Do psychological and behavioral factors classified by the West Haven-Yale Multidimensional Pain Inventory (Swedish version) predict the early clinical course of low back pain in patients receiving chiropractic care?

Andreas Eklund,Gunnar Bergström,Iben Axén,Lennart Bodin

doi:10.1186/s12891-016-0933-y

Andreas Eklund, Gunnar Bergström + Show 2 more

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https://doi.org/10.1186/s12891-016-0933-y

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Abstract

BackgroundTo investigate if psychological and behavioral factors (as determined by the Swedish version of the West Haven-Yale Multidimensional Pain Inventory, MPI-S) can predict the early clinical course of Low Back Pain (LBP).MethodsMPI-S data from patients (18–65 years of age) seeking chiropractic care for recurrent and persistent LBP were collected at the 1st visit. A follow-up questionnaire was administered at the 4th visit. The predictive value of the MPI-S subgroups Adaptive Copers (AC), Interpersonally Distressed (ID) and Dysfunctional (DYS) was calculated against the subjective improvement at the 4th visit and clinically relevant difference in pain intensity between the 1st and 4th visit.ResultsOf the 666 subjects who were included at the 1st visit, 329 completed the questionnaire at the 4th visit. A total of 64.7 % (AC), 68.0 % (ID) and 71.3 % (DYS) reported a definite improvement. The chance of “definite improvement”, expressed as relative risk (95 % CI) with the AC group as reference, was 1.05 (.87–1.27) for the ID and 1.10 (.93–1.31) for the DYS groups, respectively. The DYS and ID groups reported higher values in pain intensity both at the 1st and the 4th visit. The proportion of subjects who reported an improvement in pain intensity of 30 % or more (clinically relevant) were 63.5 % AC, 72.0 % ID and 63.2 % DYS. Expressed as relative risk (95 % CI) with the AC group as reference, this corresponded to 1.26 (.91–1.76) for the ID and 1.09 (.78–1.51) for the DYS groups, respectively.ConclusionsThe MPI-S instrument could not predict the early clinical course of recurrent and persistent LBP in this sample of chiropractic patients.Trial registrationClinical trials.gov; NCT01539863, February 22, 2012.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-0933-y) contains supplementary material, which is available to authorized users.

Highlights

To investigate if psychological and behavioral factors can predict the early clinical course of Low Back Pain (LBP)
In about 90 % of patients suffering from LBP, no underlying spinal pathology or red flags can be identified, and their LBP is classified as non-specific [4]
The objective of the study was to investigate if Multidimensional pain inventory (MPI-S) subgroup (AC, Interpersonally Distressed (ID), and DYS) assignment at the 1st visit among patients with recurrent and persistent LBP receiving chiropractic care could predict the short-term clinical course using the following outcomes: 1. A definite improvement at the 4th visit

Summary

Introduction

To investigate if psychological and behavioral factors (as determined by the Swedish version of the West Haven-Yale Multidimensional Pain Inventory, MPI-S) can predict the early clinical course of Low Back Pain (LBP). Interventions have shown moderate effects in treatment outcome [9]. One possible reason for not finding highly effective interventions for LBP is the heterogeneity of the condition [4]. A recent literature review suggests that subgrouping patients according to genetic predisposition, psychological and activity related factors holds much promise and may be a suitable way to tailor treatments to yield better treatment outcomes [10], identified in previous research as a priority [11,12,13]

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