Development of a risk stratification and prevention index for stratified care in chronic low back pain. Focus: yellow flags (MiSpEx network)

Abstract

Supplemental Digital Content is Available in the Text.Two new screening tools identify increased risk of chronic low back pain and potentially treatment-modifiable prognostic indicators in 4 yellow flag domains.

Personalized Treatment Suggestions: The Validity and Applicability of the Risk-Prevention-Index Social in Low Back Pain Exercise Treatments

“…The recruited participants follow the same inclusion and exclusion criteria as participants within the developmental study of the RPI-S [25]. For this reason, sample characteristics are similar.…”

“…The individual psychosocial risk profile for getting chronic low back pain and the expected treatment response were assessed at baseline (M1) by one domain of the RPI-S [25], which is a screening tool that should facilitate physician's decision making in back pain management. The instrument screens for the individual risk constellation in four psychosocial risk domains: subjective distress, pain experiences, social environment, and medical care environment related to each outcome (pain intensity CPI and pain disability DISS).…”

“…The instrument screens for the individual risk constellation in four psychosocial risk domains: subjective distress, pain experiences, social environment, and medical care environment related to each outcome (pain intensity CPI and pain disability DISS). The relevant items for the RPI-S were selected by Lasso algorithm [25] to obtain a total score for each domain and outcome, ranging from 0 to 100, item scores were weighted by regression coefficients and summed up. The analyses for clinical benefit were performed only for the social environment domain of the RPI-S (RPI-S domain social environment (RPI-S SE ) , total 20 items, of which 15 items scores for CPI and 17 for DISS), because not all RPI-S domain-variables were included in this randomized controlled trial.…”

“…For subjects with low domain scores, a unimodal exercise treatment would be recommended. The cut-offs for people at higher risk were already determined in the development sample by ROC curves, in which the RPI-S reached acceptable discriminant validity with AUC = 0.79 for DISS and AUC = 0.82 for CPI [25].…”

“…Solely the Keele StarT Back (SBT [4,24]) provides an individual risk profile identification and allocation to uni-or multimodal treatment for physiotherapy and usual care in primary prevention, But this is not similarly applicable for exercise treatments. Recently, the RPI-S was developed, a screening tool that focuses on psychosocial risk and protective factors with respect to exercise treatments (e.g., individual distress vs. social support) [25]. The instrument was developed for a 1-year prognosis in a secondary prevention setting, and it is still unknown whether the RPI-S is valid for a shorter prediction in another population, and whether its applicability and benefit for clinical practice is acceptable.…”