Abstract
BackgroundRecovery from low back pain (LBP) is an important outcome for patients and clinicians. Psychological factors are known to impact the course of LBP but have not been extensively investigated for predicting recovery. The purposes of this study were to: 1) describe LBP recovery rates at 6 months following 4 weeks of physical therapy; 2) identify psychological factors predictive of 6 month recovery status; and 3) identify psychological factors that co-occur with 6 month recovery status.MethodsThis study was a secondary analysis of a prospective cohort of patients (n = 111) receiving outpatient physical therapy for LBP. Patients were administered the STarT Back Screening Tool (SBT), individual psychological measures, a numerical pain rating scale (NPRS) and Roland Morris Disability Questionnaire (RMDQ) at intake, 4-week, and 6-month assessments. LBP recovery was operationally defined based on meeting NPRS = 0/10 and RMDQ ≤ 2 criterion at 6-month follow-up assessment. Recovery groups were then compared for differences on all variables at intake and on individual psychological measures at 6-months. Discriminant function analysis (DFA) identified which descriptive variables were predictive of recovery status.ResultsThe 6-month recovery rate was 14/111 (12.6%) for the combined NPRS and RMDQ criterion. Non-recovered patients were associated with SBT risk status (p = 0.004), higher intake pain intensity (p = .008) and higher depressive symptoms (p < .001) scores compared to recovered patients. The overall accuracy for intake classification using DFA was 87.2% with SBT risk status, pain intensity, and depressive symptoms all making unique contributions. At 6-months, non-recovered patients had higher fear-avoidance, kinesiophobia, and depressive symptoms (p’s < .001) compared to recovered patients. The overall accuracy for 6-month classification using DFA was 86.4% with fear-avoidance, kinesiophobia, and depressive symptoms all making unique contributions.ConclusionsOur findings indicated that psychological risk status, depressive symptoms, and pain intensity were predictive of 6 month recovery status. Furthermore elevated fear-avoidance, kinesiophobia, and depressive symptoms co-occurred with non-recovery at 6 months. Future studies should investigate whether stratified psychologically informed treatment options have the potential to improve recovery rates for those most at risk for non-recovery.
Highlights
Recovery from low back pain (LBP) is an important outcome for patients and clinicians
Outcome assessment for low back pain (LBP) has received considerable attention in the literature with pain intensity, back specific function, general health status, work disability, and patient satisfaction identified as 5 core domains [1]
Visual inspection indicated that normal distribution for the numerical pain rating scale (NPRS), Roland Morris Disability Questionnaire (RMDQ) and all individual psychological measures was approximated
Summary
Recovery from low back pain (LBP) is an important outcome for patients and clinicians. Outcome assessment for low back pain (LBP) has received considerable attention in the literature with pain intensity, back specific function, general health status, work disability, and patient satisfaction identified as 5 core domains [1]. Another assessment option is the use of absolute criterion for determining LBP outcomes. Recovery from LBP is theorized to be a complex, multifactorial construct but has been commonly operationally defined by 2/5 of the core outcome domains – pain intensity and back specific function [5]. Establishing whether psychological factors are predictive of composite recovery measures for LBP has implications for future clinical and research initiatives since psychological assessment is commonly recommended by clinical guidelines [8,9]
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