The online version of this article (doi:10.1007/s00586-017-5201-9) contains supplementary material, which is available to authorized users.
It is unknown which chronic low back pain (CLBP) patients are typically referred to spinal surgery. The present study, therefore, aimed to explore which patient-reported factors are predictive of spinal surgery referral among CLBP patients.
CLBP patients were consecutively recruited from a Dutch orthopedic hospital specialized in spine care (n = 4987). The outcome of this study was referral to spinal surgery (yes/no), and was assessed using hospital records. Possible predictive factors were assessed using a screening questionnaire. A prediction model was constructed using logistic regression, with backwards selection and p < 0.10 for keeping variables in the model. The model was internally validated and evaluated using discrimination and calibration measures.
Female gender, previous back surgery, high intensity leg pain, somatization, and positive treatment expectations increased the odds of being referred to spinal surgery, while being obese, having comorbidities, pain in the thoracic spine, increased walking distance, and consultation location decreased the odds. The model’s fit was good (X 2 = 10.5; p = 0.23), its discriminative ability was poor (AUC = 0.671), and its explained variance was low (5.5%). A post hoc analysis indicated that consultation location was significantly associated with spinal surgery referral, even after correcting for case-mix variables.
Some patient-reported factors could be identified that are predictive of spinal surgery referral. Although the identified factors are known as common predictive factors of surgery outcome, they could only partly predict spinal surgery referral.
Kamper SJ, Maher CG, Hancock MJ, Koes BW, Croft PR, Hay E (2010) Treatment-based subgroups of low back pain: a guide to appraisal of research studies and a summary of current evidence. Best Prac Res Clin Rheumatol 24(2):181–191 CrossRef
Drummond MF, Sculper MJ, Claxton K, Stoddart GL, Torrance GW (2015) Methods for the economic evaluation of health care programmes, 4th edn. Oxford University, Oxford United Kingdom
Shea D, Stuart B, Vasey J, Nag S (1999) Medicare physician referral patterns. Health Ser Res 34(1 Pt 2):331
Van der Werff S, Junco Díaz R, Reyneveld R, Heymans M, Ponce Campos M, Gorbea Bonet M (2013) Prediction of asthma by common risk factors: a follow-up study in Cuban schoolchildren. J Investig Allergol Clin Immunol 23(6):415–420 PubMed
Steyerberg E (2008) Clinical prediction models: a practical approach to development, validation, and updating. Springer Science & Business Media, Berlin
- Which patient-reported factors predict referral to spinal surgery? A cohort study among 4987 chronic low back pain patients
Johanna M. van Dongen
Miranda L. van Hooff
Marinus de Kleuver
Raymond W. J. G. Ostelo
- Springer Berlin Heidelberg
Neu im Fachgebiet Orthopädie und Unfallchirurgie
Mail Icon II