Risk Factors for the Elevation of Psychosocial Barriers in the Recovery of Lumbar Pathology

Abstract

Background/Purpose: The prevalence of low back pain (LBP) continues to rise and an appreciation for a biopsychosocial approach, which takes in multiple facets of a patient presentation, may significantly impact this increase. To the best our knowledge, there are no studies evaluating the relationship between the STarTBack Screening Tool (SBT) and the access point the patient enters the health system. Our hypothesis is that patients that access care through the medical model will exhibit greater psychosocial risk. Methods: A retrospective analysis of 1404 cases of LBP utilizing past medical history, demographic information, and SBT data. A linear regression model to identify potential predictors was utilized followed by analyses using cumulative logistic regression model with potential predictors. Results: Referral source had a positive impact on the SBT score and higher probability of high risk classification. Compared to direct access, accessing care through a primary care physician had an odds ratio of 2.802 and specialist an odds ratio of 3.195. Conclusion: This study provides evidence to the impact that access may have on the psychosocial status of patients with LBP. The approach taken by the healthcare provider may impact long term pain and functional outcomes and costs. of surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: 10 year results from the maine lumbar spine study. Spine (Phila Pa 1976). 2005; 30:927-35. | Article | PubMed 31. Deyo RA and Mirza SK. The case for restraint in spinal surgery: does quality management have a role to play? Eur Spine J. 2009; 18 Suppl 3:331-7. | Article | PubMed Abstract | PubMed FullText 32. Brox JI, Nygaard OP, Holm I, Keller A, Ingebrigtsen T and Reikeras O. Fouryear follow-up of surgical versus non-surgical therapy for chronic low back pain. Ann Rheum Dis. 2010; 69:1643-8. | Article | PubMed Abstract | PubMed FullText 33. Loupasis GA, Stamos K, Katonis PG, Sapkas G, Korres DS and Hartofilakidis G. Seven-to 20-year outcome of lumbar discectomy. Spine (Phila Pa 1976). 1999; 24:2313-7. | Article | PubMed 34. Mannion AF, Brox JI and Fairbank JC. Comparison of spinal fusion and nonoperative treatment in patients with chronic low back pain: longterm follow-up of three randomized controlled trials. Spine J. 2013; 13:1438-48. | Article | PubMed 35. Anandacoomarasamy A, Caterson I, Sambrook P, Fransen M and March L. The impact of obesity on the musculoskeletal system. Int J Obes (Lond). 2008; 32:211-22. | Article | PubMed 36. Brooks C, Siegler JC, Cheema BS and Marshall PW. No relationship between body mass index and changes in pain and disability after exercise rehabilitation for patients with mild to moderate chronic low back pain. Spine (Phila Pa 1976). 2013; 38:2190-5. | Article | PubMed 37. Fanuele JC, Abdu WA, Hanscom B and Weinstein JN. Association between obesity and functional status in patients with spine disease. Spine (Phila Pa 1976). 2002; 27:306-12. | PubMed 38. Heuts PH, Vlaeyen JW, Roelofs J, de Bie RA, Aretz K, van Weel C and...