Development of a Multivariate Prognostic Model for Pain and Activity Limitation in People With Low Back Disorders Receiving Physiotherapy.
OBJECTIVE
To identify predictors for back pain, leg pain, and activity limitation in patients with early persistent low back disorders (LBDs).


DESIGN
Prospective inception cohort study.


SETTING
Primary care private physiotherapy clinics in Melbourne, Australia.


PARTICIPANTS
Individuals (N=300) aged 18-65 years with low back and/or referred leg pain of ≥6 weeks and ≤6 months duration.


INTERVENTIONS
Not applicable.


MAIN OUTCOME MEASURES
Numeric rating scales for back pain and leg pain as well as the Oswestry Disability Scale.


RESULTS
Prognostic factors included sociodemographics, treatment related factors, subjective/physical examination, subgrouping factors, and standardized questionnaires. Univariate analysis followed by generalized estimating equations were used to develop a multivariate prognostic model for back pain, leg pain, and activity limitation. Fifty-eight prognostic factors progressed to the multivariate stage where 15 showed significant (P<.05) associations with at least 1 of the 3 outcomes. There were 5 indicators of positive outcome (2 types of LBD subgroups, paresthesia below waist, walking as an easing factor, and low transversus abdominis tone) and 10 indicators of negative outcome (both parents born overseas, deep leg symptoms, longer sick leave duration, high multifidus tone, clinically determined inflammation, higher back and leg pain severity, lower lifting capacity, lower work capacity, and higher pain drawing percentage coverage). The preliminary model identifying predictors of LBDs explained up to 37% of the variance in outcome.


CONCLUSIONS
This study evaluated a comprehensive range of prognostic factors reflective of both the biomedical and psychosocial domains of LBDs. The preliminary multivariate model requires further validation before being considered for clinical use.
['Ford|Jon J|JJ|', 'Richards|Matt C|MC|', 'Surkitt|Luke D|LD|', 'Chan|Alexander Y P|AYP|', 'Slater|Sarah L|SL|', 'Taylor|Nicholas F|NF|', 'Hahne|Andrew J|AJ|']
D000328:Adult D001315:Australia D004185:Disability Evaluation D005260:Female D006801:Humans D017116:Low Back Pain D008297:Male D008875:Middle Aged D051346:Mobility Limitation D015233:Models, Statistical D015999:Multivariate Analysis D010147:Pain Measurement D026741:Physical Therapy Modalities D011379:Prognosis D011446:Prospective Studies D018582:Sick Leave D013997:Time Factors D016896:Treatment Outcome
Back pain Prognosis Rehabilitation