Background Low back pain (LBP) is a very frequent cause for care seeking and often a long-lasting condition. However, little is known about individuals' care seeking patterns over time. Therefore the objectives of this study were 1) to describe care seeking patterns 1 year after an initial chiropractic consultation, and 2) to examine how care seeking patterns related to pain intensity trajectories. Methods Danish chiropractic clinics recruited 947 adult patients at the initial consultation for LBP. From this cohort, 617 (65%) responded to questions about care seeking within the last 2 weeks at all of the followups 2 weeks, 3 months and 12 months after inclusion. Based on these responses, we described care seeking patterns and investigated if care seeking was associated with trajectories of LBP severity. The LBP trajectories had previously been derived from weekly measures of pain intensity collected via SMS-tracking. Results Care seeking after the initial visit was reported by 95% of the patients. The most frequent care seeking pattern (51%) was to report care seeking at the 2-weeks follow-up and not later, 29% reported care seeking only 2 weeks and 3 months after the initial consultation, and 11% reported care seeking at all follow-up time points. Of those seeking care after 2 weeks, 3 months and 1 year, 98%, 76% and 50% respectively had chosen to see a chiropractor at those time points. At 1-year followup 18% of care seekers had visited a general practitioner and 27% a physiotherapist. Care seeking was associated with LBP trajectories: Most people who recovered from pain stopped care seeking, and those with persistent severe pain did most frequently seek care at all follow-ups. However, those with mild to moderate LBP had more diverse care seeking behaviours. For example in LBP trajectories of on-going moderate pain, 25% did not report care seeking after 2-weeks, and another 25% reported care seeking at all time points. Conclusions Most patients consulting Danish chiropractors for LBP are seen again within two weeks of the initial consultation and do not report continued care seeking after 3 months. One year after the initial visit, around half of the care seekers see other health care providers for their LBP instead of a chiropractor. Care seeking is related to LBP symptoms, but not in a uniform way, and it should be investigated why some people with on-going LBP continue to seek care while others do not. The study was presented to the local ethics committee. The committee found that it did not need approval, since there was no intervention involved, which is in line with Danish law (Danish National Committee on Biomedical Research Ethics. Guidelines about Notification. (http://www.nvk.dk/english/act-on-research). The project was approved by the Danish Data Protection Agency (J-no. 2004-41-4763 and J-no. 2010-41-5163 Introduction Degenerative lumbar spinal stenosis causing neurogenic claudication is a leading cause of pain, disability and loss of independence in older adults. Effective non-surgical approaches...
Background: Pain chronicity is considered an important prognostic factor for outcome. Here, it was investigated whether pain duration influences outcome when only chronic patients (pain >3 months) are considered. Secondary aims were to determine, in patients of any pain duration, how much variance in outcome is explained by pain duration and whether pain duration truly predicts outcomes, that is out-of-sample prediction in independent data. Methods: Secondary analysis of a cohort study of neck pain patients. Patients were assessed before start of treatment and at 1-week, 1-, 3-, 6-and 12-month follow-up. Outcomes were patient global impression of change (PGIC) and percent change in patients' perceived pain intensity, rated on a numerical rating scale (NRS). Regression analyses (linear and logistic) and supervised machine learning were used to test the influence of pain duration on PGIC and percent NRS change at 1-week, 1-, 3-, 6-and 12-month follow-up within sample and out-of-sample.Separate analyses were performed for the full sample (n = 720) and for chronic patients (n = 238) only. Results:No relationship between pain duration and outcome was found for chronic patients only. For the full sample, statistical relationships between pain duration and outcomes were observed at all tested follow-up time points. However, the amount of variance in outcome explained by pain duration was low and no out-of-sample prediction was possible.Conclusions: Pain duration did not emerge as an important predictor of outcome in this database of 720 neck pain patients receiving chiropractic treatment. Significance statement:The relatively large dataset of neck pain patients challenges the widely accepted wisdom that pain duration is an important predictor of pain outcomes and that very chronic patients might only have a small likelihood of getting better. It is postulated that these results are important for the attitude of the first encounter between healthcare professionals and chronic patients.
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