The prognosis of chronic low back pain is determined by changes in pain and disability in the initial period

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• 作者：Martijn W. Heymans ; Stef van Buuren ; Dirk L. Knol ; Johannes R. Anema ; Willem van Mechelen ; Henrica C.W. de Vet
• 关键词：Low back pain ; Chronic pain ; Prognosis ; Prospective cohort study ; Bootstrapping
• 刊名：The Spine Journal
• 出版年：2010
• 出版时间：October 2010
• 年：2010
• 卷：10
• 期：10
• 页码：847-856
• 全文大小：150 K

文摘

Background context

The recovery of patients with chronic low back pain (LBP) is slow. Furthermore, it is recently proposed that chronic LBP needs a prognostic approach to determine who will develop clinically significant back pain. Therefore, it is imperative to identify prognostic factors that are mostly seen in chronic LBP patients at an early stage. This may give clinicians tailored advice to prevent chronicity or may refer to a specific intervention.

Purpose

To investigate the contribution of demographic, work, clinical, and psychosocial variables, including new prognostic variables as changes in pain intensity and disability status, on the development of chronic LBP.

Study design/setting

Prospective cohort data by merging data from three randomized trials (secondary analyses).

Patient sample

Workers (n=628) on sick leave because of subacute nonspecific LBP.

Outcome measures

Chronic LBP for longer than 6 months (functional measure).

Methods

Potential prognostic variables were demographic, work, clinical, and psychosocial characteristics (self-report measures). We also included as prognostic variables a clinically relevant change in pain intensity and disability status. For the selection of variables and prognostic models, bootstrapping techniques were used in combination with multivariable logistic regression. The explained variance and discrimination were used to evaluate the clinical performance of the models.

Results

The variables most strongly related to chronic LBP were as follows: no clinically relevant change in pain intensity and in disability status in the first 3 months, a higher pain intensity score at baseline, and a higher score for kinesiophobia. This prognostic model had a bootstrap-corrected explained variance of 37 % and a discriminative ability (c index) of 0.80.

Conclusions

Clinical-, work-, and psychosocial-related variables contribute to the development of chronic LBP. The most promising variables are a clinically relevant decrease in pain intensity and in disability status in the first 3 months. These variables are relevant for clinicians to advise their patients with respect to preventive measures or treatment strategies.