Adding Physical Impairment to Risk Stratification Improved Outcome Prediction in Low Back Pain.

Beneciuk, Jason M

George, Steven Z

2020-10-01T15:00:15Z

2020-10-01T15:00:15Z

2020-09-24

2020-10-01T15:00:14Z

OBJECTIVE:Identifying subgroups of low back pain (LBP) has the potential to improve prediction of clinical outcomes. Risk stratification is one such strategy that identifies similar characteristics indicative of a common clinical outcome trajectory. The purpose of this study was to determine if an empirically derived subgrouping approach based on physical impairment measures improves information provided from the STarT Back Tool (SBT). METHODS:At baseline in this secondary analysis of a cohort study, patients (N = 144) receiving physical therapy for LBP completed the SBT and tests (active lumbar flexion, extension, lateral bending, and passive straight-leg-raise) from a validated physical impairment index. Clinical outcomes were assessed at 4 weeks and included the Numerical Pain Rating Scale (NPRS) and Oswestry Disability Index (ODI). Exploratory hierarchical agglomerative cluster analysis identified empirically derived subgroups based on physical impairment measures. Independent samples t testing and chi-square analysis assessed baseline subgroup differences in demographic and clinical measures. Spearman rho correlation coefficient was used to assess baseline SBT risk and impairment subgroup relationships, and a 3-way mixed-model ANOVA was used to assessed SBT risk and impairment subgroup relationships with clinical outcomes at 4 weeks. RESULTS:Two physical impairment-based subgroups emerged from cluster analysis: (1) Low-Risk Impairment (n = 119, 81.5%), characterized by greater lumbar mobility and (2) High-Risk Impairment (n = 25, 17.1%), characterized by less lumbar mobility. A weak, positive relationship was observed between baseline SBT risk and impairment subgroups (rs = .170). An impairment-by-SBT risk-by-time interaction effect was observed for ODI scores but not for NPRS scores at 4 weeks. CONCLUSIONS:Physical impairment subgroups were not redundant with SBT risk categories and could improve prediction of 4-week LBP disability outcomes. Physical impairment subgroups did not improve the prediction of 4-week pain intensity scores. IMPACT:Subgroups based on physical impairment and psychosocial risk could lead to better prediction of LBP disability outcomes and eventually allow for treatment options tailored to physical and psychosocial risk.

5911071

0031-9023

1538-6724

https://hdl.handle.net/10161/21564

eng

Oxford University Press (OUP)

Physical therapy

10.1093/ptj/pzaa179

Cluster Analysis

Low Back Pain

Prognosis

Subgrouping

Adding Physical Impairment to Risk Stratification Improved Outcome Prediction in Low Back Pain.

Journal article

George, Steven Z|0000-0003-4988-9421

School of Medicine

Duke Clinical Research Institute

Orthopaedics

Duke

Institutes and Centers

Clinical Science Departments

Published