Can demographic and anthropometric characteristics predict clinical improvement in patients with chronic non-specific low back pain?

doi:10.1016/j.bjpt.2018.06.005

Brazilian Journal of Physical Therapy

Volume 22, Issue 4, July–August 2018, Pages 328-335

https://doi.org/10.1016/j.bjpt.2018.06.005 Get rights and content

Highlights

•
Gender, marital status, BMI, and duration of pain do not influence the prognosis of patients with chronic LBP.
•
Age has little influence on the clinical improvement of patients with chronic LBP after four weeks of treatment.
•
Physical therapists can predict the clinical improvement of their patients based on a simple assessment of their disability at baseline consultation. This model explains 42.1% of the variability.

Abstract

Objective

To identify potential prognostic factors that may predict clinical improvement of patients treated with different physical therapy interventions in the short-term.

Methods

This is a prospective cohort study. A total of 616 patients with chronic non-specific low back pain treated with interventions commonly used by physical therapists were included. These patients were selected from five randomized controlled trials. Multivariate linear regression models were used to verify if sociodemographic characteristics (age, gender, and marital status), anthropometric variables (height, body mass, and body mass index), or duration of low back pain, pain intensity at baseline, and disability at baseline could be associated with clinical outcomes of pain intensity and disability four weeks after baseline.

Results

The predictive variables for pain intensity were age (β = 0.01 points, 95% CI = 0.00 to 0.03, p = 0.03) and pain intensity at baseline (β = 0.23 points, 95% CI = 0.13 to 0.33, p = 0.00), with an explained variability of 4.6%. Similarly, the predictive variables for disability after four weeks were age (β = 0.03 points, 95% CI = 0.00 to 0.06, p = 0.01) and disability at baseline (β = 0.71 points, 95% CI = 0.65 to 0.78, p = 0.00), with an explained variability of 42.1%.

Conclusion

Only age, pain at baseline and disability at baseline influenced the pain intensity and disability after four weeks of treatment. The beta coefficient for age was statistically significant, but the magnitude of this association was very small and not clinically important.

Introduction

Low back pain is a highly prevalent condition worldwide, and in some cases, it can be severely disabling.¹ Recent studies show that this condition is associated with loss of function and often related to poorly adapted changes in how patients perceive and interpret their pain.² The Global Burden of Disease identified low back pain as one of the highest-ranking health conditions in terms of years lived with disability.³ In Brazil, the National Household Sample Survey⁴ pointed to low back pain as the second most prevalent health condition,⁴ with the prevalence⁵ of chronic low back pain (present for more than 12 weeks)⁶ varying between 4.2% and 14.7%. In addition, in 2011, low back pain was listed as the main cause of disability among retirement and accident compensation recipients, with an incidence of 29.96 per 100,000 social security payers. These estimates were more frequent among men and older people.⁷

An Australian study that included patients with acute low back pain (i.e., with a pain duration of up to six weeks)⁶ who sought primary health care showed that a higher pain intensity may be associated with female gender, advanced age, intake of medication, and duration of low back pain episode.⁸ Other studies on prognostic factors and their influence on recovery from low back pain showed several prognostic factors related to low back pain: sociodemographic data such as educational level, age, and gender; physical factors such as pain intensity and perceived disability; psychological factors such as depression, anxiety, fear related to movement, and catastrophizing of symptoms; and occupational factors.9, 10, 11, 12, 13, 14, 15 A systematic review that investigated the prognostic factors related to persistent disabling low back pain showed that sociodemographic data (age, gender, smoking, weight, and educational level) could not correctly predict disability in patients with low back pain.¹⁶

In summary, prognostic factors can be useful to provide information related to clinical decision making and understanding the process of prediction and definition of groups that may present risks of poor prognosis.16, 17, 18, 19 This information is especially important when modifiable prognostic factors are evident. Considering that, as aging increases in the world's population²⁰ and with the estimate that approximately one-third of the adult population is overweight,²¹ there has been growing interest in the search for these prognostic factors and their association with the recovery in patients with low back pain.16, 17, 18, 19 In the same way, it is unclear whether demographic and anthropometric characteristics can influence the rate of clinical improvement in patients with chronic non-specific low back pain. Therefore, the objective of this study is to identify prognostic factors that can predict clinical improvement of pain intensity and disability of patients treated with physical therapy interventions in the short-term.

Section snippets

Study design

This is a prospective cohort study. Participants with chronic non-specific low back pain were selected from five randomized controlled trials,22, 23, 24, 25, 26 conducted in public and private clinics in Brazil between 2011 and 2014. The studies samples ranged from 8623, 25 to 14822, 24, 26 patients with chronic non-specific low back pain who received the following physical therapy interventions: Pilates,23, 25 Kinesio Taping,22, 26 McKenzie therapy,²⁴ exercise and manual therapy,²² and

Results

A total of 616 patients with chronic non-specific low back pain participated in the analysis, of which 466 were women and 150 were men with a mean age of 47 years, predominantly married and overweight. At baseline assessment, patients presented an average of 7.0 points of pain intensity and 11.4 points of disability (Table 1). After approximately four weeks of physical therapy, most patients showed a large improvement in these outcomes. For example, an average reduction of about 40–50% of the

Discussion

This study aimed to identify prognostic factors that could predict clinical improvement of pain intensity and disability of patients treated with physical therapy interventions in the short-term in Brazil. Age, pain intensity at baseline and disability at baseline were associated with pain intensity and disability after four weeks of treatment. It is worth noting that the association of age in both models was statistically significant, but the magnitude of this association was very small and

Conclusion

Age, gender, marital status, BMI, and duration of pain do not seem to influence the prognosis of patients with chronic non-specific low back pain. Age, pain intensity at baseline and disability at baseline seem to influence the clinical improvement of patients with chronic non-specific low back pain after four weeks of treatment. It is worth noting that the association of age in both models was statistically significant, but the magnitude of this association was very small and not clinically

Conflicts of interest

The authors declare no conflicts of interest.

References (47)

P. Campbell et al.
Prognostic indicators of low back pain in primary care: five-year prospective study
J Pain
(2013)
K.M. Dunn et al.
Contributions of prognostic factors for poor outcome in primary care low back pain patients
Eur J Pain
(2011)
N.E. Foster et al.
Distinctiveness of psychological obstacles to recovery in low back pain patients in primary care
Pain
(2010)
M. Grotle et al.
Are prognostic indicators for poor outcome different for acute and chronic low back pain consulters in primary care?
Pain
(2010)
D. Hoy et al.
The Epidemiology of low back pain
Best Pract Res Clin Rheumatol
(2010)
P.M. Kent et al.
Can we predict poor recovery from recent-onset nonspecific low back pain? A systematic review
Man Ther
(2008)
T. Lehnert et al.
Economic costs of overweight and obesity
Best Pract Res Clin Endocrinol Metab
(2013)
M.L. Peters et al.
The joint contribution of physical pathology, pain-related fear and catastrophizing to chronic back pain disability
Pain
(2005)
J.W. Vlaeyen et al.
Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance
Pain
(1995)
B.F. Walker et al.
Low back pain in Australian adults: prevalence and associated disability
J Manip Physiol Ther
(2004)

P.C. Austin et al.

The number of subjects per variable required in linear regression analyses

J Clin Epidemiol

(2015)

K. Mounce

Back pain

Rheumatology (Oxford)

(2002)

P.F. Beattie et al.

The evolving role of physical therapists in the long-term management of chronic low back pain: longitudinal care using assisted self-management strategies

Braz J Phys Ther

(2016)

Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

Lancet

(2015)

Instituto Brasileiro de Geografia e Estatística

Pesquisa por Amostra de Domicílios. Um panorama da saúde no Brasil: acesso e utilização dos serviços, condições de saúde e fatores de risco e proteção à saúde

(2008)

P.R. do Nascimento et al.

Low back pain prevalence in Brazil: a systematic review

Cad Saude Publica

(2015)

M.V. Tulder

Chapter 1European guidelines

Eur Spine J

(2006)

N.M. Filho et al.

Invalidez por dor nas costas entre seguradores da Prevalência Social do Brasil

Rev Saúde Pública

(2011)

N. Henschke et al.

Prognosis in patients with recent onset low back pain in Australian primary care: inception cohort study

BMJ

(2008)

C.D. Mallen et al.

Prognostic factors for musculoskeletal pain in primary care: a systematic review

J R Coll Gen Pract

(2007)

T. Pincus et al.

A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain

Spine

(2002)

R. Chou et al.

Will this patient develop persistent disabling low back pain?

JAMA

(2010)

J.A. Hayden et al.

Systematic reviews of low back pain prognosis had variable methods and results: guidance for future prognosis reviews

J Clin Epidemiol

(2009)

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Citation Excerpt :
There is evidence that the SBST is more likely to predict disability in older men1 and in patients with symptom duration ranging between 1 and 6 months.1 Additionally, there is also evidence that scores on outcomes measures at baseline are the strongest predictor of future outcomes in patients with back pain.10,25 Finally, these variables were tested as potential confounders in previous studies using the SBST.2,6,8
The STarT Back Screening Tool (SBST) is used to stratify care. It is unclear if the SBST approach works as well for patients in low- and medium-income countries as for patients from high-income countries.
(1) To investigate whether patients with chronic low back pain (LBP) stratified by the SBST are different at baseline; (2) to describe the clinical course for each SBST subgroup; (3) to investigate the SBST utility to predict clinical outcomes; and (4) to determine which SBST subgroup show greater clinical improvement.
This is a secondary analysis of data derived from a previously published clinical trial.
148 patients with chronic nonspecific LBP were included. Pain intensity, disability, global perceived effect, and the SBST were assessed at baseline and at 5, 12, and 24 weeks after baseline. Descriptive data were provided and ANOVA, unadjusted and adjusted regression models, and linear mixed models were used for data analysis.
Duration of symptoms, use of medication, pain, disability, and global perceived effect were different between SBST subgroups. Clinical improvements over a 6-month period were consistently greater in patients classified as high risk. The SBST was able to predict disability but this predictability decreased when the analysis was adjusted for possible confounders.
Clinical outcomes were different between SBST subgroups over 6 months. Adjusting for confounders influenced the predictability of SBST. Patients classified as high risk presented higher improvements in terms of disability.
Significant socio-emotional learning and improvement of empathy in physiotherapy students through service learning methodology: A mixed methods research
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It would appear that the fact of facing up to stressful situations in the shape of putting into practice workshops that the students themselves have put together involves significant learning and enhancement in the capacity to control emotions and take decisions involving interpersonal relationships. This is of relevance when it comes to establishing high-quality therapeutic relationships (Morera-Balaguer et al., 2018). In respect of the limitations of this work, it must be accepted that its results cannot be generalized.
Research into service learning (SL) in education has increased since the 1990s. In higher education physiotherapy programmes, this technique is used to achieve real practical learning and to grasp how to recognize and manage emotions, to be concerned for others and to take decisions in clinical contexts.
To create a community experience through SL methodology for physiotherapy university students and to analyse their perceptions of the learning experience and changes in empathy.
A mixed research method, a quasi-experimental quantitative approach with pre- and post-measurements of a single group and a qualitative approach through reflective diaries subjected to a contents analysis.
29 students of the Faculty of Health Sciences (Department of Nursing and Physiotherapy) designed and put into practice a workshop for promoting physical activity in 277 children from the first and the sixth year of compulsory primary education.
The project was divided into three phases: planning, performing and reflecting on the service. At the start, participants completed a questionnaire to determine their scale of empathy on the Interpersonal Reactive Index (IRI). One week after performing the service they handed over reflective diaries and completed a second IRI scale survey. An analysis was carried out of the contents of the reflective diaries.
Twenty-nine students agreed to participate. These learners consolidated their skills in the subject, indicating their satisfaction with the significant learning they achieved. The IRI scale showed a significant improvement in the Personal Distress dimension (p = 0.002).
Active learning in the context of processes of a participatory and reflective type implies greater understanding of the phenomenon studied. It allows an enhance awareness of the importance of inclusivity and involvement of users in the context of clinical practice. It also provides socio-emotional learning, improving interpersonal abilities and the capacity to face up to stressful situations.
Baseline characteristics did not identify people with low back pain who respond best to a Movement System Impairment-Based classification treatment
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Being younger, however, resulted in greater improvement after a cognitive-behavioral treatment for LBP.54 According to Oliveira et al.,55 age influenced pain intensity and disability in people with chronic LBP after four weeks of treatment. However, this association was not clinically important.
Secondary analysis of data from a randomized controlled trial.
Treatment based on the Movement System Impairment-Based classification for chronic low back pain results in the same benefit when compared to other forms of exercise. It is possible that participant's characteristics measured at baseline can identify people with chronic low back pain who would respond best to a treatment based on the Movement System Impairment model.
To assess if specific characteristics of people with chronic low back pain measured at baseline can modify the effects of a treatment based on the Movement System Impairment model on pain and disability.
Four variables assessed at baseline that could potentially modify the treatment effects of the treatment based on the Movement System Impairment model were selected (age, educational status, physical activity status and STarT back tool classification). Separate univariate models were used to investigate a possible modifier treatment effect of baseline participant's characteristics on pain and disability after the treatment. Findings of interaction values above 1 point for the outcome mean pain intensity or above 3 points for disability (Roland Morris questionnaire) were considered clinically relevant.
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Age, educational status, physical activity status and STarT back tool classification did not modify the effects of an 8-week treatment based on the Movement System Impairment model in patients with chronic low back pain.
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Low back pain (LBP) is a common, challenging medical and socioeconomic problem in working-age adults.1,2 LBP is the significant cause of years lived with disability, work absenteeism and high compensation in modern societies.2,3 Although the majority of LBP patients recover within six weeks without medical treatment, almost 20% of these cases become chronic.4
Proprioceptive neuromuscular facilitation training and general trunk exercises have been applied to treat chronic low back pain patients. However, there is currently little study to support the use of one treated intervention over the other to improve clinical outcomes and balance ability.
To examine the effects of proprioceptive neuromuscular facilitation training on pain intensity, disability and static balance ability in working-age patients with chronic low back pain.
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The proprioceptive neuromuscular facilitation training intervention showed a statistically significantly greater reduction in pain intensity and improved functional disability than the controls at three weeks (between-group difference: pain intensity 1.22 score, 95% CI: 0.58 to 1.88, p < 0.001; disability 2.23 score, 95% CI: 1.22 to 3.24, p < 0.001. The proprioceptive neuromuscular facilitation training intervention also had statistically better parameters of static balance ability than the control group (between-group difference: ellipse sway area during eye opened and closed conditions 129.09 mm², 95% CI: 64.93 to 175.25, p < 0.01 and 336.27 mm², 95% CI: 109.67 to 562.87, p < 0.05, respectively; the centre of pressure velocity during eye opened and eye closed conditions 6.68 mm/s, 95% CI: 4.41 to 8.95, p < 0.01 and 6.77 mm/s, 95% CI: 4.01 to 9.54, p < 0.01, respectively).
The three-week proprioceptive neuromuscular facilitation training provides better pain intensity, disability and static balance ability than general trunk exercises for working-age individuals with chronic low back pain but the effects do not reach the clinical meaningful level. The therapists should consider carefully when making recommendations regarding these interventions, taking into account effectiveness and costs.
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To describe the main characteristics of low back pain randomized controlled trials on the Physiotherapy Evidence Database, and to rank the journals where these trials were published according to their Impact Factor.
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View all citing articles on Scopus

View full text

Original ResearchCan demographic and anthropometric characteristics predict clinical improvement in patients with chronic non-specific low back pain?

Highlights

Abstract

Objective

Methods

Results

Conclusion

Introduction

Section snippets

Study design

Results

Discussion

Conclusion

Conflicts of interest

J Pain

Eur J Pain

Pain

Pain

Best Pract Res Clin Rheumatol

Man Ther

Best Pract Res Clin Endocrinol Metab

Pain

Pain

J Manip Physiol Ther

J Clin Epidemiol

Back pain

Rheumatology (Oxford)

The evolving role of physical therapists in the long-term management of chronic low back pain: longitudinal care using assisted self-management strategies

Braz J Phys Ther

Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

Lancet

Pesquisa por Amostra de Domicílios. Um panorama da saúde no Brasil: acesso e utilização dos serviços, condições de saúde e fatores de risco e proteção à saúde

Low back pain prevalence in Brazil: a systematic review

Cad Saude Publica

Chapter 1European guidelines

Eur Spine J

Invalidez por dor nas costas entre seguradores da Prevalência Social do Brasil

Rev Saúde Pública

Prognosis in patients with recent onset low back pain in Australian primary care: inception cohort study

BMJ

Prognostic factors for musculoskeletal pain in primary care: a systematic review

J R Coll Gen Pract

A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain

Spine

Will this patient develop persistent disabling low back pain?

JAMA

Systematic reviews of low back pain prognosis had variable methods and results: guidance for future prognosis reviews

J Clin Epidemiol

Original Research
Can demographic and anthropometric characteristics predict clinical improvement in patients with chronic non-specific low back pain?