How can we best predict outcome of low back pain?
Low back pain is the most common musculoskeletal complaint seen in primary care. There has been a shift over the past decade away from the biomedical approach to treating low back pain and this shift includes the introduction of pschological screening tools as part of an initial assesment. There are numerous pyschological screening tools available to clinicians and the current, prospective study aimed to define the best tools for predicting recovery after 6 months as well as provide an indication of which specific aspects are the best predictors.
The authors defined recovery as nil pain on 0-10 scale and a score of less than 2 on the Roland Morris Disability Questionnaire. The following screening tools were administered to 111 patients at initial assessment, 4 weeks and 6 months: STart back, FABQ (fear avoidance), PCS (pain catastrophising), TSK (kinesiophobia) and PHQ (depression).
At 6 months follow up, only 12.6% made a complete recovery as per the strict recovery criteria. Best predictors of poor outcome were a high risk rating on the STarT back, high pain levels and depressive symptoms (PHQ) at initial assessment. Fear avoidance, kinesiophobia and depression were all associated with non-recovery at 6mths follow up.
> From: George et al., BMC Musculoskelet Disord 7 (2015) . All rights reserved to BioMed Central. Click here for the Pubmed summary.