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01.12.2017 | Research article | Ausgabe 1/2017 Open Access

BMC Musculoskeletal Disorders 1/2017

Brief pain re-assessment provided more accurate prognosis than baseline information for low-back or shoulder pain

Zeitschrift:
BMC Musculoskeletal Disorders > Ausgabe 1/2017
Autoren:
G. Mansell, K. P. Jordan, G. M. Peat, K. M. Dunn, D. Lasserson, T. Kuijpers, I. Swinkels-Meewisse, D. A. W. M. van der Windt
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12891-017-1502-8) contains supplementary material, which is available to authorized users.

Abstract

Background

Research investigating prognosis in musculoskeletal pain conditions has only been moderately successful in predicting which patients are unlikely to recover. Clinical decision making could potentially be improved by combining information taken at baseline and re-consultation.

Methods

Data from four prospective clinical cohorts of adults presenting to UK and Dutch primary care with low-back or shoulder pain was analysed, assessing long-term disability at 6 or 12 months and including baseline and 4–6 week assessments of pain. Baseline versus short-term assessments of pain, and previously validated multivariable prediction models versus repeat assessment, were compared to assess predictive performance of long-term disability outcome. A hypothetical clinical scenario was explored which made efficient use of both baseline and repeated assessment to identify patients likely to have a poor prognosis and decide on further treatment.

Results

Short-term repeat assessment of pain was better than short-term change or baseline score at predicting long-term disability improvement across all cohorts. Short-term repeat assessment of pain was only slightly more predictive of long-term recovery (c-statistics 0.78, 95% CI 0.74 to 0.83 and 0.75, 95% CI 0.69 to 0.82) than a multivariable baseline prognostic model in the two cohorts presenting such a model (c-statistics 0.71, 95% CI 0.67 to 0.76 and 0.72, 95% CI 0.66 to 0.78). Combining optimal prediction at baseline using a multivariable prognostic model with short-term repeat assessment of pain in those with uncertain prognosis in a hypothetical clinical scenario resulted in reduction in the number of patients with an uncertain probability of recovery, thereby reducing the instances where patients may be inappropriately referred or reassured.

Conclusions

Incorporating short-term repeat assessment of pain into prognostic models could potentially optimise the clinical usefulness of prognostic information.
Zusatzmaterial
Additional file 1: Changes over time (Means, SDs and percentages) and descriptive data for outcome and predictor variables. (DOCX 21 kb)
12891_2017_1502_MOESM1_ESM.docx
Literatur
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