Pain pattern classification and directional preference are associated with clinical outcomes for patients with low back pain

Abstract

Pain Pattern Classification (PPC) and Directional Preference (DP) have shown merit as reliable and predictable clinical solutions to help reduce the burden posed by low back pain (LBP). We conducted a prospective, observational cohort study to verify the association between PPC, DP, and clinical outcomes. We hypothesized that (1) patients who demonstrated DP Centralization (CEN) would have lower pain intensity and disability at follow-up than patients who demonstrated Non-DP Non-CEN, and (2) the prevalence of DP at first examination would be lowest for patients with chronic LBP and are greater than 65 years old. First examination and follow-up data were completed by 639 patients. Clinical outcome measures, including pain intensity and disability, were collected at first examination and follow-up. Baseline comparisons were made between groups with first examination data only and groups with first examination data and follow-up data. A Pearson's chi-squared test was used to determine differences in prevalence rates for the categorical variables, and two-sample -tests were used for the continuous variables. A Turkey's range test was used to determine differences in follow-up pain intensity and disability for LBP dual-classifications. Multiple regression was used to investigate DP prevalence considering risk adjusted factors. Overall prevalence of DP was 84.5% and prevalence was lowest for patients with sub-acute symptoms. No significant difference existed for the prevalence of DP for patients based on age. Patients classified as DP CEN had, on average, 1.99 pain intensity units less than patients classified as Non-DP Non-CEN at follow-up. Patients classified as DP CEN had, on average, 3.43 RMDQ units less than patients classified as Non-DP Non-CEN at follow-up.These findings support previous reports, verifying the association between LBP dual-classification schemes and clinical outcomes.

Artificial intelligence to improve back pain outcomes and lessons learnt from clinical classification approaches: three systematic reviews

“…No studies aimed to assess the classification on pain intensity in a multivariate model when adjusted for baseline values. For disability, five studies showed no significant benefit of classification on prognosis 117,128,130,134,137 , while five showed a significant effect 114,120,124,138,139 . Only two studies assessed disability prognosis within multivariate models, with one showing significant 138 and one non-significant results 137 .…”

“…Four studies reported the follow-up as when the patient was discharged; however, they did not provide a timeframe 114,130,138,139 . Three studies showed that classification was a significant predictor of pain intensity in univariate models 114,135,139 , while one did not 117 . No studies aimed to assess the classification on pain intensity in a multivariate model when adjusted for baseline values.…”

An empirical, pragmatic approach applying reflection in interaction approach to manual therapy treatments

“…Pain and stiffness are often considered the primary deficits targeted by manual therapy. The ability of patients to perceive and report changes in pain location and intensity occurring during treatment has been clearly demonstrated in the literature on centralisation (May, Runge and Aina, 2018;Yarznbowicz et al, 2018) The ability of clinicians to perceive differences in stiffness within a treatment session is less clearly established. There is evidence that differences in PA stiffness related to symptoms are greater than the approximately 10% differences needed to be palpable by manual palpation (Tuttle and Hazle, 2018).…”

Directional preference constructs for patients’ low back pain in the absence of centralization

“…The first study was a prospective, observational cohort study examining the association between Pain Pattern Classification (PPC), DP, and clinical outcomes (i.e. pain intensity and selfreported disability) [10]. The current study is a subgroup of patients who exhibited DP at the first examination in the absence of CEN.…”

“…Many different clinical profiles exist relative to DP assessment and DP should not be viewed as a homogeneous entity [5][6][7], nor can it be presumed that all patients with LBP will respond in the same way [8]. DP in the absence of CEN is common [9][10][11]; George et al reported that 50% of patients exhibited a DP without CEN [9], and CEN has found to be as low as 19.6% at the first examination [10,11]. However, the manner in which DP has been recorded in many studies has been inconsistent which may be leading to inconclusive research findings.…”