The Nordic back pain subpopulation program: predicting outcome among chiropractic patients in Finland (original) (raw)
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Chiropractic & Osteopathy, 2010
Background: It is widely believed that non-specific low back pain (LBP) consists of a number of subgroups which should be identified in order to improve treatment effects. In order to identify subgroups, patient characteristics that relate to different outcomes are searched for. However, LBP is often fluctuating or recurring rather than clearly limited in time. Therefore it would be relevant to consider outcome after completed treatment from a longitudinal perspective (describing "course patterns") instead of defining it from an arbitrarily selected end-point. Aims: The objectives of this pilot study were to investigate the interobserver reliability of a diagnostic classification system and to evaluate whether diagnostic classes or other baseline characteristics are associated with the LBP course pattern over a period of 18 weeks.
A Pilot Study to Gather and Evaluate Data on Chiropractic Treatment of LBP and NP
IOSR Journal of Dental and Medical Sciences, 2014
Objectives:This is a retrospectivenonexperimental observational study with a dual purpose: first,to gather and evaluate pre-and post-treatment statistics at a chiropractic university outpatient teachingclinic using customary instruments of pain and functionality measurement of Low Back Pain (LBP) viz.,the Revised Oswestry Disability Index (RODI) and the Neck Disability Index (NDI), the latter for associated Neck Pain (NP). The second purpose is to look into the effectivenessof treatment for indications of LBP and NP. Methods: The study analyzed patient reported outcomes (PRO) data abouttreatments that patients go through and theresulting improvement in RODI and NDI scores. The pre and post data were then analyzed. Results:The analysis showedeffectiveness in terms of improvements in functionality as quantified by decreases in RODIand NDI points. The global rate of effectiveness for all patients was computed. Repeated measures or paired samples student t tests done separately on RODI and NDI data indicated significant improvements in both LBP and NP (p-value = 0.0000). Evidence did not support linear correlation between age and baseRODI (r = 0.27, p-value = 0.08042). For the subgroup with associated NP linear correlation between RODI and NDI (both before and after treatment) was significant (p-value = 0.0000). Incremental improvements in RODI and NDI scores tended to taper off after an optimal number of doses or treatments. Conclusions:The study substantiated improvements in functionality and reduction in pain following chiropractic intervention. It did not demonstrate significant associations between a) age and baseRODI, and b) incremental improvements in RODI or NDI and treatments (doses) beyond a threshold.
Journal of Manipulative and Physiological Therapeutics, 2005
Objective: To investigate the Bournemouth Questionnaire (BQ) as a baseline, monitoring of progress, and prognostic instrument in chiropractic patients with persistent low back pain (LBP). Study Design: Predictive and concurrent validation study. Study Participants and Setting: One hundred fifteen Norwegian chiropractors collected prospective data on 875 patients with persistent LBP, defined as LBP for at least 2 weeks at baseline and a minimum of 30 days totaling within the preceding year. Methods: Data collection took place at first consultation, fourth visit, and 3 months using the BQ, the revised Oswestry questionnaire, and a 10-point pain box scale. Follow-up at 12 months included the BQ, Oswestry questionnaire, and additional questions on the number of days with LBP and the number of days off work in the past year. Data Analysis: Frequency of reporting of each 7 items in the BQ at baseline was identified as median value with 10th and 90th percentiles. Concurrent analyses of the 2 questionnaires were made at the 4 points in time with calculation of mean differences with limits of agreement together with Bland-Altman plots. Logistic regression was used to identify and compare the predictive values of the questionnaires and to test the relevance of each individual item in the BQ. Results: The median baseline values of the 7 items in the BQ ranged from 2 to 5. The 2 questionnaires did not agree on patients' status, and mean differences between the Oswestry questionnaire and the BQ were largest when patients reported higher scores. The predictive values for the 2 questionnaires were low, with no significant difference between the 2. The predictive value of the BQ could be improved by removing most of the 7 items. Certain items can predict specific outcomes. Conclusions: The BQ is not a useful instrument to identify baseline status, monitor progress, or predict the 1-year progress in chiropractic patients having persistent LBP. However, certain individual items are useful to predict specific outcomes. (J Manipulative Physiol Ther 2005;28:219-227)
BMC Musculoskeletal Disorders, 2012
Background: Low-back related leg pain with or without nerve root involvement is associated with a poor prognosis compared to low back pain (LBP) alone. Compared to the literature investigating prognostic indicators of outcome for LBP, there is limited evidence on prognostic factors for low back-related leg pain including the group with nerve root pain. This 1 year prospective consultation-based observational cohort study will describe the clinical, imaging, demographic characteristics and health economic outcomes for the whole cohort, will investigate differences and identify prognostic indicators of outcome (i.e. change in disability at 12 months), for the whole cohort and, separately, for those classified with and without nerve root pain. In addition, nested qualitative studies will provide insights on the clinical consultation and the impact of diagnosis and treatment on patients' symptom management and illness trajectory.