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Trajectories of Disability and Low Back Pain Impact: 2-year Follow-up of the Groningen Spine Cohort.

ABSTRACT: STUDY DESIGN:Prospective cohort study. OBJECTIVE:The aim of this study was to identify treatment response trajectories in patients with low back pain (LBP) during and after multidisciplinary care in a tertiary spine center, and to examine baseline patient characteristics that can distinguish trajectories. SUMMARY OF BACKGROUND DATA:Treatment response is often heterogeneous between patients with LBP. Knowledge on key characteristics that are associated with courses of disability could identify patients at risk for less favorable outcome. This knowledge will help improve shared decision-making. METHODS:Adult patients with LBP completed questionnaires on disability (Pain Disability Index) and LBP impact (Impact Stratification of the National Institutes of Health minimal dataset) at baseline, 6, 12, 18, and 24 months' follow-up. Latent class analyses were applied to identify trajectories of disability and LBP impact. Baseline sociodemographic and clinical patient characteristics were compared between trajectory subgroups. RESULTS:Follow-up was available for 996 patients on disability and 707 patients on LBP impact. Six trajectories were identified for both outcome measures. Three disability trajectories remained stable at distinct levels of severity (68% of patients) and three trajectories showed patterns of recovery (32%). For LBP impact there was one stable trajectory (17%), two slightly improving (59%), two recovering (15%), and one with a pattern of recovery and relapse (15%). Significant differences between trajectories were observed for almost all baseline patient characteristics. CONCLUSION:On average, patients show moderate improvements in disability and LBP impact 2 years after visiting a multidisciplinary tertiary spine center. However, latent class analyses revealed that most patients belong to subgroups experiencing stable levels of disability and LBP impact. Differences in baseline patient characteristics were mostly associated with baseline levels of functioning, instead of (un)favorable outcome during follow-up. LEVEL OF EVIDENCE:2.

SUBMITTER: Dutmer AL

PROVIDER: S-EPMC7647438 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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Trajectories of Disability and Low Back Pain Impact: 2-year Follow-up of the Groningen Spine Cohort.

Dutmer Alisa L AL Schiphorst Preuper Henrica R HR Stewart Roy E RE Soer Remko R Reneman Michiel F MF Wolff André P AP

Spine 20201201 23

<h4>Study design</h4>Prospective cohort study.<h4>Objective</h4>The aim of this study was to identify treatment response trajectories in patients with low back pain (LBP) during and after multidisciplinary care in a tertiary spine center, and to examine baseline patient characteristics that can distinguish trajectories.<h4>Summary of background data</h4>Treatment response is often heterogeneous between patients with LBP. Knowledge on key characteristics that are associated with courses of disabi ...[more]

PMID: 32833933

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Project description:ObjectiveTo compare the efficacy of surgery with disc prosthesis versus non-surgical treatment for patients with chronic low back pain.DesignA prospective randomised multicentre study.SettingFive university hospitals in Norway.Participants173 patients with a history of low back pain for at least one year, Oswestry disability index of at least 30 points, and degenerative changes in one or two lower lumbar spine levels (86 patients randomised to surgery). Patients were treated from April 2004 to September 2007.InterventionsSurgery with disc prosthesis or outpatient multidisciplinary rehabilitation for 12-15 days.Main outcome measuresThe primary outcome measure was the score on the Oswestry disability index after two years. Secondary outcome measures were low back pain, satisfaction with life (SF-36 and EuroQol EQ-5D), Hopkins symptom check list (HSCL-25), fear avoidance beliefs (FABQ), self efficacy beliefs for pain, work status, and patients' satisfaction and drug use. A blinded independent observer evaluated scores on the back performance scale and Prolo scale at two year follow-up.ResultsThe study was powered to detect a difference of 10 points on the Oswestry disability index between the groups at two years. At two years there was a mean difference of -8.4 points (95% confidence interval -13.2 to -3.6) in favour of surgery. In the analysis of prespecified secondary outcomes, there were significant differences in favour of surgery for low back pain (mean difference -12.2, -21.3 to -3.1), patients' satisfaction (63% (n = 46) v 39% (n = 26)), SF-36 physical component score (mean difference 5.8, 2.5 to 9.1), self efficacy for pain (mean difference 1.0, 0.2 to 1.9), and the Prolo scale (mean difference 0.9, 0.1 to 1.6). There were no significant differences in return to work, SF-36 mental component score, EQ-5D, fear avoidance beliefs, Hopkins symptom check list, drug use, and the back performance scale. One serious complication of leg amputation occurred during surgical revision of a polyethylene dislodgement. The drop-out rate was 20% (34) and the crossover rate was 6% (5).ConclusionsSurgical intervention with disc prosthesis for chronic low back pain resulted in a significantly greater improvement in the Oswestry score compared with rehabilitation, but this improvement did not clearly exceed the prespecified minimally important clinical difference between groups of 10 points, and the data are consistent with a wide range of differences between the groups, including values well below 10 points. The potential risks of surgery and the substantial amount of improvement experienced by a sizeable proportion of the rehabilitation group also have to be incorporated into overall decision making. Trial registration NCT 00394732.

Dataset Information

Trajectories of Disability and Low Back Pain Impact: 2-year Follow-up of the Groningen Spine Cohort.

Publications

Trajectories of Disability and Low Back Pain Impact: 2-year Follow-up of the Groningen Spine Cohort.

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