Early predictors of the long-term outcome of low back pain--results of a 22-year prospective cohort study

The Effect of the Severity of Preoperative Back Pain on Patient-Reported Outcomes, Recovery Ratios, and Patient Satisfaction Following Minimally Invasive Transforaminal Lumbar Interbody Fusion (MIS-TLIF)

BACKGROUND

Limited literature has addressed impact of preoperative back pain severity on patient-reported outcome measures (PROMs), recovery ratios (RRs), and patient satisfaction following minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).

METHODS

MIS TLIFs were retrospectively identified and grouped: preoperative visual analog scale (VAS) back ≤7 or VAS back >7. PROMs, including PROMIS-PF, VAS back and leg, Oswestry Disability Index (ODI), and SF-12 Physical Composite Score and Mental Composite Score (MCS), were collected pre- and postoperatively. A PROM's RR was calculated as proportion of postoperative improvement to overall potential improvement.

RESULTS

In total, 740 patients were included: 359 patients with VAS back ≤7 and 381 patients with VAS back >7. The VAS back >7 cohort reported significantly greater postoperative inpatient pain (P ≤ .003, both). All preoperative and the following postoperative PROMs favored the VAS back ≤7 cohort: PROMIS-PF 2-years, VAS back overall, SF-12 Physical Composite Score 12 weeks and 1 year, SF-12 MCS 6 weeks/12 weeks, VAS leg 6 weeks, 12 weeks, 6 months, and 2 years, and ODI overall (P ≤ 0.048, all). The VAS back >7 cohort demonstrated greater delta PROMs for all VAS back and ODI except 2 years (P ≤ 0.021, all). A greater proportion of patients in the VAS back >7 group achieved minimal clinically important difference for VAS back overall, ODI 6 weeks/12 weeks, PROMIS-PF 6 weeks, and SF-12 MCS 6 weeks/6 months (P ≤ 0.044, all). The VAS back>7 cohort RR was significantly greater for VAS back 6 months and VAS leg 6 months/2 years (P ≤ 0.034, all). The VAS back ≤7 cohort's postoperative satisfaction was significantly greater for VAS back 12 weeks, VAS leg 12 weeks, and ODI 6 weeks/12 weeks (P ≤ 0.046, all).

CONCLUSIONS

Patients with greater preoperative back pain demonstrated significantly worse postoperative scores for most PROMs at most time points and significantly worse patient satisfaction for disability, back and leg pain at multiple time points.

Musculoskeletal signs in female homecare personnel: A longitudinal epidemiological study

BACKGROUND:

In Sweden, homecare services take care of elderly and disabled people, work that often requires heavy lifting and forward bending, resulting in high prevalences of pain and work accidents.

OBJECTIVE:

Using an eight-year follow-up, this study determines the prognostic importance of certain musculoskeletal signs reported in earlier studies [1, 2] with respect to aspects of pain and perceived disability.

METHODS:

Baseline data has been reported in earlier studies of 607 women [1–3]. This study uses a postal questionnaire survey and reports the results of eight years post initial study.

RESULTS:

Segmental pain at L4-L5 and/or L5-S1 levels was associated with higher low back pain intensity and disability at the eight-year follow-up. A decrease in low back pain intensity over eight years was larger for those with segmental pain. The important signs in the longitudinal analyses of pain aspects and disability were lumbar spinal mobility and segmental pain at L4-L5 and L5-S1 levels, but the explained variations were low.

CONCLUSION:

Evaluation of low lumbar segmental pain provocation and mobility should be considered in routine clinical assessments, as this type of evaluation provides prognostic pain and disability information over time.

Prognostic factors for disability and sick leave in patients with subacute non-malignant pain: a systematic review of cohort studies

OBJECTIVE

This systematic review aims to identify generic prognostic factors for disability and sick leave in subacute pain patients.

SETTING

General practice and other primary care facilities.

PARTICIPANTS

Adults (>18 years) with a subacute (≤ 3-month) non-malignant pain condition. Eligibility criteria were cohort studies investigating the prediction of disability or long-term sick leave in adults with a subacute pain condition in a primary care setting. 19 studies were included, referring to a total of 6266 patients suffering from pain in the head, neck, back and shoulders.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was long-term disability (>3 months) due to a pain condition. The secondary outcome was sick leave, defined as 'absence from work' or 'return-to-work'.

RESULTS

PubMed, EMBASE, CINAHL and PEDro databases were searched from 16 January 2003 to 16 January 2014. The quality of evidence was presented according to the GRADE WG recommendations. Several factors were found to be associated with disability at follow-up for at least two different pain symptoms. However, owing to insufficient studies, no generic risk factors for sick leave were identified.

CONCLUSIONS

Multiple site pain, high pain severity, older age, baseline disability and longer pain duration were identified as potential prognostic factors for disability across pain sites. There was limited evidence that anxiety and depression were associated with disability in patients with subacute pain, indicating that these factors may not play as large a role as expected in developing disability due to a pain condition. Quality of evidence was moderate, low or very low, implying that confidence in the results is limited. Large prospective prognostic factor studies are needed with sufficient study populations and transparent reporting of all factors examined.

TRIAL REGISTRATION NUMBER

CRD42014008914.

Clinical examination findings as prognostic factors in low back pain: a systematic review of the literature

Background

There is a strong tradition of performing a clinical examination of low back pain (LBP) patients and this is generally recommended in guidelines. However, establishing a pathoanatomic diagnosis does not seem possible in most LBP patients and clinical tests may potentially be more relevant as prognostic factors. The aim of this review of the literature was to systematically assess the association between low-tech clinical tests commonly used in adult patients with acute, recurrent or chronic LBP and short- and long-term outcome.

Methods

MEDLINE, Embase, and MANTIS were searched from inception to June 2012. Prospective clinical studies of adult patients with LBP with or without leg pain and/or signs of nerve root involvement or spinal stenosis, receiving non-surgical or no treatment, which investigated the association between low-tech clinical tests and outcome were included. Study selection, data extraction and appraisal of study quality were performed independently by two reviewers.

Results

A total of 5,332 citations were retrieved and screened for eligibility, 342 articles were assessed as full text and 49 met the inclusion criteria. Due to clinical and statistical heterogeneity, qualitative synthesis rather than meta-analysis was performed. Associations between clinical tests and outcomes were often inconsistent between studies. In more than one third of the tests, there was no evidence of the tests being associated with outcome. Only two clinical tests demonstrated a consistent association with at least one of the outcomes: centralization and non-organic signs.

Conclusions

For most clinical tests in LBP there is not consistent evidence for an association with outcome. Centralization and non-organic signs are exceptions from that. None of the other clinical tests have been investigated in confirmatory studies and study quality is generally low. There is a need for hypothesis testing studies designed specifically to investigate the prognostic value of the clinical tests, and a need for standardization of the performance and interpretation of tests.

Electronic supplementary material

The online version of this article (doi:10.1186/s12998-015-0054-y) contains supplementary material, which is available to authorized users.

Interventions focusing on psychosocial risk factors for patients with non-chronic low back pain in primary care--a systematic review

BACKGROUND

Low back pain (LBP) is a problem that is frequently encountered in primary care, and current guidelines encourage care providers to take into account psychosocial risk factors in order to avoid transition from acute to chronic LBP.

OBJECTIVE

To review the effectiveness of interventions focusing on psychosocial risk factors for patients with non-chronic LBP in primary care.

METHODS

A systematic search was undertaken for controlled trials focusing on psychosocial factors in adult patients with non-chronic, non-specific LBP in primary care by exploring Medline, Embase, PsycInfo, Francis, Web of Sciences and The Cochrane Library. The methodological quality of the studies included was assessed before analysing their findings.

RESULTS

Thirteen studies were selected, seven being considered as having a low risk of bias. Information strategies were assessed by eight trials, with high-quality evidence of no effectiveness for pain, function, work issues and health care use, low-quality evidence of no effectiveness for self-rated overall improvement, satisfaction and pain beliefs and lack of evidence in terms of quality of life. Cognitive behavioural therapy was assessed by three trials, with very low-quality evidence of moderate effectiveness for pain, function, quality of life, work issues and health care use. There was lack of evidence concerning the effectiveness of individual and group education intervention or work coordination.

CONCLUSION

Among the wide range of psychosocial risk factors, research has focused mainly on pain beliefs and coping skills, with disappointing results. Extended theoretical models integrating several psychosocial factors and multicomponent interventions are probably required to meet the challenge of LBP.

A closer examination of the interaction among risk factors for low back pain

PURPOSE

To evaluate the interactions of risk factors and identify their most powerful discrimination pathway for the occurrence of low back pain (LBP).

DESIGN

A cross-sectional study.

SETTING

Taiwan.

SUBJECTS

Taiwanese population of 30 to 64 years old.

MEASURES

A self-reported question, "Have you experienced LBP within the last 3 months?" was used to evaluate LBP. The study variables included demographics (age, gender, occupation, education level, marital status, and household income), biometric health measures (bone mineral density and body mass index), dietary habits (weekly milk, coffee, tea, and soybean consumption), and other lifestyle factors (smoking habits, alcohol consumption, betel nut chewing, body weight control, exercise regularity, and stress management).

ANALYSIS

Logistic regression and classification tree analyses.

RESULTS

A total of 969 Taiwanese participants were analyzed. Primary logistic regression analysis identified three critical risk factors (gender, bone mineral density, and exercise regularity) for the occurrence of LBP. By classification tree analysis, demographic factors, dietary habits, and lifestyle factors had modifying effects on LBP.

CONCLUSIONS

Various factors contribute to the risk of LBP. Interactions between risk factors should be considered when developing future strategies for the prevention and management of LBP.