Prognostic factors for perceived recovery or functional improvement in non-specific low back pain: secondary analyses of three randomized clinical trials

• Published in: European spine journal 2010-04, Vol.19 (4), p.650-659
• Main Authors: Helmhout, Pieter H., Staal, J. Bart, Heymans, Martijn W., Harts, Chris C., Hendriks, Erik J. M., de Bie, Rob A.
• Format: Article
• Language: English
• Subjects: Activities of Daily Living - psychology; Adult; Female; Humans; Low Back Pain - diagnosis; Low Back Pain - psychology; Low Back Pain - rehabilitation; Male; Medicine; Medicine & Public Health; Middle Aged; Neurosurgery; Original; Original Article; Pain Measurement - psychology; Prognosis; Prospective Studies; Recovery of Function; Regression Analysis; Severity of Illness Index; Surgical Orthopedics; Surveys and Questionnaires
• ISSN: 0940-6719; 1432-0932
• DOI: 10.1007/s00586-009-1254-8

The objective of this study was to report on secondary analyses of a merged trial dataset aimed at exploring the potential importance of patient factors associated with clinically relevant improvements in non-acute, non-specific low back pain (LBP). From 273 predominantly male army workers (mean age 39 ± 10.5 years, range 20–56 years, 4 women) with LBP who were recruited in three randomized clinical trials, baseline individual patient factors, pain-related factors, work-related psychosocial factors, and psychological factors were evaluated as potential prognostic variables in a short-term (post-treatment) and a long-term logistic regression model (6 months after treatment). We found one dominant prognostic factor for improvement directly after treatment as well as 6 months later: baseline functional disability, expressed in Roland–Morris Disability Questionnaire scores. Baseline fear of movement, expressed in Tampa Scale for Kinesiophobia scores, had also significant prognostic value for long-term improvement. Less strongly associated with the outcome, but also included in our final models, were supervisor social support and duration of complaints (short-term model), and co-worker social support and pain radiation (long-term model). Information about initial levels of functional disability and fear-avoidance behaviour can be of value in the treatment of patient populations with characteristics comparable to the current army study population (e.g., predominantly male, physically active, working, moderate but chronic back problems). Individuals at risk for poor long-term LBP recovery, i.e., individuals with high initial level of disability and prominent fear-avoidance behaviour, can be distinguished that may need additional cognitive-behavioural treatment.