The Need for Multidimensional Stratification of Chronic Low Back Pain (LBP)

Rampersaud, Raja; Bidos, Andrew; Fanti, Caroline; Perruccio, Anthony V.

doi:10.1016/j.spinee.2015.07.097

Cited by 3 publications

(3 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Further developments in risk stratification tools continue despite challenges of accuracy and application reported by therapists [37]. Some argue for a more multidimensional stratification approach, although our results have not consistently supported this [38]. There are other approaches that might be used to explore these data to identify how participant characteristics might moderate response to different treatments approaches.…”

Section: Other Researchmentioning

confidence: 66%

Identification of subgroup effect with an individual participant data meta-analysis of randomised controlled trials of three different types of therapist-delivered care in low back pain

Hee

Mistry

Friede

et al. 2021

BMC Musculoskelet Disord

View full text Add to dashboard Cite

Background Proven treatments for low back pain, at best, only provide modest overall benefits. Matching people to treatments that are likely to be most effective for them may improve clinical outcomes and makes better use of health care resources. Methods We conducted an individual participant data meta-analysis of randomised controlled trials of three types of therapist delivered interventions for low back pain (active physical, passive physical and psychological treatments). We applied two statistical methods (recursive partitioning and adaptive risk group refinement) to identify potential subgroups who might gain greater benefits from different treatments from our individual participant data meta-analysis. Results We pooled data from 19 randomised controlled trials, totalling 9328 participants. There were 5349 (57%) females with similar ratios of females in control and intervention arms. The average age was 49 years (standard deviation, SD, 14). Participants with greater psychological distress and physical disability gained most benefit in improving on the mental component scale (MCS) of SF-12/36 from passive physical treatment than non-active usual care (treatment effects, 4.3; 95% confidence interval, CI, 3.39 to 5.15). Recursive partitioning method found that participants with worse disability at baseline gained most benefit in improving the disability (Roland Morris Disability Questionnaire) outcome from psychological treatment than non-active usual care (treatment effects, 1.7; 95% CI, 1.1 to 2.31). Adaptive risk group refinement did not find any subgroup that would gain much treatment effect between psychological and non-active usual care. Neither statistical method identified any subgroups who would gain an additional benefit from active physical treatment compared to non-active usual care. Conclusions Our methodological approaches worked well and may have applicability in other clinical areas. Passive physical treatments were most likely to help people who were younger with higher levels of disability and low levels of psychological distress. Psychological treatments were more likely to help those with severe disability. Despite this, the clinical importance of identifying these subgroups is limited. The sizes of sub-groups more likely to benefit and the additional effect sizes observed are small. Our analyses provide no evidence to support the use of sub-grouping for people with low back pain.

show abstract

Section: Other Researchmentioning

confidence: 66%

Identification of subgroup effect with an individual participant data meta-analysis of randomised controlled trials of three different types of therapist-delivered care in low back pain

Hee

Mistry

Friede

et al. 2021

BMC Musculoskelet Disord

View full text Add to dashboard Cite

show abstract

“…The PH-LOW group had a higher CCI score (1 [0, 2] vs 0 [0, 1], p < 0.001), a higher prevalence of depression (45.3 vs 28.2%, p = 0.001), more physical therapy appointment cancellations or no shows (3 [2,7] vs 3 [1,5], p = 0.014), shorter appointment lead time (20 [15,25] vs 22 [17,28], p = 0.031), and a higher incidence of spine imaging ordered post-encounter (17.0 vs 6.7%, p = 0.005) compared to PH-HIGH (Table 2). The MH-LOW group had a higher CCI score (1 [0, 3] vs 0 [0, 1], p < 0.001), a higher prevalence of depression (59.6 vs 29.3%, p < 0.001), less physical therapy visits (3 [1,6] vs 4 [2,6], p = 0.043), more appointment cancellations or no-shows (4 [2, 9.5] vs 3 [1,5], p = 0.008), and a higher incidence of opioid prescription orders post-encounter (14.0 vs 5.4%, p = 0.011) compared to MH-HIGH.…”

Section: Resultsmentioning

confidence: 99%

“…Chronic low back pain (cLBP), defined as non-specific back pain lasting at least three months [1], is one of the most common and debilitating health problems in the Open Access adult population in the United States [2]. The condition of cLBP is associated with decreased quality of life and represents a tremendous economic and healthcare burden [3][4][5][6]. In particular, health-related quality of life (HRQoL)-defined as patient's self-perceived function and well-being in physical, mental, and social domains of health [7,8]-is often negatively impacted by cLBP [8].…”

Section: Introductionmentioning

confidence: 99%

Use of the PROMIS-10 global health in patients with chronic low back pain in outpatient physical therapy: a retrospective cohort study

Pak

Miller

Cheuy

2021

J Patient Rep Outcomes

View full text Add to dashboard Cite

Background Although evidence-based guidelines for physical therapy for patients with chronic low back pain (cLBP) are available, selecting patient-reported outcome measures to capture complexity of health status and quality of life remains a challenge. PROMIS-10 Global Health (GH) may be used to screen for impactful health risks and enable patient-centered care. The purpose of this study was to investigate the interrelationships between PROMIS-10 GH scores and patient demographics, health status, and healthcare utilization in patients with cLBP who received physical therapy. Methods A retrospective review of de-identified electronic health records of patients with cLBP was performed. Data were collected for 328 patients seen from 2017 to 2020 in three physical therapy clinics. Patients were grouped into HIGH and LOW initial assessment scores on the PROMIS-10 Global Physical Health (PH) and Global Mental Health (MH) measures. Outcomes of interest were patient demographics, health status, and healthcare utilization. Mann–Whitney U and chi-square tests were used to determine differences between groups, and binary logistic regression was used to calculate odds ratios (OR) to determine predictors of PH-LOW and MH-LOW group assignments. Results The PH-LOW and MH-LOW groups contained larger proportions of patients who were African American, non-Hispanic, and non-commercially insured compared to PH-HIGH and MH-HIGH groups (p < .05). The PH-LOW and MH-LOW groups also had a higher Charlson comorbidity index (CCI), higher rates of diabetes and depression, and more appointment cancellations or no-shows (p < .05). African American race (OR 2.54), other race (2.01), having Medi-Cal insurance (OR 3.37), and higher CCI scores (OR 1.55) increased the likelihood of being in the PH-LOW group. African American race (OR 3.54), having Medi-Cal insurance (OR 2.19), depression (OR 3.15), kidney disease (OR 2.66), and chronic obstructive pulmonary disease (OR 1.92) all increased the likeihood of being in the MH-LOW group. Conclusions Our study identified groups of patients with cLBP who are more likely to have lower PH and MH scores. PROMIS-10 GH provides an opportunity to capture and identify quality of life and global health risks in patients with cLBP. Using PROMIS-10 in physical therapy practice could help identify psychosocial factors and quality of life in the population with cLBP.

show abstract

Predictors of response following standardized education and self-management recommendations for low back pain stratified by dominant pain location

Perruccio¹,

Wong²,

Badley³

et al. 2021

North American Spine Society Journal (NASSJ)

Self Cite

View full text Add to dashboard Cite

Background Low back pain (LBP) is a leading cause of disability globally. Risk-stratification systems (e.g. STarT Back) have been proposed to guide treatment, but with varying success. We investigated factors associated with poor response to standardized LBP education and self-management recommendations stratified by dominant pain location (back or leg). Methods LBP patients underwent a standardized primary care model of care of education and self-management recommendations. Poor response was defined as an Oswestry Disability Index (ODI) change score <10 units by 6 months. Multivariable logistic regression was used to identify poor response risk factors, stratified by back-dominant and leg-dominant back pain. Baseline factors: age, sex, body mass index, ODI, LBP/leg-pain intensity, LBP/leg-pain duration, STarT Back chronicity-risk, smoking, comorbidity count, and self-efficacy. Results The sample consisted of 767 patients (443 back-dominant, 324 leg-dominant). Mean age was 53 years, and 59% were female. Females accounted for 66% of back-dominant and 50% of leg-dominant patients. Chronicity risk was ‘high’ for 18% of back-dominant and 29% of leg-dominant patients. Poor response was higher in back- (57%) compared to leg-dominant (42%) patients. Adjusted stratified analyses: female sex, moderate or high chronicity-risk, and increasing age were associated with increased risk of poor response, and greater self-efficacy with favourable response, in leg-dominant patients; these were not the cases among back-dominant patients. Increased comorbidity count was associated with poor response in back dominant patients. In both patient groups, higher baseline ODI score was associated with favorable response, and smoking and longer pain duration with poor response. Conclusions Differences in the influence of sex and chronicity risk in particular on outcome by dominant pain location suggests that considering these patients as a single group may not be appropriate. Furthermore, findings suggest that stratification by pain dominance may enhance the use of established risk stratification tools such as the STarT Back.

show abstract

The Need for Multidimensional Stratification of Chronic Low Back Pain (LBP)

Cited by 3 publications

References 27 publications

Identification of subgroup effect with an individual participant data meta-analysis of randomised controlled trials of three different types of therapist-delivered care in low back pain

Identification of subgroup effect with an individual participant data meta-analysis of randomised controlled trials of three different types of therapist-delivered care in low back pain

Use of the PROMIS-10 global health in patients with chronic low back pain in outpatient physical therapy: a retrospective cohort study

Predictors of response following standardized education and self-management recommendations for low back pain stratified by dominant pain location

Contact Info

Product

Resources

About