Prognostic factors for long-term improvement in pain and disability among patients with persistent low back pain.

IF 2 4区 医学 Q2 REHABILITATION Chiropractic & Manual Therapies Pub Date : 2024-06-25 DOI:10.1186/s12998-024-00546-z
Elin Mihlberg, Bodil Al-Mashhadi Arnbak
{"title":"Prognostic factors for long-term improvement in pain and disability among patients with persistent low back pain.","authors":"Elin Mihlberg, Bodil Al-Mashhadi Arnbak","doi":"10.1186/s12998-024-00546-z","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Prognostic research in low back pain (LBP) is essential for understanding and managing the condition. This study aimed to, (1) describe the proportions with mild-moderate and severe pain and disability at baseline, 1-year and 4-year follow-up, and (2) investigate prognostic factors for improvement in pain and disability over 4 years in a cohort of secondary care LBP patients.</p><p><strong>Methods: </strong>This was a secondary analysis of a cohort of patients with LBP aged 18-40 years recruited from a non-surgical outpatient spine clinic between March 2011 and October 2013 (n = 1037). Questionnaires were collected at baseline, 1-year, and 4-year follow-up. Disability was assessed using the Roland Morris Disability Questionnaire (RMDQ 0-100) and pain intensity using the Numeric Rating Scale (NRS 0-10). 'Mild-moderate pain' was defined as NRS < 7 and 'severe pain' as NRS ≥ 7. Likewise, 'mild-moderate disability' was defined as RMDQ < 58.3, and 'severe disability' was RMDQ ≥ 58.3. In the prognostic analysis, improvement in pain and disability over 4 years was defined as meeting both criteria: decrease of ≥ 2 on the NRS and of ≥ 20.8 on the RMDQ. Sixteen candidate prognostic factors were assessed by multivariate logistic regression.</p><p><strong>Results: </strong>Among patients with information available at all three time points (n = 241), 54%/48% had persistent mild-moderate pain/disability, while only 7%/15% had persistent severe pain/disability. Of patients included in the multivariate prognostic analysis regarding improvement over 4 years (n = 498), 32% had improved in pain and disability after 4 years. Positive associations were found for pain intensity (OR 1.34 [95%CI: 1.17-1.54]), disability (OR 1.01 [1.00-1.02]), and regular employment or studying (OR 1.67 [1.06-2.64]), and negative associations for episode duration (OR 0.99 [0.99-1.00]) and risk of persistent pain (OR 0.58 [0.38-0.88]).</p><p><strong>Conclusion: </strong>Patients with persistent LBP in secondary care had mostly mild-moderate pain and disability consistently at all three time points, with few having consistently severe symptoms over 4 years. Moreover, approximately half of the included patients improved in pain and disability. We found that pain intensity, disability, episode duration, regular employment or studying, and risk of persistent pain predicted a long-term improvement. However, the limited availability of complete follow-up data may affect generalisability.</p>","PeriodicalId":48572,"journal":{"name":"Chiropractic & Manual Therapies","volume":"32 1","pages":"26"},"PeriodicalIF":2.0000,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11202371/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Chiropractic & Manual Therapies","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s12998-024-00546-z","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"REHABILITATION","Score":null,"Total":0}
引用次数: 0

Abstract

Background: Prognostic research in low back pain (LBP) is essential for understanding and managing the condition. This study aimed to, (1) describe the proportions with mild-moderate and severe pain and disability at baseline, 1-year and 4-year follow-up, and (2) investigate prognostic factors for improvement in pain and disability over 4 years in a cohort of secondary care LBP patients.

Methods: This was a secondary analysis of a cohort of patients with LBP aged 18-40 years recruited from a non-surgical outpatient spine clinic between March 2011 and October 2013 (n = 1037). Questionnaires were collected at baseline, 1-year, and 4-year follow-up. Disability was assessed using the Roland Morris Disability Questionnaire (RMDQ 0-100) and pain intensity using the Numeric Rating Scale (NRS 0-10). 'Mild-moderate pain' was defined as NRS < 7 and 'severe pain' as NRS ≥ 7. Likewise, 'mild-moderate disability' was defined as RMDQ < 58.3, and 'severe disability' was RMDQ ≥ 58.3. In the prognostic analysis, improvement in pain and disability over 4 years was defined as meeting both criteria: decrease of ≥ 2 on the NRS and of ≥ 20.8 on the RMDQ. Sixteen candidate prognostic factors were assessed by multivariate logistic regression.

Results: Among patients with information available at all three time points (n = 241), 54%/48% had persistent mild-moderate pain/disability, while only 7%/15% had persistent severe pain/disability. Of patients included in the multivariate prognostic analysis regarding improvement over 4 years (n = 498), 32% had improved in pain and disability after 4 years. Positive associations were found for pain intensity (OR 1.34 [95%CI: 1.17-1.54]), disability (OR 1.01 [1.00-1.02]), and regular employment or studying (OR 1.67 [1.06-2.64]), and negative associations for episode duration (OR 0.99 [0.99-1.00]) and risk of persistent pain (OR 0.58 [0.38-0.88]).

Conclusion: Patients with persistent LBP in secondary care had mostly mild-moderate pain and disability consistently at all three time points, with few having consistently severe symptoms over 4 years. Moreover, approximately half of the included patients improved in pain and disability. We found that pain intensity, disability, episode duration, regular employment or studying, and risk of persistent pain predicted a long-term improvement. However, the limited availability of complete follow-up data may affect generalisability.

查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
持续性腰背痛患者疼痛和残疾长期改善的预后因素。
背景:腰背痛(LBP)的预后研究对于了解和控制病情至关重要。本研究旨在:(1) 描述基线、1 年和 4 年随访时轻度-中度和重度疼痛及残疾的比例;(2) 调查一组二级护理腰背痛患者 4 年疼痛和残疾改善的预后因素:这是对 2011 年 3 月至 2013 年 10 月间从非手术脊柱门诊招募的 18-40 岁腰椎间盘突出症患者队列(n = 1037)进行的二次分析。在基线、1年和4年随访时收集了调查问卷。残疾程度采用罗兰-莫里斯残疾问卷(RMDQ 0-100)进行评估,疼痛强度采用数字评分量表(NRS 0-10)进行评估。轻-中度疼痛 "定义为 NRS 结果:在三个时间点均可提供信息的患者中(n = 241),54%/48%的患者有持续的轻度中度疼痛/残疾,而只有 7%/15%的患者有持续的严重疼痛/残疾。在纳入有关 4 年改善情况的多变量预后分析的患者中(n = 498),32% 的患者在 4 年后疼痛和残疾情况有所改善。疼痛强度(OR 1.34 [95%CI:1.17-1.54])、残疾程度(OR 1.01 [1.00-1.02])、正常工作或学习(OR 1.67 [1.06-2.64])呈正相关,发作持续时间(OR 0.99 [0.99-1.00])和持续疼痛风险(OR 0.58 [0.38-0.88])呈负相关:结论:接受二级护理的持续性腰背痛患者在所有三个时间点上的疼痛和残疾程度大多为轻度-中度,很少有患者在 4 年中持续出现严重症状。此外,约半数患者的疼痛和残疾状况有所改善。我们发现,疼痛强度、残疾程度、发作持续时间、正常工作或学习以及持续疼痛的风险都预示着长期改善。然而,完整的随访数据有限,可能会影响其普遍性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 去求助
来源期刊
Chiropractic & Manual Therapies
Chiropractic & Manual Therapies Medicine-Complementary and Alternative Medicine
CiteScore
3.20
自引率
15.80%
发文量
48
审稿时长
20 weeks
期刊介绍: Chiropractic & Manual Therapies publishes manuscripts on all aspects of evidence-based information that is clinically relevant to chiropractors, manual therapists and related health care professionals. Chiropractic & Manual Therapies is an open access journal that aims to provide chiropractors, manual therapists and related health professionals with clinically relevant, evidence-based information. Chiropractic and other manual therapies share a relatively broad diagnostic practice and treatment scope, emphasizing the structure and function of the body''s musculoskeletal framework (especially the spine). The practices of chiropractic and manual therapies are closely associated with treatments including manipulation, which is a key intervention. The range of services provided can also include massage, mobilisation, physical therapies, dry needling, lifestyle and dietary counselling, plus a variety of other associated therapeutic and rehabilitation approaches. Chiropractic & Manual Therapies continues to serve as a critical resource in this field, and as an open access publication, is more readily available to practitioners, researchers and clinicians worldwide.
期刊最新文献
Assessing research culture and capacity amongst faculty at a north American chiropractic institution: an explanatory mixed methods study. The association between students' confidence and ability to modulate spinal manipulation force-time characteristics of specific target forces: a cross-sectional study. Variability and repeatability of spinal manipulation force-time characteristics in thoracic spinal manipulation on a manikin. Applying an osteopathic intervention to improve mild to moderate mental health symptoms: a mixed-methods feasibility randomised trial. Societal costs of older adults with low back pain seeking chiropractic care: findings from the BACE-C cohort study.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1