Predictors of outcome after surgery with disc prosthesis and rehabilitation in patients with chronic low back pain and degenerative disc: 2-year follow-up
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A prospective study to evaluate whether certain baseline characteristics can predict outcome in patients treated with disc prosthesis or multidisciplinary rehabilitation.
Secondary analysis of 154 patients with chronic low back pain (LBP) for at least 1 year and degenerative discs originally recruited for a randomized trial. Outcome measures were Oswestry Disability Index (ODI) dichotomized to < or ≥15 points improvement and whether subjects were working at 2-year follow-up. A multiple logistic regression analysis was used.
In patients treated with disc prosthesis, long duration of LBP and high Fear-Avoidance Beliefs for work (FABQ-W) predicted worse ODI outcome [odds ratio (OR) = 1.9, 95% confidence interval (CI) 1.2–3.2 and OR = 1.7, CI 1.2–2.4 for every 5 years or 5 points]. Modic type I or II predicted better ODI outcome (OR = 5.3, CI 1.1–25.3). In patients treated with rehabilitation, a high ODI, low emotional distress (HSCL-25), and no daily narcotics predicted better outcome for ODI (OR = 2.5, CI 1.4–4.5 for every 5 ODI points, OR = 2.1, CI 1.1–5.1 for every 0.5 HSCL points and OR = 23.6, CI 2.1–266.8 for no daily narcotics). Low FABQ-W and working at baseline predicted working at 2-year follow-up after both treatments (OR = 1.3, CI 1.0–1.5 for every 5 points and OR = 4.1, CI 1.2–13.2, respectively).
Shorter duration of LBP, Modic type I or II changes and low FABQ-W were the best predictors of success after treatment with disc prosthesis, while high ODI, low distress and not using narcotics daily predicted better outcome of rehabilitation. Low FABQ-W and working predicted working at follow-up.
KeywordsLBP Degenerative disc Disc replacement Multidisciplinary rehabilitation
We want to thank the patients participated in the study, the South Eastern Norway Regional Health Authority and EXTRA funds from the Norwegian Foundation for Health and Rehabilitation, through the Norwegian Back Pain Association, for financial support, The Coast Hospital for Physical Medicine and Rehabilitation, Stavern, for videos and material for instructions on the rehabilitation intervention, Hege Andresen at St.Olavs Hospital, Trondheim, for data coordination, Astrid Woodhouse and Kirsti Vanvik from St.Olavs Hospital for performing the 2-year control and Prof. Leiv Sandvik for statistical counseling and support. Financial support was received from the South Eastern Norway Regional Health Authority and EXTRA funds from the Norwegian Foundation for Health and Rehabilitation, through the Norwegian Back Pain Association.
Conflict of interest
All authors involved declare that they have no conflict of interests and no financial disclosures to report.
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