Generic prognostic factors for musculoskeletal pain in primary care: a systematic review

Artus, Majid; Campbell, Paul; Mallen, Christian; Dunn, Kate M.; Windt, Danielle A W van der

doi:10.1136/bmjopen-2016-012901

Cited by 152 publications

(174 citation statements)

References 25 publications

(21 reference statements)

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“…Within this review we were looking to determine predictors of functional outcome across MSK patient populations to allow for a more evidence based approach to adjustment of case-mix to take into consideration those at a higher or lower risk of a poor outcome, not to provide information on which patients respond better to which specific treatments (modifiers of treatment outcome) (Hancock et al, 2009). This review of independent predictors of MSK functional outcome largely reflects the review findings of Artus et al (2017) and of Mallen et al (2007) on prognostic factors for patients with MSK pain. Artus et al (2017) found generic predictors of a poor prognosis with strong evidence to be: widespread pain, high functional disability, and somatisation, and predictors with a moderate level of evidence to be: high pain intensity, long pain duration and a high depression/anxiety score.…”

Section: Strongmentioning

confidence: 77%

“…This review of independent predictors of MSK functional outcome largely reflects the review findings of Artus et al (2017) and of Mallen et al (2007) on prognostic factors for patients with MSK pain. Artus et al (2017) found generic predictors of a poor prognosis with strong evidence to be: widespread pain, high functional disability, and somatisation, and predictors with a moderate level of evidence to be: high pain intensity, long pain duration and a high depression/anxiety score. Evidence for no association was also found for: low education (strong), pain medications (moderate) and older age and gender (weak).…”

Section: Strongmentioning

confidence: 77%

“…To be considered a generic predictor of functional outcome, prognostic factors had to be investigated for two or more musculoskeletal pain regions (Artus et al, 2017). Like Artus et al (2017), synthesis of results took into consideration statistically significant associations, consistency of results (direction of effect) and study quality. Guyatt et al (2011) describe the GRADE system in a series of articles which encompasses how to grade quality of evidence and the strength of recommendations formulated through evidence syntheses.…”

Section: Summarising Evidence Across Studiesmentioning

confidence: 99%

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Predictors of functional outcome in musculoskeletal healthcare: An umbrella review

Burgess

Mansell

Bishop

et al. 2019

European Journal of Pain

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Background Multiple cohort and systematic review studies exist, reporting independent predictive factors associated with outcome in musculoskeletal populations. These studies have found evidence for a number of “generic” factors that have been shown to predict outcome across musculoskeletal patient cohorts. This review provides a higher level review of the evidence with a focus on generic patient factors associated with functional musculoskeletal outcome with a view to informing predictive modelling. Objectives (a) Identify patient factors found to have evidence to support their association with functional outcome, and (b) review these findings across body areas/conditions to identify generic predictive factors. Databases and Data Treatment Electronic databases of MEDLINE, AMED, EMBASE, CINAHL and Cochrane were searched for eligible studies. Two reviewers independently extracted data and assessed quality using an established checklist for umbrella reviews. Results Twenty‐one systematic reviews met inclusion criteria, all were of moderate/high quality. Six independent predictors were found to have strong evidence of association with worse musculoskeletal functional outcome across anatomical body sites (worse baseline function, higher symptom/pain severity, worse mental well‐being, more comorbidities, older age and higher body mass index). Longer duration of symptoms, worse pain coping, presence of workers compensation, lower vitality and lower education were also found to have moderate evidence of association with worse functional outcome across body sites. Conclusions This study identifies a number of factors associated with musculoskeletal functional outcome. The generic predictive factors identified should be considered for inclusion into musculoskeletal prognostic models, including models used for case‐mix‐adjustment of patient reported outcome measure data. Significance This article identifies “generic” patient factors that predict functional outcome (measured using Patient Reported Outcome Measures (PROMs)) across musculoskeletal conditions. Findings provide support for the development and content of generic musculoskeletal prognostic models including models used to case‐mix adjust PROM data for baseline complexity. Generic musculoskeletal models and functional PROMs would facilitate more feasible comparison and benchmarking of musculoskeletal services in order to identify variation and address health inequalities.

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Section: Strongmentioning

confidence: 77%

Section: Strongmentioning

confidence: 77%

Section: Summarising Evidence Across Studiesmentioning

confidence: 99%

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Predictors of functional outcome in musculoskeletal healthcare: An umbrella review

Burgess

Mansell

Bishop

et al. 2019

European Journal of Pain

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“…However, recent cohort studies and systematic reviews have highlighted similarities in symptom trajectories and identified generic prognostic factors across different regional musculoskeletal pain problems (e.g. [6, 29, 30]). This is supported by our findings from objective 1, confirming the prognostic value of short-term changes in pain for predicting long-term disability outcomes in both back and shoulder pain.…”

Section: Discussionmentioning

confidence: 99%

Brief pain re-assessment provided more accurate prognosis than baseline information for low-back or shoulder pain

Mansell

Jordan

Peat

et al. 2017

BMC Musculoskelet Disord

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BackgroundResearch investigating prognosis in musculoskeletal pain conditions has only been moderately successful in predicting which patients are unlikely to recover. Clinical decision making could potentially be improved by combining information taken at baseline and re-consultation.MethodsData from four prospective clinical cohorts of adults presenting to UK and Dutch primary care with low-back or shoulder pain was analysed, assessing long-term disability at 6 or 12 months and including baseline and 4–6 week assessments of pain. Baseline versus short-term assessments of pain, and previously validated multivariable prediction models versus repeat assessment, were compared to assess predictive performance of long-term disability outcome. A hypothetical clinical scenario was explored which made efficient use of both baseline and repeated assessment to identify patients likely to have a poor prognosis and decide on further treatment.ResultsShort-term repeat assessment of pain was better than short-term change or baseline score at predicting long-term disability improvement across all cohorts. Short-term repeat assessment of pain was only slightly more predictive of long-term recovery (c-statistics 0.78, 95% CI 0.74 to 0.83 and 0.75, 95% CI 0.69 to 0.82) than a multivariable baseline prognostic model in the two cohorts presenting such a model (c-statistics 0.71, 95% CI 0.67 to 0.76 and 0.72, 95% CI 0.66 to 0.78). Combining optimal prediction at baseline using a multivariable prognostic model with short-term repeat assessment of pain in those with uncertain prognosis in a hypothetical clinical scenario resulted in reduction in the number of patients with an uncertain probability of recovery, thereby reducing the instances where patients may be inappropriately referred or reassured.ConclusionsIncorporating short-term repeat assessment of pain into prognostic models could potentially optimise the clinical usefulness of prognostic information.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-017-1502-8) contains supplementary material, which is available to authorized users.

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“…Evidence of some generic prognostic factors for musculoskeletal conditions prevalent in primary care has been presented, identifying high pain severity, multisite pain, baseline disability, longer pain duration, and older age as potential prognostic factors for disability across pain sites [15, 16]. However, there is limited confidence in the results.…”

Section: Introductionmentioning

confidence: 99%

Predictors of multidisciplinary rehabilitation outcomes in patients with chronic musculoskeletal pain: protocol for a systematic review and meta-analysis

et al. 2017

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BackgroundChronic musculoskeletal pain is a major public health problem. Early prediction for optimal treatment results has received growing attention, but there is presently a lack of evidence regarding what information such proactive management should be based on. This study protocol, therefore, presents our planned systematic review and meta-analysis on important predictive factors for health and work-related outcomes following multidisciplinary rehabilitation (MDR) in patients with chronic musculoskeletal pain.MethodsWe aim to perform a synthesis of the available evidence together with a meta-analysis of published peer-reviewed original research that includes predictive factors preceding MDR. Included are prospective studies of adults with benign, chronic (> 3 months) musculoskeletal pain diagnoses who have taken part in MDR. In the studies, associations between personal and rehabilitation-based factors and the outcomes of interest are reported. Outcome domains are pain, physical functioning including health-related quality of life, and work ability with follow-ups of 6 months or more. We will use a broad, explorative approach to any presented predictive factors (demographic, symptoms-related, physical, psychosocial, work-related, and MDR-related) and these will be analyzed through (a) narrative synthesis for each outcome domain and (b) if sufficient studies are available, a quantitative synthesis in which variance-weighted pooled proportions will be computed using a random effects model for each outcome domain. The strength of the evidence will be evaluated using the Grading of Recommendations, Assessment, Development and Evaluation.DiscussionThe strength of this systematic review is that it aims for a meta-analysis of prospective cohort or randomized controlled studies by performing an extensive search of multiple databases, using an explorative study approach to predictive factors, rather than building on single predictor impact on the outcome or on predefined hypotheses. In this way, an overview of factors central to MDR outcome can be made and will help strengthen the evidence base and inform a wide readership including health care practitioners and policymakers.Systematic review registrationPROSPERO CRD42016025339 Electronic supplementary materialThe online version of this article (10.1186/s13643-017-0598-0) contains supplementary material, which is available to authorized users.

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Generic prognostic factors for musculoskeletal pain in primary care: a systematic review

Cited by 152 publications

References 25 publications

Predictors of functional outcome in musculoskeletal healthcare: An umbrella review

Predictors of functional outcome in musculoskeletal healthcare: An umbrella review

Brief pain re-assessment provided more accurate prognosis than baseline information for low-back or shoulder pain

Predictors of multidisciplinary rehabilitation outcomes in patients with chronic musculoskeletal pain: protocol for a systematic review and meta-analysis

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