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Lawan A, Aubertin A, Mical J, Hum J, Graf ML, Marley P, Bolton Z, Walton DM. Is educational attainment associated with the onset and outcomes of low back pain? a systematic review and meta-analysis. PLoS One 2024; 19:e0308625. [PMID: 39137213 PMCID: PMC11321572 DOI: 10.1371/journal.pone.0308625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 07/26/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Low back pain (LBP) is the leading global cause of years lived with disability. Of the biopsychosocial domains of health, social determinants of LBP remain under-researched. Socioeconomic status (SES) may be associated with the onset of new LBP or outcomes of acute LBP, with educational attainment (EA) being a key component of SES. The association between EA and LBP has yet to be the subject of a dedicated review and meta-analysis. PURPOSE To review evidence of the association between EA and a) onset or b) outcomes of acute and subacute LBP in the adult general population and to conduct statistical pooling of data where possible. METHODS An electronic search was conducted in MEDLINE, Embase, CINAHL, and ProQuest from inception to 2nd November 2023 including reference lists to identify relevant prospective studies. Risk of bias (RoB) was assessed using the Quality in Prognostic Studies (QUIPS) tool. Where adequate data were available, estimates were pooled using a random-effects meta-analysis. Overall evidence for each outcome was graded using an adapted GRADE. RESULTS After screening 8498 studies, 29 were included in the review. Study confounding and attrition were common biases. Data from 19 studies were statistically pooled to explore EA as a predictor of new LBP onset or as prognostic for outcomes of acute or subacute LBP. Pooled results showed no association between EA and the onset of new LBP (OR: 0.927, 95%CI: 0.747 to 1.150; I2 = 0%). For predicting outcomes of acute LBP, compared to those with no more than secondary-level education, post-secondary education or higher was associated with better outcomes of pain (OR: 0.538, 95%CI: 0.432 to 0.671; I2 = 35%) or disability (OR: 0.565, 95%CI: 0.420 to 0.759; I2 = 44%). High heterogeneity (I2>80%) prevented meaningful pooling of estimates for subacute LBP outcomes. CONCLUSION We found no consistent evidence that lower EA increases the risk of LBP onset. Lower EA shows a consistent association with worse LBP outcomes measured at least 3 months later after acute onset with inconclusive findings in subacute LBP. Causation cannot be supported owing to study designs. High-quality research is needed on potential mechanisms to explain these effects.
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Affiliation(s)
- Aliyu Lawan
- Faculty of Health Sciences, School of Physical Therapy, Western University, London, Ontario, Canada
| | - Alex Aubertin
- School of Health Sciences, Nursing and Emergency Services, Cambrian College, Sudbury, Ontario, Canada
| | - Jane Mical
- Faculty of Health Sciences, School of Physical Therapy, Western University, London, Ontario, Canada
| | - Joanne Hum
- Palliative Care, Fraser Health Authority, New Westminster, British Columbia, Canada
| | - Michelle L. Graf
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter Marley
- Faculty of Health Sciences, School of Physical Therapy, Western University, London, Ontario, Canada
| | - Zachary Bolton
- Faculty of Health Sciences, School of Physical Therapy, Western University, London, Ontario, Canada
| | - David M. Walton
- Faculty of Health Sciences, School of Physical Therapy, Western University, London, Ontario, Canada
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Dunn M, Rushton AB, Mistry J, Soundy A, Heneghan NR. The biopsychosocial factors associated with development of chronic musculoskeletal pain. An umbrella review and meta-analysis of observational systematic reviews. PLoS One 2024; 19:e0294830. [PMID: 38557647 PMCID: PMC10984407 DOI: 10.1371/journal.pone.0294830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/18/2024] [Indexed: 04/04/2024] Open
Abstract
AIM The aim of this umbrella review was to establish which biopsychosocial factors are associated with development of chronic musculoskeletal pain. METHODS Ovid Medline, Embase, Web of Science Core Collection, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, PsycINFO, CINAHL, PEDro, PROSPERO, Google Scholar and grey literature were searched from database inception to 4th April 2023. Systematic reviews of observational prospective longitudinal studies, including populations with <3 months (not chronic) musculoskeletal pain, investigating biopsychosocial factors that contribute to development of chronic (>3 months) musculoskeletal pain. Two reviewers searched the literature, assessed risk of bias (Assessing the Methodological Quality of Systematic Reviews-2), and evaluated quality (Grading of Recommendations, Assessment, Development and Evaluation) to provide an overall statement on the certainty of evidence for each biopsychosocial factor. Data analysis was performed through random effects meta-analysis (including meta-analysis of meta-analyses where possible) and descriptive synthesis. RESULTS 13 systematic reviews were included comprising 185 original research studies (n = 489,644 participants). Thirty-four biopsychosocial factors are associated with development of chronic musculoskeletal pain. Meta-analyses of odds and/or likelihood ratios were possible for 25 biopsychosocial factors. There is moderate certainty evidence that smoking (OR 1.24 [95%CI, 1.14-1.34), fear avoidance (LR+ 2.11 [95%CI, 1.59-2.8]; LR- 0.5 [95%CI, 0.35-0.71]) poorer support networks (OR 1.21 [95%CI, 1.14-1.29]), lower socioeconomic status (OR 2.0 [95%CI, 1.64-2.42]), and high levels of pain (OR 5.61 [95%CI, 3.74-8.43]) are associated with development of chronic musculoskeletal pain (all P<0.001). Remaining factors are of low or very low certainty evidence. CONCLUSIONS AND RELEVANCE There is moderate certainty evidence that smoking, fear avoidance, poorer support networks, lower socioeconomic status, and high levels of pain are associated with development of chronic musculoskeletal pain. High risk of bias was evident in most included reviews; this highlights the need for higher quality systematic reviews.
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Affiliation(s)
- Michael Dunn
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport and Exercise Science, University of Birmingham, Birmingham, West Midlands, United Kingdom
- Musculoskeletal Physiotherapy, St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
- Institute of Medical and Biomedical Education, Centre for Allied Health, St. George's University of London, London, United Kingdom
| | - Alison B Rushton
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport and Exercise Science, University of Birmingham, Birmingham, West Midlands, United Kingdom
- School of Physical Therapy, Western University, London, Ontario, Canada
| | - Jai Mistry
- Musculoskeletal Physiotherapy, St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
- School of Physical Therapy, Western University, London, Ontario, Canada
| | - Andrew Soundy
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport and Exercise Science, University of Birmingham, Birmingham, West Midlands, United Kingdom
| | - Nicola R Heneghan
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport and Exercise Science, University of Birmingham, Birmingham, West Midlands, United Kingdom
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Tousignant-Laflamme Y, Houle C, Longtin C, Gérard T, Lagueux E, Perreault K, Beaudry H, Tétreault P, Blanchette MA, Décary S. Prognostic factors specific to work-related musculoskeletal disorders: An overview of recent systematic reviews. Musculoskelet Sci Pract 2023; 66:102825. [PMID: 37463542 DOI: 10.1016/j.msksp.2023.102825] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 06/20/2023] [Accepted: 07/03/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE Work-related injuries affect a considerable number of people each year and represent a significant burden for society. To reduce this burden, optimizing rehabilitation care by integrating prognostic factors (PF) into the clinical decision-making process is a promising way to improve clinical outcomes. The aim of this study was to identify PF specific to work-related musculoskeletal disorders. METHODS We performed an overview of systematic reviews reporting on PF that had the following outcomes of interest: Return to work, pain, disability, functional status, or poor outcomes. Each extracted PF was categorized according to its level of evidence (grade A or B) and whether it was modifiable or not. The risk of bias of each study was assessed with the ROBIS tool. RESULTS We retrieved 757 citations from 3 databases. After removing 307 duplicates, 450 records were screened, and 20 studies were retained. We extracted a total of 20 PF with a Grade A recommendation, where 7 were deemed modifiable, 11 non-modifiable and 2 were index test. For example, return to work expectations, previous sick leave, delay in referral and pain intensity were found to be predictors of return-to-work outcomes. We also identified 17 PF with a Grade B recommendation, where 11 were deemed modifiable. For example, poor general health, negative recovery expectations, coping and fear-avoidance beliefs, pain severity, and particularly physical work were found to predict return to work outcomes. CONCLUSION We found numerous modifiable PFs that can help clinicians personalize their treatment plan beyond diagnostic-related information for work-related musculoskeletal disorders.
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Affiliation(s)
- Yannick Tousignant-Laflamme
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada; Clinical Research of the Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, QC, Canada.
| | - Catherine Houle
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada; Clinical Research of the Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, QC, Canada
| | - Christian Longtin
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada; Clinical Research of the Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, QC, Canada
| | - Thomas Gérard
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada; Clinical Research of the Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, QC, Canada
| | - Emilie Lagueux
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada; Clinical Research of the Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, QC, Canada
| | - Kadija Perreault
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, QC, Canada; Department of Rehabilitation, Faculty of Medicine, Laval University, Québec, QC, Canada
| | | | - Pascal Tétreault
- Clinical Research of the Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, QC, Canada; Departments of Anesthesiology and Nuclear Medicine and Radiobiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Marc-André Blanchette
- Chiropractic Department, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Simon Décary
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada; Clinical Research of the Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, QC, Canada
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Otero-Ketterer E, Peñacoba-Puente C, Ferreira Pinheiro-Araujo C, Valera-Calero JA, Ortega-Santiago R. Biopsychosocial Factors for Chronicity in Individuals with Non-Specific Low Back Pain: An Umbrella Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191610145. [PMID: 36011780 PMCID: PMC9408093 DOI: 10.3390/ijerph191610145] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/12/2022] [Accepted: 08/14/2022] [Indexed: 06/12/2023]
Abstract
Low back pain (LBP) is a global and disabling problem. A considerable number of systematic reviews published over the past decade have reported a range of factors that increase the risk of chronicity due to LBP. This study summarizes up-to-date and high-level research evidence on the biopsychosocial prognostic factors of outcomes in adults with non-specific low back pain at follow-up. An umbrella review was carried out. PubMed, the Cochrane Database of Systematic Reviews, Web of Science, PsycINFO, CINAHL Plus and PEDro were searched for studies published between 1 January 2008 and 20 March 2020. Two reviewers independently screened abstracts and full texts, extracted data and assessed review quality. Fifteen systematic reviews met the eligibility criteria; all were deemed reliable according to our criteria. There were five prognostic factors with consistent evidence of association with poor acute-subacute LBP outcomes in the long term (high levels of pain intensity and disability, high emotional distress, negative recovery expectations and high physical demands at work), as well as one factor with consistent evidence of no association (low education levels). For mixed-duration LBP, there was one predictor consistently associated with poor outcomes in the long term (high pain catastrophism). We observed insufficient evidence to synthesize social factors as well as to fully assess predictors in the chronic phase of LBP. This study provides consistent evidence of the predictive value of biological and psychological factors for LBP outcomes in the long term. The identified prognostic factors should be considered for inclusion into low back pain explanatory models.
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Affiliation(s)
- Emilia Otero-Ketterer
- Escuela Internacional de Doctorado, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
- Physiotherapy Department, Mutua Universal Mugenat, 28001 Alcalá de Henares, Spain
| | | | | | - Juan Antonio Valera-Calero
- Valtradofi Research Group, Department of Physiotherapy, Faculty of Health, Universidad Camilo José Cela, Villanueva de la Cañada, 28692 Madrid, Spain
| | - Ricardo Ortega-Santiago
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
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Walton DM, Elliott JM, Schabrun S, Modarresi S, Seo W, May C. Exploring Social Determinants of Posttraumatic Pain, Distress, Depression, and Recovery Through Cross-Sectional, Longitudinal, and Nonlinear Trends. Clin J Pain 2022; 38:511-519. [PMID: 35647765 DOI: 10.1097/ajp.0000000000001050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/24/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Pain, distress, and depression are predictors of posttrauma pain and recovery. We hypothesized that pretrauma characteristics of the person could predict posttrauma severity and recovery. METHODS Sex, age, body mass index, income, education level, employment status, pre-existing chronic pain or psychopathology, and recent life stressors were collected from adults with acute musculoskeletal trauma through self-report. In study 1 (cross-sectional, n=128), pain severity was captured using the Brief Pain Inventory (BPI), distress through the Traumatic Injuries Distress Scale (TIDS) and depression through the Patient Health Questionnaire-9 (PHQ-9). In study 2 (longitudinal, n=112) recovery was predicted using scores on the Satisfaction and Recovery Index (SRI) and differences within and between classes were compared with identify pre-existing predictors of posttrauma recovery. RESULTS Through bivariate, linear and nonlinear, and regression analyses, 8.4% (BPI) to 42.9% (PHQ-9) of variance in acute-stage predictors of chronicity was explainable through variables knowable before injury. In study 2 (longitudinal), latent growth curve analysis identified 3 meaningful SRI trajectories over 12 months. Trajectory 1 (start satisfied, stay satisfied [51%]) was identifiable by lower TIDS, BPI, and PHQ-9 scores, higher household income and less likely psychiatric comorbidity. The other 2 trajectories (start dissatisfied, stay dissatisfied [29%] versus start dissatisfied, become satisfied [20%]) were similar across most variables at baseline save for the "become satisfied" group being mean 10 years older and entering the study with a worse (lower) SRI score. DISCUSSION The results indicate that 3 commonly reported predictors of chronic musculoskeletal pain (BPI, TIDS, PHQ-9) could be predicted by variables not related to the injurious event itself. The 3-trajectory recovery model mirrors other prior research in the field, though 2 trajectories look very similar at baseline despite very different 12-month outcomes. Researchers are encouraged to design studies that integrate, rather than exclude, the pre-existing variables described here.
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Affiliation(s)
- David M Walton
- School of Physical Therapy
- Health and Rehabilitation Sciences, Faculty of Health Sciences
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London
| | - James M Elliott
- School of Health Sciences, Northern Sydney Local Health District, The Kolling Institute, Faculty of Medicine and Health, University of Sydney
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Siobhan Schabrun
- Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Shirin Modarresi
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario
| | - Wonjin Seo
- Health and Rehabilitation Sciences, Faculty of Health Sciences
| | - Curtis May
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Mansell G, Corp N, Wynne-Jones G, Hill J, Stynes S, van der Windt D. Self-reported prognostic factors in adults reporting neck or low back pain: An umbrella review. Eur J Pain 2021; 25:1627-1643. [PMID: 33864327 DOI: 10.1002/ejp.1782] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 04/09/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Numerous systematic reviews have attempted to synthesize evidence on prognostic factors for predicting future outcomes such as pain, disability and return-to-work/work absence in neck and low back pain populations. DATABASES AND DATATREATMENT An umbrella review of systematic reviews was conducted to summarize the magnitude and quality of the evidence for each prognostic factor investigated. Searches were limited to the last 10 years (2008-11th April 2018, updated 28th September 2020). A two-stage approach was undertaken: in stage one, data on prognostic factors was extracted from systematic reviews identified from the systematic search that met the inclusion criteria. Where a prognostic factor was investigated in ≥1 systematic review and where 50% or more of those reviews found an association between the prognostic factor and one of the outcomes of interest, it was taken forward to stage two. In stage two, additional information extracted included the strength of association found, consistency of effects and risk of bias. The GRADE approach was used to grade confidence in the evidence. RESULTS Stage one identified 41 reviews (90 prognostic factors), with 35 reviews (25 prognostic factors) taken forward to stage two. Seven prognostic factors (disability/activity limitation, mental health; pain intensity; pain severity; coping; expectation of outcome/recovery and fear-avoidance) were judged as having moderate confidence for robust findings. CONCLUSIONS Although there was conflicting evidence for the strength of association with outcome, these factors may be used for identifying vulnerable subgroups or people able to self-manage. Further research can investigate the impact of using such prognostic information on treatment/referral decisions and patient outcomes.
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Affiliation(s)
- Gemma Mansell
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, UK
| | - Nadia Corp
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, UK
| | - Gwenllian Wynne-Jones
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, UK
| | - Jonathan Hill
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, UK
| | - Siobhán Stynes
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, UK
| | - Daniëlle van der Windt
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, UK
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Relating the Diers formetric measurements with the subjective severity of acute and chronic low back pain. Med Hypotheses 2019; 133:109390. [DOI: 10.1016/j.mehy.2019.109390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 07/23/2019] [Accepted: 09/02/2019] [Indexed: 10/26/2022]
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Walton DM, Marsh J. The Multidimensional Symptom Index: A new patient-reported outcome for pain phenotyping, prognosis and treatment decisions. Eur J Pain 2018; 22:1351-1361. [PMID: 29635812 DOI: 10.1002/ejp.1224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND There are few patient-reported outcomes routinely used that capture frequency and interference of different pain-related symptoms on a single scale. The purpose of this study was to describe the development and initial validation of the new Multidimensional Symptom Index (MSI). METHODS Items were generated from patient interviews of the experience of chronic pain. Health valuations were created from rankings of 82 healthy subjects for each of 120 symptom (×10) × frequency (×3) × interference (×4) combinations using preference-based health valuations (0-100). Ranks for each symptom combination were then used in scale scoring. A sample of 300 patients with acute or chronic pain subsequently completed the MSI and a battery of other tools. Exploratory (EFA) and Confirmatory (CFA) factor analyses were triangulated with theory to arrive at the factor structure. Convergent validity was tested against established measures. RESULTS Health rankings resulted in scores of 0-12 for each of the 10 symptom types. Factor analyses revealed two factors: MSI Somatic Symptoms and MSI Non-Somatic Symptoms. The MSI also quantified number of symptoms experienced (/10), mean frequency (/3) and mean interference (/4). The indices showed appropriate associations with the established PROs. CONCLUSIONS The MSI is a new symptom-focused PRO that allows patient phenotyping and may have value for screening, prognosis and evaluating change. SIGNIFICANCE This article presents the development and psychometric properties of a new measure of pain and related symptom frequency and interference. This measure could aid clinicians in establishing clinically relevant pain phenotypes for screening, prognosis and treatment decisions.
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Affiliation(s)
- D M Walton
- School of Physical Therapy, Western University, London, ON, Canada.,Bone and Joint Institute, Western University, London, ON, Canada
| | - J Marsh
- School of Physical Therapy, Western University, London, ON, Canada.,Bone and Joint Institute, Western University, London, ON, Canada
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