The Nordic back pain subpopulation program: Can low back pain patterns be predicted from the first consultation with a chiropractor? A longitudinal pilot study (original) (raw)
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Chiropractic & Osteopathy, 2008
Background: In a previous Swedish study it was shown that it is possible to predict which chiropractic patients with persistent LBP will not report definite improvement early in the course of treatment, namely those with LBP for altogether at least 30 days in the past year, who had leg pain, and who did not report definite general improvement by the second treatment. The objectives of this study were to investigate if the predictive value of this set of variables could be reproduced among chiropractic patients in Finland, and if the model could be improved by adding some new potential predictor variables.
Absence of low back pain to demarcate an episode: a prospective multicentre study in primary care
Chiropractic & Manual Therapies, 2016
Background: It has been proposed that an episode of low back pain (LBP) be defined as: "a period of pain in the lower back lasting for more than 24 h preceded and followed by a period of at least 1 month without LBP". Previous studies have tested the definition in the general population and in secondary care populations with distinctly different results. The objectives of this study (in a primary care population) were to investigate the prevalence of 1) the number of consecutive weeks free from bothersome LBP, 2) the prevalence of at least four consecutive weeks free from bothersome LBP at any time during the study period, and 3) the prevalence of at least four consecutive weeks free from bothersome LBP at any time during the study period among subgroups that reported >30 days or ≤30 days of LBP the preceding year. Method: In this prospective multicentre study subjects with LBP (n = 262) were consecutively recruited from chiropractic primary care clinics in Sweden. The number of days with bothersome LBP was collected through weekly automated text messages. The maximum number of weeks in a row without bothersome LBP and the number of periods of at least four consecutive weeks free from bothersome LBP was counted for each individual and analysed as proportions. Results: Data from 222 recruited subjects were analysed, of which 59 % reported at least one period of four consecutive weeks free from bothersome LBP. The number of consecutive pain free weeks ranged from 82 (at least one) to 31 % (9 or more). In subjects with a total duration of LBP of ≤ 30 days the previous year, 75 % reported a period of 4 consecutive weeks free from bothersome LBP during the study period whereas this was reported by only 48 % of subjects with a total duration of LBP of >30 days the previous year. Conclusion: Prevalence of four consecutive pain free weeks is found in the majority of subjects in this population logically reflects duration of LBP within the sample and may be applied on patients in primary care to demarcate a LBP episode.
Physiotherapy Research International, 2018
Objectives: The evidence for the effectiveness of interventions targeting acute low back pain (LBP) is suboptimal. It is difficult to identify those patients who are more likely to develop chronic pain and disability after an acute episode of LBP. These shortcomings may be attributed to considering LBP as one homogenous condition. Methods: In this quasi-experimental study, we examined and analysed a prospective cohort of 267 patients with first-onset LBP and classified them into one of the groups based on treatment-based classification: direction-specified exercises (Group 2), manipulation (Group 3), stabilization exercises (Group 4), traction (Group 5), and a physician care group (Group 1). Disability and pain were assessed at baseline, after treatment, and at 6 months using the Oswestry Disability Index and the Numerical Rating Scale, respectively. Comparisons were made between the groups, and we predicted measures of disability and pain intensity at 6 months with age, gender, fear avoidance behaviour, centralization phenomenon (CP), expectations about recovery, CP, group classification, baseline pain, and disability. Results: Analysis showed that all the heterogeneous groups of LBP improved their outcomes with the respective treatment provided. However, when the entire sample was considered as one homogenous group of LBP, the results showed improvement with time (p < 0.05) only and no difference was found between groups (p > 0.05). None of the studied factors, except baseline pain (R = 0.227, R 2 = 0.051, p < 0.05), were able to accurately predict the development of chronic pain in our study sample. Conclusion: Though our results showed no differences between the subgroups in the reduction of pain and disability, we conclude that classifying and treating patients with LBP into subgroups based on signs and symptoms produce better outcomes. Baseline pain alone may predict a small percentage of people who may develop chronic pain.
Chiropractic & Osteopathy, 2010
Background: Low back pain (LBP) is known to have a fluctuating course. In clinical studies, when deciding on duration of treatment and time for follow-up, it is important to know at what point in time a definite pattern of recovery becomes apparent and at what time a possible recurrence is likely to occur. A detailed description of the pain pattern has been difficult to establish with commonly used methods for follow-up, and we now introduce data collection by means of text messaging on mobile phones. The purpose of this study was to describe the detailed course of LBP during 18 weeks in a population treated in the primary care sector by chiropractors. Methods: The study population consisted of 78 patients presenting to a chiropractor with LBP, who for at least 12 weeks responded to the questions sent by text messaging concerning 1) the number of LBP-days the preceding week and 2) the intensity of present LBP.
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)
Journal of Manipulative and Physiological Therapeutics, 2005
Objectives: The aims of the study are to describe the low-back pain and disability status at baseline, the fourth visit, and at 3 and 12 months in Norwegian patients treated by chiropractors for persistent low back pain (LBP) and to describe movements between various subgroups over time. Design: Prospective uncontrolled multicenter study. Methods: Self-reported pain was measured with a 0-10 box scale and disability with the revised Oswestry LBP questionnaire. The main outcome measures were mean pain or disability values and numbers of LBP-free patients. LBP status was assessed through patient questionnaires at baseline, the fourth visit, and after 3 and 12 months. Study Subjects and Setting: Of 205 invited chiropractors, 115 Norwegian chiropractors were each willing to recruit 10 consecutive patients who had LBP for at least 2 weeks at the time of consultation and a minimum of 30 days altogether within the preceding year. The numbers of participants were 875 (baseline), 799 (fourth visit), 598 (3 months), and 512 (12 months). Results: Considerable improvement was noted between baseline and the fourth visit both for mean values and in numbers of LBP-free patients. There was virtually no further mean improvement up to the third month, whereas the number of LBP-free individuals doubled. At 12 months, no additional improvement was noted, and 80% reported that they had experienced recurrent problems. Less than 1% reported considerable worsening. Severity of symptoms at baseline determined the subsequent outcome, mild symptoms tending to worsen, and severe symptoms tending to improve. Conclusion: The outcome pattern is similar to that found in other clinical studies. Treatment outcome should be measured early with follow-up at 3 rather than at 12 months, because patients will improve or recover quickly but may experience recurring problems. Numbers bcuredQ appear to be a feasible outcome variable in this type of study population.