A multisite longitudinal evaluation of patient characteristics associated with a poor response to non-surgical multidisciplinary management of low back pain in an advanced practice physiotherapist-led tertiary service

Shaun O’leary ,Alison Smith ,Darryl Lee,Maree Raymer,Damien Nolan ,Erica Williams ,Brendan Diplock,Daniel Wickins ,Linda Parnwell,Michelle Cottrell ,Darryn Marks,Linda Garsden,Peter Window,Ben Phillips ,Will O’sullivan ,Tracy Comans,Luen Pearce,B Vicenzino ,Sheryl Pahor ,Ian Seels,Vicki Parravicini,Patrick Swete Kelly ,Jody Anning,Anneke Wake,Asaduzzaman Khan,Rebecca Tweedy,David Thompson ,R C Mclean ,Steven Mcphail

doi:10.1186/s12891-020-03839-5

Abstract

BackgroundNon-surgical multidisciplinary management is often the first pathway of care for patients with chronic low back pain (LBP). This study explores if patient characteristics recorded at the initial service examination have an association with a poor response to this pathway of care in an advanced practice physiotherapist-led tertiary service.MethodsTwo hundred and forty nine patients undergoing non-surgical multidisciplinary management for their LBP across 8 tertiary public hospitals in Queensland, Australia participated in this prospective longitudinal study. Generalised linear models (logistic family) examined the relationship between patient characteristics and a poor response at 6 months follow-up using a Global Rating of Change measure.ResultsOverall 79 of the 178 (44%) patients completing the Global Rating of Change measure (28.5% loss to follow-up) reported a poor outcome. Patient characteristics retained in the final model associated with a poor response included lower Formal Education Level (ie did not complete school) (Odds Ratio (OR (95% confidence interval)) (2.67 (1.17–6.09), p = 0.02) and higher self-reported back disability (measured with the Oswestry Disability Index) (OR 1.33 (1.01–1.77) per 10/100 point score increase, p = 0.046).ConclusionsA low level of formal education and high level of self-reported back disability may be associated with a poor response to non-surgical multidisciplinary management of LBP in tertiary care. Patients with these characteristics may need greater assistance with regard to their comprehension of health information, and judicious monitoring of their response to facilitate timely alternative care if no benefits are attained.

Highlights

Non-surgical multidisciplinary management is often the first pathway of care for patients with chronic low back pain (LBP)
A low level of formal education and high level of self-reported back disability may be associated with a poor response to non-surgical multidisciplinary management of LBP in tertiary care
Obvious advantages exist in the early identification of patient characteristics that may be associated with a poor response to non-surgical multidisciplinary management

Summary

Introduction

Non-surgical multidisciplinary management is often the first pathway of care for patients with chronic low back pain (LBP). It is suggested that non-surgical multidisciplinary management of LBP is aligned to the biopsychosocial conceptualization of chronic pain [3, 4] delivered by a team of multidisciplinary health professionals providing a combination of coordinated educational, physical and psychological interventions [3]. Obvious advantages exist in the early identification of patient characteristics that may be associated with a poor response to non-surgical multidisciplinary management. This knowledge may facilitate a more tailored management approach for patients with these identified characteristics, and secondly, their response to management may be more closely monitored to facilitate timely referral if no benefits are observed

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Results

Discussion

Conclusion