboeuf-Yde C. Can patient reactions to the first chiropractic treatment predict early favourable treatment outcome in persistent low back pain? J Manip Physiol Ther 2002;25:450—4. 4. Leboeuf-Yde C, Gronstvedt A, Borge JA, Magnesen E, Nilsson O, Rosok G, et al. The Nordic back subpopulation program: demographic and clinical predictors for outcome in patients receiving chiropractic treatment for low-back pain. J Manip Physiol Ther 2004;27:493—502. 5. Axen I, Rosenbaum A, Robech R, Larsen K, Leboeuf-Yde C. The Nordic back pain subpopulation program: can patient reactions to the first chiropractic treatment predict early favourable treatment outcome in non-persistent low back pain? J Manip Physiol Ther 2005;28:153—8. 6. Axen I, Jones JJ, Rosenbaum A, Lovgren PW, Halasz L, Larsen K, et al. The Nordic back pain subpopulation program: validation and improvement of a predictive model for treatment outcome in patients with low back pain receiving chiropractic treatment. J Manip Physiol Ther 2005;28:381—5. 7. Malmqvist S, Leboeuf-Yde C, Ahola T, Andersson O, Ekstro ¨m K, Pekkarinen H, et al. The Nordic back pain subpopulation program: predicting outcome among chiropractic patients in Finland. Chiropr Osteopathy 2008;16:13. 8. Langworthy JM, Breen AC. Psychosocial factors and their predictive value in chiropractic patients with low back pain: a prospective inception cohort study. Chiropr Osteopathy 2007;15:5. 9. Newell D, Field J. Who will get better? Predicting clinical outcomes in a chiropractic practice. Clin Chiropr 2007;10:179—86. http://dx.doi.org/10.1016/j.clch.2012.06.003
Prognostic factors for short-term improvement in acute and persistent musculoskeletal pain consulters in primary care Hugh Hurst a, Jennifer Bolton b a Chiropractor, Independent Practice, Bristol, UK b Research Professor, AECC, Bournemouth, UK
Introduction Given the costs associated with the management of musculoskeletal pain in primary care, predicting the course of these conditions remains a research priority. Much of the research into prognostic indicators however considers musculoskeletal conditions in terms of single pain sites, whereas in reality many patients present with pain in more than one site. The aim of this study was to identify prognostic factors for early improvement in primary care consulters with acute and persistent musculoskeletal conditions across a range pain sites.
Methods Consecutive patients with a new episode of musculoskeletal pain completed self-report questionnaires at baseline, and then again at the 4/5th treatment visit, and if still consulting, at the 10th visit. The outcome was defined as patient self-report improvement sufficient to make a meaningful difference. Independent predictors of outcome were identified using multivariate regression analyses.
E-mail address: [email protected].
82
Chiropractic Evidence 2012
Results Acute (<7 weeks) patients, on average, had more severe conditions in terms of pain, disability, anxiety and work fear avoidance behaviour than patients with persistent (7 weeks) pain, but were more likely to be better by the 4/5th visit. Several variables at baseline were associated with improvement at the 4/5th visit, but the predictive models were weak and unable to discriminate between patients who were improved and those who were not. In contrast, it was possible to elicit a predictive model for improvement later on at the 10th visit, but only in patients with persistent pain. Being employed, reporting a decline in work fear avoidance behaviour at the 4/5th visit, and being better by the 4/5th visit, were all independently associated with improvement. This model accounted for 34.3% of the variation in observed improvement, and had good discriminative ability (area under curve 0.80) and approximate balance in correctly identifying improved and non-improved cases (79.0% and 68% respectively).
Conclusions We were unable to identify baseline characteristics that predicted early outcome in musculoskeletal pain patients. However, early self-reported improvement and decline in work fear avoidance behaviour as predictors of later improvement highlighted the importance of speedy recovery in persistent musculoskeletal pain consulters. Our findings reinforce the elusive nature of baseline predictors, and the need for more emphasis on early changes as prognostic predictors in musculoskeletal conditions. http://dx.doi.org/10.1016/j.clch.2012.06.004
Predictive value of subgroups defined by the STarT Back Tool in a chiropractic population Dave Newell a, Jonathan Field b a AECC, 13-15 Parkwood Road, Bournemouth, Dorset, United Kingdom b Back2Health, 2 Charles Street, Petersfield, Hampshire, United Kingdom
Introduction The ‘Subgroups for Targeted Treatment Back Screening Tool’ (SBT) is being recommended as a decision aid to help GP’s in the UK make treatment recommendations for patients presenting with lower back pain (LBP).1 Scoring the SBT places patients into one of three categories of risk for having LBP with disability that persists at three months; Low — few risk factors, suitable for GP management without referral (e.g. advice, analgesia and education). Medium — physical risk factors for poor prognosis, appropriate for referral to physical therapy. High — psychosocial risk factors for a very unfavourable prognosis likely to respond better to care including psychological components. If the tool becomes used to influence referral decisions by GP’s in the UK it will be important for chiropractors wishing to work with NHS patients to understand how patients from the three SBT categories are likely to improve or otherwise during their care. Additionally if the SBT is able to identify groups of patients less likely to respond well to ‘standard’ treatment, its use by practitioners could help identify individuals appropriate for alternative management or onwards referral.
Methods Eight hundred and eight consecutive patients aged over 16, presenting with LBP to one of six chiropractic clinics were asked to complete the SBTand Bournemouth Questionnaire (BQ) before their first visit (52% male, mean age (47.9), median duration of 21 days (range; 1 day to 20 years), 7.8% with any leg pain). Those who
E-mail address: [email protected].