Value of predictive instruments to determine persisting restriction of function in patients with subacute non-specific low back pain. Systematic review
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Low back pain (LBP) can restrict function with all the personal, interpersonal, and social consequences, such as a loss of independence and the inability to fulfil diverse roles in social life. Therefore, the prevention of the consequences of LBP would reduce costs, individual burdens and social burdens. Being able to fulfil the requirements of daily living is a cornerstone of quality of life. Early identification of patients who are likely to develop chronic pain with persistent restricted function is important, as effective prevention needs informed allocation of health care and social work. The aim of this study was to report and discuss the predictive value of instruments used to identify patients at risk of chronic LBP. Medline, Embase, CINAHL, Central, PEDro, Psyndex, PsychInfo/PsycLit, and Sociofile were systematically searched up to July 2004. Reference lists of systematic reviews on risk factors, and reference lists of the studies included were also searched. The selected studies evaluated predictive values of tools or predictive models applied 2–12 weeks after an initial medical consultation for a first or a new episode of non-specific LBP with restriction in function. Instruments had to predict function-related outcomes. Because of the heterogeneity of the instruments used we did not pool the data. Sixteen publications on function-related outcomes were included. The predictive instruments in these studies showed only moderate ability to predict or explain function-related outcome (maximal 51% of the variability). There was great variability in the predictors included and not all known risk factors were included in the models. The reviewed tools showed a limited ability to predict function-related outcome in patients with risk of chronic low back pain. Future instruments should be based on models with a comprehensive set of known risk factors. These models should be constructed and validated by international, coordinated research teams.
KeywordsBack pain Prognosis Function
The authors whish to thank Dr. Pius Estermann, IT specialist, for the construction of the search string and for performing the search; Leokardia Zurek, librarian, for preparing the fulltext articles; Daria Buson for assessing the Italian and Spanish articles; Leanne Pobjoy for manuscript preparation; and the experts contacted for their help. This manuscript was written as a part of a Master of Physiotherapy Sciences at the University of Maastricht and the University of Zurich. Funding: Dr. Bachmann’s work was supported by the Swiss National Science Foundation (grants no. 3233B0-103182 and 3200B0-103183). Furthermore, the project was supported by the National Research Programme NRP53 of the Swiss National Science Foundation, project “Interdisciplinary intervention strategy for chronic MSDs” (module: intervention studies with groups at high risk), 2004–2009.
- 12.Egger M, Smith G, Altmann D (2001) Systematic reviews in health care. Meta-analysis in context, 2nd edn. BMJ Books, LondonGoogle Scholar
- 13.Epping Jordan JE, Wahlgren DR, Williams RA, Pruitt SD, Slater MA, Patterson TL, Grant I, Webster JS, Atkinson JH (1998) Transition to chronic pain in men with low back pain: predictive relationships among pain intensity, disability, and depressive symptoms. Health Psychol 17:421–427PubMedCrossRefGoogle Scholar
- 21.Kendall NAS, Linton S, Main CJ (2004) New Zealand guidelines groupGoogle Scholar
- 22.Kendall NAS, Linton SJ, Main CJ (2004) Guide to assessing psycho-social yellow flags in acute low back pain: risk factors for long-term disability and work loss. ACCatNZG Group, Wellington, New ZealandGoogle Scholar
- 36.Truchon M, Cote D (2005) Predictive validity of the chronic pain coping inventory in subacute low back pain. Pain 116(3):205–212Google Scholar
- 38.Valat JP, Goupille P, Vedere V (1997) Low back pain: risk factors for chronicity. Rev Rhum 64:189–194Google Scholar
- 44.Waddell G (2004) The back pain revolution. 2nd edn. Churchill Livingstone, EdinburghGoogle Scholar
- 45.Waddell G, Burton AK, Main CJ (2003) Screening to identify people at risk of long-term incapacity for work. The Royal Society of Medicine Press Limited, LondonGoogle Scholar
- 48.Wyatt JC, Altman DG (1995) Commentary: prognostic models: clinically usefull or quickly forgotten? BMJ (British Medical Journal) 311:1539–1541Google Scholar