Abstract
BackgroundBeing able to estimate the likelihood of poor recovery from episodes of back pain is important for care. Studies of psychosocial factors in inception cohorts in general practice and occupational populations have begun to make inroads to these problems. However, no studies have yet investigated this in chiropractic patients.MethodsA prospective inception cohort study of patients presenting to a UK chiropractic practice for new episodes of non-specific low back pain (LBP) was conducted. Baseline questionnaires asked about age, gender, occupation, work status, duration of current episode, chronicity, aggravating features and bothersomeness using Deyo's 'Core Set'. Psychological factors (fear-avoidance beliefs, inevitability, anxiety/distress and coping, and co-morbidity were also assessed at baseline. Satisfaction with care, number of attendances and pain impact were determined at 6 weeks. Predictors of poor outcome were sought by the calculation of relative risk ratios.ResultsMost patients presented within 4 weeks of onset. Of 158 eligible and willing patients, 130 completed both baseline and 6-week follow-up questionnaires. Greatest improvements at 6 weeks were in interference with normal work (ES 1.12) and LBP bothersomeness (ES 1.37). Although most patients began with moderate-high back pain bothersomeness scores, few had high psychometric ones. Co-morbidity was a risk for high-moderate interference with normal work at 6 weeks (RR 2.37; 95% C.I. 1.15–4.74). An episode duration of >4 weeks was associated with moderate to high bothersomeness at 6 weeks (RR 2.07; 95% C.I. 1.19 – 3.38) and negative outlook (inevitability) with moderate to high interference with normal work (RR 2.56; 95% C.I. 1.08 – 5.08).ConclusionPatients attending a private UK chiropractic clinic for new episodes of non-specific LBP exhibited few psychosocial predictors of poor outcome, unlike other patient populations that have been studied. Despite considerable bothersomeness at baseline, scores were low at follow-up. In this independent health sector back pain population, general health and duration of episode before consulting appeared more important to outcome than psychosocial factors.
Highlights
Being able to estimate the likelihood of poor recovery from episodes of back pain is important for care
Recovery from persistent low back pain is determined not solely by clinical factors and by the individual's psychological state [1]. Such psychological and social factors have come to be considered important in general practice and occupational back pain populations [2]
Recruitment Over a one-year period, 200 consecutive new patients contacting a chiropractic clinic in the market town of Salisbury in the UK for an appointment were asked by the clinic receptionists to confirm if their primary complaint was a new episode of pain in the lower back
Summary
Being able to estimate the likelihood of poor recovery from episodes of back pain is important for care. Studies of psychosocial factors in inception cohorts in general practice and occupational populations have begun to make inroads to these problems. No studies have yet investigated this in chiropractic patients. Recovery from persistent low back pain is determined not solely by clinical factors and by the individual's psychological state [1]. Such psychological and social factors have come to be considered important in general practice and occupational back pain populations [2]. Chiropractic investigators have given these less attention. This is not to suggest that chiropractors themselves regard these issues as unimportant. Less than half said they were able to evaluate these factors while just one-third felt able to treat them
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