Abstract
BackgroundDue to the recurrent nature of low back pain (LBP), the traditional concepts of cure and recovery are challenged, and investigating the course rather than status at fixed time-points may help us understand prognosis as well as treatment effect. However, methods of frequent measuring still need development and validation. Therefore, this study aims to evaluate the agreement between continuous, quantitative self-assessment (weekly SMS) of the course of LBP over a one-year period and qualitatively derived retrospective patient self-appraisal of the same time-period.MethodsParticipants were 32 subjects with LBP from primary care. The quantitative measures consisted of weekly SMS questions for one-year about pain intensity, days with LBP, and activity limitations for that week. For each subject, the weekly responses were graphed and categorized into categories based on intensity, variation and overall change patterns. Qualitative measures were based on semi-structured telephone interviews one-year after a consultation for LBP, where two coders independently categorized the self-appraisal of LBP course into the same predefined categories as the SMS-based trajectories. Furthermore, patients’ perceived overall recovery was related to variation patterns from SMS track.ResultsThere was perfect agreement for 48% in the pain intensity domain, 53% in the variation domain and 63% in the change pattern domain. Most of the discordant cases were classified in neighboring categories with the majority relating to fluctuating patterns. The self-perceived overall recovery status seemed to be reflected quite well by the quantitative measures of pain intensity and days with pain in this study.ConclusionThis study shows that a real time quantitative measure (weekly SMS) and the patient’s retrospective appraisal do not fundamentally differ in their reflection of the one-year course of LBP.As a first investigation into this area, these results are promising, as longitudinal quantitatively derived trajectories of LBP seem to reflect the lived experience of the patient to a large degree. Furthermore, the patient’s ability to retrospectively recall their one-year course of LBP appears to be quite good. Future studies should focus on refining the categories of trajectories.
Highlights
Due to the recurrent nature of low back pain (LBP), the traditional concepts of cure and recovery are challenged, and investigating the course rather than status at fixed time-points may help us understand prognosis as well as treatment effect
A category describing the change pattern as ‘unchanged’ was added and the four categories in the intensity domain were combined into two categories (‘none to mild’= NRS 0–3 and ‘moderate to severe’: NRS 4–10), because we considered that to be a more realistic level of distinction obtained from interviews
Consensus was reached through discussion and all patients were classified in all three domains
Summary
Due to the recurrent nature of low back pain (LBP), the traditional concepts of cure and recovery are challenged, and investigating the course rather than status at fixed time-points may help us understand prognosis as well as treatment effect. In diseases that are not life threatening it is not straight forward defining what a “successful” outcome is In back pain, this is clearly demonstrated in two reviews of recovery definitions [1, 2]. The different measurements primarily cover various definitions of pain, disability, and to a lesser extent physical performance, overall recovery and return to work; alone or in combination [2]. It is self-evident that such absence of a clear conceptual understanding of “success” is a barrier for understanding the effect of interventions, and for the development of accurate and relevant outcome measurements
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