Predictors of response following standardized education and self-management recommendations for low back pain stratified by dominant pain location

Background: Low back pain (LBP) is a leading cause of disability globally. Risk-stratification systems (e.g. STarT Back) have been proposed to guide treatment, but with varying success. We investigated factors associated with poor response to standardized LBP education and self-management recommenda...

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Main Authors:	Anthony V. Perruccio, Jessica T.Y. Wong, Elizabeth M. Badley, J. Denise Power, Calvin Yip, Y. Raja Rampersaud
Format:	article
Language:	EN
Published:	Elsevier 2021
Subjects:	Low back pain Back-dominant Leg-dominant prospective Risk assessment Model of care Orthopedic surgery RD701-811 Neurology. Diseases of the nervous system RC346-429
Online Access:	https://doaj.org/article/f9da2d857bc54d3e9a2bc526c9269022
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spelling	oai:doaj.org-article:f9da2d857bc54d3e9a2bc526c92690222021-11-22T04:31:23ZPredictors of response following standardized education and self-management recommendations for low back pain stratified by dominant pain location2666-548410.1016/j.xnsj.2021.100092https://doaj.org/article/f9da2d857bc54d3e9a2bc526c92690222021-12-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2666548421000445https://doaj.org/toc/2666-5484Background: Low back pain (LBP) is a leading cause of disability globally. Risk-stratification systems (e.g. STarT Back) have been proposed to guide treatment, but with varying success. We investigated factors associated with poor response to standardized LBP education and self-management recommendations stratified by dominant pain location (back or leg). Methods: LBP patients underwent a standardized primary care model of care of education and self-management recommendations. Poor response was defined as an Oswestry Disability Index (ODI) change score <10 units by 6 months. Multivariable logistic regression was used to identify poor response risk factors, stratified by back-dominant and leg-dominant back pain. Baseline factors: age, sex, body mass index, ODI, LBP/leg-pain intensity, LBP/leg-pain duration, STarT Back chronicity-risk, smoking, comorbidity count, and self-efficacy. Results: The sample consisted of 767 patients (443 back-dominant, 324 leg-dominant). Mean age was 53 years, and 59% were female. Females accounted for 66% of back-dominant and 50% of leg-dominant patients. Chronicity risk was ‘high’ for 18% of back-dominant and 29% of leg-dominant patients. Poor response was higher in back- (57%) compared to leg-dominant (42%) patients. Adjusted stratified analyses: female sex, moderate or high chronicity-risk, and increasing age were associated with increased risk of poor response, and greater self-efficacy with favourable response, in leg-dominant patients; these were not the cases among back-dominant patients. Increased comorbidity count was associated with poor response in back dominant patients. In both patient groups, higher baseline ODI score was associated with favorable response, and smoking and longer pain duration with poor response. Conclusions: Differences in the influence of sex and chronicity risk in particular on outcome by dominant pain location suggests that considering these patients as a single group may not be appropriate. Furthermore, findings suggest that stratification by pain dominance may enhance the use of established risk stratification tools such as the STarT Back.Anthony V. PerruccioJessica T.Y. WongElizabeth M. BadleyJ. Denise PowerCalvin YipY. Raja RampersaudElsevierarticleLow back painBack-dominantLeg-dominantprospectiveRisk assessmentModel of careOrthopedic surgeryRD701-811Neurology. Diseases of the nervous systemRC346-429ENNorth American Spine Society Journal, Vol 8, Iss , Pp 100092- (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Low back pain Back-dominant Leg-dominant prospective Risk assessment Model of care Orthopedic surgery RD701-811 Neurology. Diseases of the nervous system RC346-429
spellingShingle	Low back pain Back-dominant Leg-dominant prospective Risk assessment Model of care Orthopedic surgery RD701-811 Neurology. Diseases of the nervous system RC346-429 Anthony V. Perruccio Jessica T.Y. Wong Elizabeth M. Badley J. Denise Power Calvin Yip Y. Raja Rampersaud Predictors of response following standardized education and self-management recommendations for low back pain stratified by dominant pain location
description	Background: Low back pain (LBP) is a leading cause of disability globally. Risk-stratification systems (e.g. STarT Back) have been proposed to guide treatment, but with varying success. We investigated factors associated with poor response to standardized LBP education and self-management recommendations stratified by dominant pain location (back or leg). Methods: LBP patients underwent a standardized primary care model of care of education and self-management recommendations. Poor response was defined as an Oswestry Disability Index (ODI) change score <10 units by 6 months. Multivariable logistic regression was used to identify poor response risk factors, stratified by back-dominant and leg-dominant back pain. Baseline factors: age, sex, body mass index, ODI, LBP/leg-pain intensity, LBP/leg-pain duration, STarT Back chronicity-risk, smoking, comorbidity count, and self-efficacy. Results: The sample consisted of 767 patients (443 back-dominant, 324 leg-dominant). Mean age was 53 years, and 59% were female. Females accounted for 66% of back-dominant and 50% of leg-dominant patients. Chronicity risk was ‘high’ for 18% of back-dominant and 29% of leg-dominant patients. Poor response was higher in back- (57%) compared to leg-dominant (42%) patients. Adjusted stratified analyses: female sex, moderate or high chronicity-risk, and increasing age were associated with increased risk of poor response, and greater self-efficacy with favourable response, in leg-dominant patients; these were not the cases among back-dominant patients. Increased comorbidity count was associated with poor response in back dominant patients. In both patient groups, higher baseline ODI score was associated with favorable response, and smoking and longer pain duration with poor response. Conclusions: Differences in the influence of sex and chronicity risk in particular on outcome by dominant pain location suggests that considering these patients as a single group may not be appropriate. Furthermore, findings suggest that stratification by pain dominance may enhance the use of established risk stratification tools such as the STarT Back.
format	article
author	Anthony V. Perruccio Jessica T.Y. Wong Elizabeth M. Badley J. Denise Power Calvin Yip Y. Raja Rampersaud
author_facet	Anthony V. Perruccio Jessica T.Y. Wong Elizabeth M. Badley J. Denise Power Calvin Yip Y. Raja Rampersaud
author_sort	Anthony V. Perruccio
title	Predictors of response following standardized education and self-management recommendations for low back pain stratified by dominant pain location
title_short	Predictors of response following standardized education and self-management recommendations for low back pain stratified by dominant pain location
title_full	Predictors of response following standardized education and self-management recommendations for low back pain stratified by dominant pain location
title_fullStr	Predictors of response following standardized education and self-management recommendations for low back pain stratified by dominant pain location
title_full_unstemmed	Predictors of response following standardized education and self-management recommendations for low back pain stratified by dominant pain location
title_sort	predictors of response following standardized education and self-management recommendations for low back pain stratified by dominant pain location
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/f9da2d857bc54d3e9a2bc526c9269022
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Predictors of response following standardized education and self-management recommendations for low back pain stratified by dominant pain location

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