1. Trajectories of Disability and Low Back Pain Impact
- Author
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Dutmer, Alisa L., Schiphorst Preuper, Henrica R., Stewart, Roy E., Soer, Remko, Reneman, Michiel F., and Wolff, André P.
- Subjects
musculoskeletal diseases ,Adult ,Male ,Time Factors ,Epidemiology ,responder analysis ,multidisciplinary care ,Cohort Studies ,Tertiary Care Centers ,recovery ,health services administration ,Surveys and Questionnaires ,Outcome Assessment, Health Care ,cohort study ,latent class analysis ,trajectories ,Humans ,Disabled Persons ,functional limitation ,Prospective Studies ,low back pain ,Netherlands ,Pain Measurement ,minimal clinically important difference ,follow-up study ,Middle Aged ,disability ,population characteristics ,Female ,chronic pain ,Follow-Up Studies - Abstract
Treatment response trajectories were identified in 996 patients with low back pain (LBP) visiting multidisciplinary spine care. Six disability and six LBP impact trajectories were identified, with most patients experiencing stable levels of functioning. Baseline patient characteristics were not associated with (un)favorable outcome during 2-year follow-up., Study Design. Prospective cohort study. Objective. The aim of this study was to identify treatment response trajectories in patients with low back pain (LBP) during and after multidisciplinary care in a tertiary spine center, and to examine baseline patient characteristics that can distinguish trajectories. Summary of Background Data. Treatment response is often heterogeneous between patients with LBP. Knowledge on key characteristics that are associated with courses of disability could identify patients at risk for less favorable outcome. This knowledge will help improve shared decision-making. Methods. Adult patients with LBP completed questionnaires on disability (Pain Disability Index) and LBP impact (Impact Stratification of the National Institutes of Health minimal dataset) at baseline, 6, 12, 18, and 24 months’ follow-up. Latent class analyses were applied to identify trajectories of disability and LBP impact. Baseline sociodemographic and clinical patient characteristics were compared between trajectory subgroups. Results. Follow-up was available for 996 patients on disability and 707 patients on LBP impact. Six trajectories were identified for both outcome measures. Three disability trajectories remained stable at distinct levels of severity (68% of patients) and three trajectories showed patterns of recovery (32%). For LBP impact there was one stable trajectory (17%), two slightly improving (59%), two recovering (15%), and one with a pattern of recovery and relapse (15%). Significant differences between trajectories were observed for almost all baseline patient characteristics. Conclusion. On average, patients show moderate improvements in disability and LBP impact 2 years after visiting a multidisciplinary tertiary spine center. However, latent class analyses revealed that most patients belong to subgroups experiencing stable levels of disability and LBP impact. Differences in baseline patient characteristics were mostly associated with baseline levels of functioning, instead of (un)favorable outcome during follow-up. Level of Evidence: 2
- Published
- 2020