Background
Methods
Registration
Data sources and searches
# | Searches |
---|---|
1 | Back Pain/ |
2 | Low Back Pain/ |
3 | Sciatica/ |
4 | Radiculopathy/ |
5 | (back pain or low back pain or radiculopathy or sciatica or back?ache or lumbago).mpa
|
6 | (pain or ache or aching or complaint or dysfunction or disability or disorder).mpa
|
7 | Back or spine or lumbar or lumbar spine or low*back).mpa
|
8 | 6 and 7 |
9 | 1 or 2 or 3 or 4 or 5 or 8 |
10 | (screen* or risk screen* or risk).mpa
|
11 | (tool or questionnaire or instrument).mpa
|
12 | 10 and 11 |
13 | 9 and 12 |
14 | (predict* or prognosis or prediction rule* or early identification or predictive validity or predictive factors or prognostic or prognostic indicators).mpa
|
15 | 13 and 14 |
16 | Limit 15 to (English language and humans) |
Eligibility criteria
Types of participants
Types of studies
Types of outcomes
Study selection
Data extraction and analysis
Assessment of methodological quality
Results
Study selection
Reference | Prognostic screening instruments | Reason for exclusion |
---|---|---|
Bergstrom et al. (2011) [62] | MPI-S | Mixed cohort;b authors did not differentiate an acute/subacute group |
Bernstein et al. (1994) [63] | SCL-90-R | Chronic pain cohort (pain > 3 months) |
Morso et al. (2011) [64] | PainDETECT questionnaire | Chronic pain cohort (pain duration 3–12 months) |
Late exclusions:a
| ||
Fischer et al. (2014) [30] | HKF-R10 | Mixed cohort;b authors did not differentiate an acute/subacute group |
Hurley et al. (2001) [31] | ALBPSQ | Mixed cohortb,c
|
Linton et al. (2011) [32] | OMPSQ (Short Form) | Mixed cohortb,c
|
Morso et al. (2013) [65] | SBT | Mixed cohortb,c
|
Morso et al. (2014) [33] | SBT | Mixed cohortb,c
|
Cats-Baril et al. (1991) [35] | VDPQ | Mixed cohort;b unable to contact authors to request data from recent onset participants |
Reference | Country of investigation and clinical setting | Definition of poor outcome |
N at baseline, (n at follow-up, % at follow-up) | Discrimination (AUC (95% confidence interval)) |
---|---|---|---|---|
STarT Back Screening Tool | ||||
Beneciuk et al. 2012 [43] | USA Outpatient physiotherapy clinics | At 6 months:
aPain NRS score ≥ 3
aDisability (ODI score ≥ 30%) | 73 (55, 75.3%) |
aPain 0.61 (0.45–0.76)
aDisability 0.75 (0.60–0.90) |
Field & Newell, 2012 [44] | UK Chiropractic clinics | At 90 days:
aPain NRS score ≥ 3 | 477 (151, 31.7%) |
aPain 0.597 (0.499–0.694) |
Hill et al. 2008 [46] | UK General practice clinics | 6 months: RMDQ score ≥ 7
aPain NRS score ≥ 3
aDisability ≥ 30% RMDQ | 177 at follow-up. (N at baseline not specified |
aPain 0.70 (0.62–0.88)
aDisability 0.81 (0.75–0.88) |
Kongsted et al. 2015 [38] | Denmark Chiropractic clinics | 3 months:
aPain NRS score ≥ 3
aDisability ≥ 30% RMDQ | 754 (604, 80.1%) |
aPain 0.56 (0.49–0.60)
aDisability 0.67 (0.62–0.73) |
Newell et al. 2014 [45] | UK Chiropractic clinics | At 90 days:
aPain NRS score ≥ 3 | 284 (192, 67.6%) |
aPain 0.59 (0.48–0.69) |
Orebro Musculoskeletal Pain Screening Questionnaire; Acute Low Back Pain Screening Questionnaire | ||||
Gabel et al. 2011 [39] | Australia Physiotherapy outpatient clinics | At 6 months: Functional status ≥ 10% Problem severity > 1 Absenteeism > 0 days Long term absenteeism > 28 days
aPain NRS score ≥ 3
aDisability (SFI score ≥ 30%) | 66 (58, 87.9%) (OMPSQ - Original) | Functional status 0.88 (0.78–0.99) Problem severity 0.85 (0.72–0.97) Absenteeism 0.86 (0.76–0.96) Long-term absenteeism 0.85 (0.73–0.96)
aPain 0.84 (0.71–0.97)
aDisability 0.80 (0.67–0.92) |
Grotle et al. 2006 [25] | Norway General practitioner/Chiropractor/Physiotherapy clinics (27% recruited through advertisement) | At 6 & 12 months: Pain NRS score ≥ 3 Disability (RMDQ score > 4) Sick leave (> 30 days) | 123 (112, 91.1%) | Pain 0.62 (0.51–0.73) Disability 0.68 (0.56–0.80) Sick leave 0.80 (0.66–0.93) |
Heneweer et al. 2007 [66] | Netherlands Physiotherapy clinics | Not recovered at 12 weeks
aPain NRS score ≥ 3
aDisability QBPDS ≥ 30%) | 66 (56, 84.8%) | Non-recovery 0.64 (0.5–0.79)
aPain 0.64 (0.50–0.78)
aDisability 0.67 (0.54–0.8) |
Jellema et al. 2007 [52] | Netherlands General practice clinics | 12 months: score of ‘slightly improved’ or worse at two or more follow-up time points | 314 (296, 94.3%) | Non-recovery 0.61 (0.54–0.67) |
Law et al. 2013 [37] | China Physiotherapy clinics in public hospitals | 12 months post discharge: Failure to return to work Prolonged sick leave (> 30 days) | 241 (220, 91.3%) | Return to work 0.69 (0.62–0.76) Prolonged sick leave 0.71 (0.64–0.78) |
Nonclercq et al. 2012 [42] | Belgium Emergency facility or outpatient clinic | At 6 months: Pain index score > 16 ODI ≥ 20% Functional index < 45 Work absence > 30 days
aPain NRS score ≥ 3
aDisability ≥ 30% ODI | 91 (73, 80%) | Pain 0.73 (no confidence intervals) Functional index 0.79 (no confidence intervals) Absenteeism 0.83 (standard error 0.71) Disability 0.75 (no confidence intervals)
aPain 0.70 (standard error 0.66)
aDisability 0.72 (standard error 0.86) |
Schmidt et al. 2016 [48] | Germany General practice clinics | 6 months: Disability ≥ 4/11 (dichotomised mean response to three GCPS disability items) | 181 (112, 62%) | Disability (OMPSQ scale sum score) 0.79 (0.67–0.90) Disability (OMPSQ item sum score) 0.77 (0.66–0.87) |
Vermont Disability Prediction Questionnaire | ||||
Hazard et al. 1996 [49] | USA Vermont Department of Labour and Industry database | Not returned to work at 3 months | 166 (163, 98%) | Return to work 0.92 (no confidence interval or standard error reported) |
Hazard et al. 1997 [50] | USA Vermont Department of Labour and Industry database | Not returned to work at 3 months | 304 (268, 88.2%) | Return to work 0.78 (no confidence interval or standard error reported) |
Absenteeism Screening Questionnaire | ||||
Truchon et al. 2012 [51] | Canada Quebec Workers Compensation Board database | 12 months: Absenteeism > 182 cumulative days | 535 (310, 58%) | Absenteeism 0.73 (no confidence intervals or standard error reported) |
Chronic Pain Risk Score | ||||
Turner et al. 2013 [61] | USA Primary care | 4 months Pain grades 3 & 4
aPain NRS ≥ 3 | 458 (425, 92.8%) | Pain grades 3 & 4 0.67 (0.59–0.72)
aPain 0.67 (0.59–0.72) |
Back Disability Risk Questionnaire | ||||
Shaw et al. 2009 [40] | USA Occupational health clinics | 3 months: Pain ≥ 5 Disability ≥ 50%
aPain NRS score ≥ 3
aDisability ≥ 30% RMDQ | 568 (519, 91.4%) |
aPain 0.61 (0.56–0.66)
aDisability 0.66 (0.62–0.70) |
Hancock Clinical Prediction Rule | ||||
Williams et al. 2014 [41] | Australia General practice clinics, Pharmacists or physiotherapy clinics | 3 months: No sustained recovery (0 or 1/10 on a NRS for 7 consecutive days)
aPain NRS ≥ 3 | 956 (937, 82%) | Sustained recovery 0.60 (0.56–0.64)
aPain 0.62 (0.60–0.65) |
Study characteristics
PSIs
Instrument | Summary of instrument | Scoring method | Cut-off scores/subgrouping |
---|---|---|---|
STarT Back Tool (SBT) [46] | 9-item, self-report questionnaire; items screen for predictors of persistent disabling back pain and include radiating leg pain, pain elsewhere, disability (2 items), fear, anxiety, pessimistic patient expectations, low mood and how much the patient is bothered by their pain; all 9-items use a response format of ‘agree’ or ‘disagree’, with exception to the bothersomeness item, which uses a Likert scale. | Two scores are produced – an overall score and a distress (psychosocial) subscale | Total scores of 3 or less = low risk If total score is 4 or more: - Those with psychosocial subscale scores of 3 or less = medium risk - Those with psychosocial subscale scores of 4 or more = high risk |
25-item, self-report questionnaires; items screen for six factors: self-perceived function, pain experience, fear-avoidance beliefs, distress, return to work expectancy, and pain coping | Total score calculated from 21 items and can range from 2 to 210 points; higher values indicate more psychosocial problems | A cut-off of 105 proposed for indicating those ‘at risk’ of persisting problems | |
OMPSQ (Short form) [32] | 10-item questionnaire covering five domains: self-perceived function, pain experience, fear-avoidance beliefs, distress, and return to work expectancy; demonstrated to have similar discriminative ability to original OMPSQ | Scores range from 0 to 100 (higher scores indicate higher risk) | A cut-off of 50 recommended to indicate those ‘at risk’ of persisting pain related disability |
Vermont Disability Prediction Questionnaire (VDPQ) [49] | 11-item self-report questionnaire; assesses perceptions of who was to blame for the injury, relationships with co-workers and employer, confidence that they will be working in 6 months, current work status, job demands, availability of job modifications, length of time employed, and job satisfaction | Hand scored (maximum score of 23) | No optimal cut-off recommended |
Back Disability Risk Questionnaire (BDRQ) [40] | 16-item self-report questionnaire; items include demographics, health ratings, workplace concerns, pain severity, mood, and expectations for recovery | Sum score calculated | No optimal cut-off recommended |
Absenteeism screening questionnaire (ASQ) [51] | 16-item, self-report questionnaire; assesses potential occupational back pain disability and risk factors including: work factors (3), physical health (2), supervisor response (1), pain (2), mood (2), wellness/job satisfaction (3), and expectations for recovery (1); mixture of nominal, ordinal and interval scale response options | ‘Flag’ related items are summed and level of risk categorised as low, medium or high | 0–1 flag items = low risk 2–3 items = medium risk 4–9 items = high risk |
Chronic Pain Risk Score (CPRS) [61] | Three graded chronic pain scale ratings of pain intensity, three ratings of activity interference, the number of activity limitation days, the number of days with pain in the past 6 months, depressive symptoms, the number of painful sites | Maximum score of 28 (higher scores indicate greater risk) | No optimal cut-off recommended |
Hancock Clinical Prediction Rule (HCPR) [69] | 3-item self-report questionnaire, items assess baseline pain (≤ 7/10), pain duration (≤ 5 days) and number of previous painful episodes (≤ 1) | Status on the prediction rule determined by calculating the number of predictors of recovery present | Risk classification based on the number of predictors of recovery present (0–3) |
Outcomes
Meta-analysis
SBT
PSI | Outcome | Studies (Total N) | Heterogeneity I
2 (P) | Pooled AUC value | 95% confidence interval |
---|---|---|---|---|---|
SBT | Pain (≥ 3) | 5 studies (1153) | 0.00% (0.47) | 0.59 | 0.55–0.63 |
SBT | Disability (≥ 30%) | 3 studies (821) | 80.95% (0.01) | 0.74 | 0.66–0.82 |
OMPSQ | Pain (≥ 3) | 4 studies (360) | 40.95% (0.17) | 0.69 | 0.62–0.76 |
OMPSQ | Disability (≥ 30%) | 3 studies (512) | 0.00% (0.42) | 0.75 | 0.69–0.82 |
OMPSQ | 6 month absenteeism (> 28 days) | 3 studies (243) | 0.00% (0.86) | 0.83 | 0.75–0.90 |
OMPSQ | 12 month absenteeism (> 30 days) | 2 studies (440) | 0.00% (0.90) | 0.71 | 0.64–0.78 |
OMPSQ
AUC | 95% Confidence interval |
I
2 (P) | |
---|---|---|---|
All studies included | 0.75 | 0.69–0.82 | 0.00% (0.64) |
Schmidt et al. (2016) [48] removed (≥ 40%) | 0.73 | 0.65–0.81 | 0.00% (0.60) |
Grotle et al. (2006) [25] removed (≥ 20%) | 0.75 | 0.69–0.82 | 0.00% (0.50) |
0.74 | 0.65–0.82 | 0.00% (0.42) |
All instruments
Studies not included in the meta-analysis
Jellema et al. 2007 [52] – OMPSQ
Hazard et al. 1996 [49] & 1997 [50] – VDPQ
Truchon et al. (2012) [51] – ASQ
Methodologic quality
Study | A. Study participation | B. Study attrition | C. Prognostic factor measurement | D. Outcome measurement | E. Study confounding | F. Statistical analysis and reporting | Overall assessment of risk of biasa
|
---|---|---|---|---|---|---|---|
Beneciuk et al. 2012 [43] | Low | Moderate | Moderate | Low | Low | Low | Low |
Field & Newell 2012 [44] | Moderate | Moderate | Low | Low | Low | Low | Low |
Gabel et al. 2011 [39] | Moderate | Low | Moderate | Low | Low | Low | Low |
Grotle et al. 2006 [25] | Moderate | Low | Moderate | Low | Low | Moderate | Low |
Hazard et al. 1996 [49] | Moderate | Low | Low | Low | Low | Moderate | Low |
Hazard et al. 1997 [50] | Moderate | Low | Low | Low | Low | Low | Low |
Heneweer et al. 2007 [66] | Moderate | Low | Low | Low | Low | Low | Low |
Hill et al. 2008 [46] | Moderate | Moderate | Low | Low | Low | Low | Low |
Jellema et al. 2007 [52] | Low | Low | Low | Moderate | Low | Low | Low |
Kongsted et al. 2015 [38] | Low | Low | Low | Low | Low | Low | Low |
Law et al. 2013 [37] | Low | Moderate | Low | Low | Moderate | Low | Low |
Newell et al. 2014 [45] | Low | High | Moderate | Low | Low | Low | High |
Nonclercq et al. 2010 [42] | Moderate | Low | Low | Low | Low | Low | Low |
Shaw et al. 2009 [40] | Low | Low | Low | Low | Low | Low | Low |
Schmidt et al. 2016 [48] | Moderate | Moderate | Low | Low | Low | Low | Low |
Truchon et al. 2012 [51] | Moderate | High | Low | Moderate | Low | Moderate | High |
Turner et al. 2013 [61] | Moderate | Low | Low | Low | Low | Low | Low |
Williams et al. 2014 [41] | Low | Low | Low | Low | Low | Low | Low |