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Pauli J, Starkweather A, Robins JL. Screening Tools to Predict the Development of Chronic Low Back Pain: An Integrative Review of the Literature. PAIN MEDICINE 2020; 20:1651-1677. [PMID: 30307521 DOI: 10.1093/pm/pny178] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To identify and describe available instruments that can be used to screen patients with acute or subacute low back pain for a chronic low back pain trajectory. DESIGN Integrative literature review. METHODS An electronic search of PubMed/MEDLINE, CINAHL, Cochrane Database of Systematic Reviews, and PsychINFO databases took place from May through July of 2014 using systematic search strategies to identify screening instruments developed to identify people at risk of chronic low back pain. After screening for inclusion and exclusion criteria as well as quality indicators, the identified studies were categorized based on whether the instrument measured psychological, clinical, or functional measures to predict chronic low back pain. RESULTS Initial searches identified 2,274 potential articles. After assessing for duplicates, title, and abstract content, there were 129 remaining articles. Articles were further excluded after analysis of the text, for a total of 42 studies reviewed. Most instruments reviewed were unable to provide evidence of predictive power for developing chronic low back pain. CONCLUSIONS This review identified numerous instruments developed to assess the likelihood of chronic low back pain in acute and subacute low back pain populations. Of the instruments reviewed, the STarT Back Screening Tool and the Örebro Musculoskeletal Pain Questionnaire demonstrated superior predictive power compared with other instruments. Both screening tools offer evidence of validation, translation into different languages and international application, and usage in various health care settings and provide data on predictive power.
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Affiliation(s)
- Jena Pauli
- Virginia Commonwealth University, School of Nursing, Richmond, Virginia
| | | | - Jo Lynne Robins
- Virginia Commonwealth University, School of Nursing, Richmond, Virginia
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Gabel CP, Mokhtarinia HR, Hoffman J, Osborne J, Laakso EL, Melloh M. Does the performance of five back-associated exercises relate to the presence of low back pain? A cross-sectional observational investigation in regional Australian council workers. BMJ Open 2018; 8:e020946. [PMID: 30093512 PMCID: PMC6089271 DOI: 10.1136/bmjopen-2017-020946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Investigate the relationships between the ability/inability to perform five physical test exercises and the presence or absence of low back pain (LBP). SETTING Regional Australian council training facility. PARTICIPANTS Consecutive participants recruited during 39 back education classes (8-26 participants per class) for workers in general office/administration, parks/gardens maintenance, roads maintenance, library, child care and management. Total sample (n=539) was reduced through non-consent and insufficient demographic data to n=422. Age 38.6±15.3 years, range 18-64 years, 67.1% male. METHODS Cross-sectional, exploratory, observational investigation. LBP presence was ascertained from a three-response option questionnaire: 0=none/rarely (no) 1=sometimes (some), 2=mostly/always (most). Statistical correlation was performed with the number of the five test exercises the individual successfully performed: (1) extension in lying: 3 s; (2) 'toilet squat'; feet flat, feet touched: 3 s; (3) full squat then stand up: 5 times; (4) supine sit-up, knees flexed: 10 times; and (5) leg extension, supine bilateral: 10 times. INTERVENTIONS Nil. RESULTS For the group 'no-some', 94.3% completed 4-5 test exercises, while for group 'With', 95.7% completed 0-1 test exercises. The relationship between LBP presence and number of exercises performed was highly significant (χ2(10)=300.61, p<0.001). Furthermore, multinomial logistic regression predicting LBP (0=no, 1=some, 2=most) from the number of exercises completed, substantially improved the model fit (initial-2LL=348.246, final-2LL=73.620, χ2(2)=274.626, p<0.001). As the number of exercises performed increased, the odds of reporting 'some LBP' or 'most LBP' dropped substantially (ORs of 0.34 and 0.17, respectively). CONCLUSION The ability to complete/not complete five test exercises correlated statistically and significantly with a higher LBP absence/presence in a general working population. Training individuals to complete such exercises could facilitate reductions in LBP incidence; however, causality cannot be inferred. Randomised trials are recommended to establish the potential efficacy of exercise-based approaches, considering these five selected exercises, for predicting and managing LBP.
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Affiliation(s)
| | - Hamid Reza Mokhtarinia
- Department of Ergonomics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Jonathan Hoffman
- Human Movement, Independent Private Researcher, Placencia Village, Belize
| | - Jason Osborne
- Department of Mathematical Sciences, Clemson University, Clemson, South Carolina, USA
- Department of Public Health Science, Clemson University, Clemson, South Carolina, USA
| | - E-Liisa Laakso
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
- Mater Research, Mater Medical Research Institute, Brisbane, Queensland, Australia
| | - Markus Melloh
- School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
- UWA Medical School, University of Western Australia, Perth, Western Australia, Australia
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Laker S, Friedrich J, Stanos SP, Tyburski MD. Management of Chronic Pain. PM R 2015; 7:S316-S323. [PMID: 26568509 DOI: 10.1016/j.pmrj.2015.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 09/28/2015] [Indexed: 11/24/2022]
Affiliation(s)
- Scott Laker
- Department of Physical Medicine and Rehabilitation, University of Colorado, 2120 Professional Drive, Suite 225, Denver, CO 95661
| | - Jason Friedrich
- Department of Physical Medicine and Rehabilitation, University of Colorado Denver, Denver, CO
| | - Steven P Stanos
- Pain Medicine Services and Occupational Medicine Services, Swedish Medical System, Seattle, WA
| | - Mark D Tyburski
- Department of Physical Medicine and Rehabilitation, The Permanente Medical Group, Inc., Sacramento/Roseville, CA
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Melloh M, Cornwall J, Crawford RJ, Elfering A. Does injury claim status and benefit status predict low back pain outcomes? Australas Med J 2015; 8:268-76. [PMID: 26392824 PMCID: PMC4560897 DOI: 10.4066/amj.2015.2464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
BACKGROUND In New Zealand the Accident Compensation Corporation (ACC) is a state-funded insurance agency that accepts claims for accidental injuries, including lumbar spine injuries. It is unknown whether ACC claim status (accepted, not accepted) affects low back pain (LBP) outcomes, or whether benefit status (e.g., sickness, disability) further affects outcomes in patients without ACC cover. AIMS This study aimed to determine whether ACC claim and benefit status are likely to influence a range of outcomes for people with LBP in New Zealand. METHODS A prospective survey of low back pain patients was performed (April 2008-October 2010). ACC claim status was recorded, and individuals without accepted claims indicated benefit status. Surveys were sent at multiple time points; pain, functional limitation, psychological factors, and general health were assessed. Statistical analysis was undertaken using ANCOVA and ANOVA (p<0.05). RESULTS In total, 168 patients completed the study. Six-month measures showed individuals with no ACC claim for LBP to overall have poorer outcomes (mental health, p=0.039; pain, p=0.045; functional limitation, p=0.049); sub-group analysis (no ACC claim) between those with or without a benefit showed those on benefits to have significantly higher functional limitation (p<0.001), poorer physical health (p=0.002), greater pain (p=0.027), and stronger fear avoidance behaviours for both work (p=0.047) and physical activity (p=0.35). CONCLUSION Findings indicate individuals with accepted ACC claims for LBP have significantly better outcomes than those without, and patients on benefits with no accepted ACC claim for LBP have even poorer outcomes.
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Affiliation(s)
- Markus Melloh
- Zurich University of Applied Sciences, Zurich, Switzerland
| | - Jon Cornwall
- Zurich University of Applied Sciences, Zurich, Switzerland
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Melloh M, Elfering A, Käser A, Salathé CR, Barz T, Aghayev E, Röder C, Theis JC. Depression impacts the course of recovery in patients with acute low-back pain. Behav Med 2014; 39:80-9. [PMID: 23930900 DOI: 10.1080/08964289.2013.779566] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Little is known about the course of recovery of acute low back pain (LBP) patients as a function of depression. In a prospective study, 286 acute LBP patients were assessed at baseline and followed up over 6 months. Recovery was defined as improvement in the Oswestry Disability Index (ODI). Repeated-measures analysis of covariance was employed with ODI as repeated factor, age, sex, and body mass index as covariates, depression and all other potential prognostic factors as between-subject factors. Of study participants, 18% were classified as depressive (>33 points on the Zung Self-Rating Depression Scale). Of 286 participants, 135 were lost to follow-up. In the longitudinal sample of 151 patients the course of recovery was slower in depressive patients. Depression was associated with LBP especially after 6 weeks and should therefore be included in screening instruments for acute LBP patients to identify those at risk of delayed recovery at an early stage.
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Affiliation(s)
- Markus Melloh
- Western Australian Institute for Medical Research-WAIMR, University ofWestern Australia, B Block, QEII Medical Center, Hospital Avenue, Nedlands, WA 6009, Australia.
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Melloh M, Salathé CR, Elfering A, Käser A, Barz T, Aghayev E, Röder C, Theis JC. Occupational, personal and psychosocial resources for preventing persistent low back pain. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2013; 19:29-40. [PMID: 23498709 DOI: 10.1080/10803548.2013.11076964] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of this prospective cohort study was to identify modifiable protective factors of the progression of acute/subacute low back pain (LBP) to the persistent state at an early stage to reduce the socioeconomic burden of persistent LBP. Patients attending a health practitioner for acute/subacute LBP were assessed at baseline addressing occupational, personal and psychosocial factors, and followed up over 12 weeks. Pearson correlations were calculated between these baseline factors and the presence of nonpersistent LBP at 12-week follow-up. For those factors found to be significant, multivariate logistic regression analyses were performed. The final 3-predictor model included job satisfaction, mental health and social support. The accuracy of the model was 72%, with 81% of nonpersistent and 60% of persistent LBP patients correctly identified. Further research is necessary to confirm the role of different types of social support regarding their prognostic influence on the development of persistent LBP.
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Affiliation(s)
- Markus Melloh
- Western Australian Institute for Medical Research, University of Western Australia, Nedlands, Australia.
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Elfering A, Käser A, Melloh M. Relationship between depressive symptoms and acute low back pain at first medical consultation, three and six weeks of primary care. PSYCHOL HEALTH MED 2013; 19:235-46. [DOI: 10.1080/13548506.2013.780131] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Melloh M, Elfering A, Salathé CR, Käser A, Barz T, Röder C, Theis JC. Predictors of sickness absence in patients with a new episode of low back pain in primary care. INDUSTRIAL HEALTH 2012; 50:288-298. [PMID: 22673362 DOI: 10.2486/indhealth.ms1335] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This study examines predictors of sickness absence in patients presenting to a health practitioner with acute/ subacute low back pain (LBP). Aims of this study were to identify baseline-variables that detect patients with a new LBP episode at risk of sickness absence and to identify prognostic models for sickness absence at different time points after initial presentation. Prospective cohort study investigating 310 patients presenting to a health practitioner with a new episode of LBP at baseline, three-, six-, twelve-week and six-month follow-up, addressing work-related, psychological and biomedical factors. Multivariate logistic regression analysis was performed to identify baseline-predictors of sickness absence at different time points. Prognostic models comprised 'job control', 'depression' and 'functional limitation' as predictive baseline-factors of sickness absence at three and six-week follow-up with 'job control' being the best single predictor (OR 0.47; 95%CI 0.26-0.87). The six-week model explained 47% of variance of sickness absence at six-week follow-up (p<0.001). The prediction of sickness absence beyond six-weeks is limited, and health practitioners should re-assess patients at six weeks, especially if they have previously been identified as at risk of sickness absence. This would allow timely intervention with measures designed to reduce the likelihood of prolonged sickness absence.
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Affiliation(s)
- Markus Melloh
- Western Australian Institute for Medical Research, University of Western Australia, Australia
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Prognostic occupational factors for persistent low back pain in primary care. Int Arch Occup Environ Health 2012; 86:261-9. [PMID: 22434236 DOI: 10.1007/s00420-012-0761-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 03/05/2012] [Indexed: 01/07/2023]
Abstract
PURPOSE To reduce the socio-economic burden of persistent low back pain (LBP), factors influencing the progression of acute/subacute LBP to the persistent state must be identified at an early stage. METHODS Prospective inception cohort study of patients attending a health practitioner for their first episode of acute/subacute or recurrent LBP. Patients were assessed at baseline addressing occupational, psychological, biomedical and demographic/lifestyle factors and followed up over 6 months. Multivariate logistic regression analysis was performed separately for the variables groups of the four different domains, controlling for age, gender and body mass index. The overall predictive value was calculated for the full regression models of the different domains. Finally, all significant variables from the different domains were combined into a final predictor model. RESULTS The final four-predictor model predicted 51 % of variance of persistent LBP and included 'resigned attitude towards the job' (OR 1.73; 95 % CI 1.16-2.59), 'social support at work' (OR 0.54; 95 % CI 0.32-0.90), 'functional limitation' (OR 1.05; 95 % CI 1.01-1.10) and 'duration of LBP' (OR 1.04; 95 % CI 1.02-1.06). The accuracy of the model was 83 %, with 92 % of non-persistent and 67 % of persistent LBP patients correctly identified. CONCLUSIONS In this study of patients with acute/subacute LBP, 'resigned attitude towards the job' increased the likelihood of persistent LBP at 6 month. Addressing this factor with workplace interventions has the potential to modify the outcome. In patients experiencing 'social support at work', the development of persistent LBP was less likely and might therefore be considered as potential resource for prevention of persistent LBP.
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Melloh M, Elfering A, Egli Presland C, Roder C, Hendrick P, Darlow B, Theis JC. Predicting the transition from acute to persistent low back pain. Occup Med (Lond) 2011; 61:127-31. [DOI: 10.1093/occmed/kqq194] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Harms MC, Peers CE, Chase D. Low back pain: what determines functional outcome at six months? An observational study. BMC Musculoskelet Disord 2010; 11:236. [PMID: 20942925 PMCID: PMC2973928 DOI: 10.1186/1471-2474-11-236] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Accepted: 10/13/2010] [Indexed: 11/23/2022] Open
Abstract
Background The rise in disability due to back pain has been exponential with escalating medical and societal costs. The relative contribution of individual prognostic indicators to the pattern of recovery remains unclear. The objective of this study was to determine the prognostic value of demographic, psychosocial, employment and clinical factors on outcome in patients with low back pain Methods A prospective cohort study with six-month follow-up was undertaken at a multidisciplinary back pain clinic in central London employing physiotherapists, osteopaths, clinical psychologists and physicians, receiving referrals from 123 general practitioners. Over a twelve-month period, 593 consecutive patients referred from general practice with simple low back pain were recruited. A baseline questionnaire was developed to elicit information on potential prognostic variables. The primary outcome measures were change in 24-item Roland Morris disability questionnaire score at six months as a measure of low back related functional disability and the physical functioning scale of the SF-36, adjusted for baseline scores. Results Roland Morris scores improved by 3.8 index points (95% confidence interval 3.23 to 4.32) at six months and SF-36 physical functioning score by 10.7 points (95% confidence interval 8.36 to 12.95). Ten factors were linked to outcome yet in a multiple regression model only two remained predictive. Those with episodic rather than continuous pain were more likely to have recovered at six months (odds ratio 2.64 confidence interval 1.25 to 5.60), while those that classified themselves as non-white were less likely to have recovered (0.41 confidence interval 0.18 to 0.96). Conclusions Analysis controlling for confounding variables, demonstrated that participants showed greater improvement if their episodes of pain during the previous year were short-lived while those with Middle Eastern, North African and Chinese ethnicity demonstrated minimal improvement. The study did not support previous findings that a wide range of factors could predict outcome.
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Affiliation(s)
- Michele C Harms
- Faculty of Health and Social Care Sciences, Kingston University, St Georges University of London, Cranmer Terrace, London SW17 0RE, UK.
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Melloh M, Elfering A, Egli Presland C, Roeder C, Barz T, Rolli Salathé C, Tamcan O, Mueller U, Theis JC. Identification of prognostic factors for chronicity in patients with low back pain: a review of screening instruments. INTERNATIONAL ORTHOPAEDICS 2009; 33:301-13. [PMID: 19130056 DOI: 10.1007/s00264-008-0707-8] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2008] [Revised: 10/17/2008] [Accepted: 10/31/2008] [Indexed: 01/07/2023]
Abstract
Low back pain (LBP) is currently the most prevalent and costly musculoskeletal problem in modern societies. Screening instruments for the identification of prognostic factors in LBP may help to identify patients with an unfavourable outcome. In this systematic review screening instruments published between 1970 and 2007 were identified by a literature search. Nine different instruments were analysed and their different items grouped into ten structures. Finally, the predictive effectiveness of these structures was examined for the dependent variables including "work status", "functional limitation", and "pain". The strongest predictors for "work status" were psychosocial and occupational structures, whereas for "functional limitation" and "pain" psychological structures were dominating. Psychological and occupational factors show a high reliability for the prognosis of patients with LBP. Screening instruments for the identification of prognostic factors in patients with LBP should include these factors as a minimum core set.
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Affiliation(s)
- M Melloh
- Department of Medical and Surgical Sciences, Dunedin School of Medicine, University of Otago, Private Bag 1921, Dunedin, New Zealand.
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