Cohort Of Low Back Pain Patients Research Articles

The importance of identifying and modifying unemployment predictor variables in the evolution of a novel model of care for low back pain in the general population

Background ContextCare for low back pain (LBP) is costly, fragmented and, in non-compensation populations, rarely specifically addresses factors associated with maintaining employment status or return to work (RTW). PurposeThis study aimed to identify modifiable independent risk factors for (1) a negative work status at presentation and (2) a change in work status during treatment in a cohort of LBP patients. The results are intended to inform improvement in best-evidence care pathways to maximize societal outcomes and overall value of a new model of care. Study Design/SettingA prospective observational study was carried out. Inclusion criteria: Work-eligible, non-workers compensation patients with recurrent or persistent LBP ≥6 weeks and ≤12 months. Setting: The Inter-professional Spine Assessment and Education Clinics (ISAEC)—a novel Government-funded shared-care model of management for LBP. MethodsThis study used the following methods: (1) Cross-sectional analysis of baseline data from the initial ISAEC consultation (t0) from December 2012 to April 2014. Work status at t0 was dichotomized as employed (E) or underemployed (UE; unemployed, modified work duty, or disability). Multivariate logistic regression modeling was used to determine independent predictors of UE status at t0. (2) Bivariate analysis of longitudinal data from t0 to 6 months (t1) to identify risk factors for work status change. Employment journey categorized into four groups: Et0/Et1—employed at t0 and employed at t1; Et0/UEt1—employed at t0 and underemployed at t1; UEt0/Et1—underemployed at t0 and employed at t1; UEt0/UEt1—underemployed at t0 and underemployed at t1. ResultsThis study yielded the following results: (1) Initial consultation data on 462 consecutive patients (Et0=344, UEt0=118). Multivariate logistic regression identified legal claim, depression, smoking, and higher STarT Back (or Oswestry Disability Index [ODI]) score as independent risk factors for UEt0. (2) Overall UE rate did not significantly change during longitudinal analysis (n=178, UEt0=25.5%, UEt1=22.9%). However, 10.5% of Et0 became UEt1 (Et0/Et1=102, Et0/UEt1=12). Bivariate analysis identified elevated baseline ODI score as the only significant predictor variable for UEt1 in Et0 cohort (p=.0101). Conversely, ISAEC improved the employment status in 41% of UEt0 to Et1 (UEt0/Et1=16, UEt0/UEt1=23), and the absence of depression was significant for predicting RTW (p=.0001). ConclusionsFrom a societal perspective, employment status as an outcome measure is paramount in assessing the value of a new model of care for LBP. Mitigation strategies for the predictor variables identified will be included in ISAEC pathways to translate clinical improvement into societal added value.

Prognostic Factors of Short-Term Outcome of Low Back Pain in Patients Attending Health Insurance Clinics in Sharkia Governorate, Egypt

Objectives. This study aimed to determine the predictors of short-term outcome of low back pain (LBP) in a cohort of LBP patients. Subjects and Methods. A prospective cohort of 400 LBP patients who attending the health insurance clinics at Al-Hussinia city, Sharakia governorate, Egypt, were the subjects of this study. The data were collected by using a predesigned questionnaire at the index consultation. The outcome variable (good versus bad outcome), in terms of return to work, was collected one/two weeks later on the next consultation or by telephone. Statistical analyses including predictive regression analysis was done. Results. Out of the analysed 349 patients, there have been 202 patients (58%) with good back pain outcome. Logistic regression analyses showed that the factors most significantly associated with good back pain outcome were the recency of pain (OR = 4.85; 95% CI = 2.88–8.17), patient's occupation (OR = 2.11; 95% CI = 1.33–3.35) and absence of obesity (OR = 2.70; 95% CI = 1.15–5.22). Other significant less important factors were age of the patient, and site of pain. Conclusions. Reliable information on back pain related history, patient's occupation, body mass index and age of the patient at the index consultation are important to assess short-term prognosis in LBP patients.

Lidocaine Patch Treatment in Patients with Low Back Pain: Results of an Open-Label, Nonrandomized Pilot Study

This prospective, 6-week, multicenter, open-label, nonrandomized pilot study was designed to assess the effectiveness and safety of a lidocaine patch 5% in patients with low back pain (LBP). Patients with moderate to severe LBP, defined as acute/subacute (< 3 months, n = 21), short-term chronic (3-12 months, n = 33), or long-term chronic (> 12 months, n = 77), were recruited from 5 clinics; participants applied < or = 4 patches (560 cm total) once daily to area of maximal LBP as add-on treatment through week 2, with the option to taper concomitant analgesics during weeks 3-6. Scores on Brief Pain Inventory (BPI) were obtained at weeks 2 and 6. Safety analyses included reports of adverse events (AEs) and skin sensitivity to pinprick/light touch. Significant improvements in average daily pain intensity on the BPI were noted at weeks 2 and 6 (P < or = 0.001). Significant improvements in pain interference with quality of life (QOL) were noted for all BPI measures of QOL at weeks 2 and 6 for the acute/subacute (P < or = 0.007) and long-term chronic LBP groups (P < 0.0001) and for 5 of 7 BPI measures for the short-term chronic LBP group (P < or = 0.042). Fifty-eight percent of patients reported being "satisfied" or "very satisfied" with treatment. The lidocaine patch was well tolerated. Most common AEs were dizziness and rash (n = 5, 3.8%), and most AEs (80%) were mild to moderate in intensity. Significant improvement in pain intensity and QOL in this cohort of LBP patients was noted during treatment with the lidocaine patch 5%. Controlled clinical trials are warranted.