Predictive factors for 1-year outcome of chronic low back pain following manipulation, stabilizing exercises, and physician consultation or physician consultation alone
Leena Niemistö A1, Seppo Sarna A2, Tiina Lahtinen-Suopanki A1, Karl-August Lindgren A1, Heikki Hurri A1
A1 Rehabilitation Unit of Orthopaedic Hospital ORTON, Invalid Foundation, Helsinki, Finland
A2 Department of Public Health, University of Helsinki, Helsinki, Finland
Objectives: To examine the relative influences of sociodemographic and episode-specific factors on change in low back pain intensity and self-rated disability.Methods: Of 204 patients with chronic low back pain, 102 were randomized to a combined manipulation, exercise and physician consultation group and 102 to a consultation-alone group. These groups were each divided into 2 clusters based on change in both pain intensity and self-rated disability at 1 year. The first cluster included patients whose symptoms clearly decreased, and the second those whose trouble persisted. Association between sociodemographic and episode-specific factors and poor recovery from low back pain and disability were evaluated by univariate and multivariate analysis.Results: Severe affective distress (OR 3.81; 95% CI 1.3-10.8) predicted poor response to the manipulative treatment. Over a 25-day sick leave during previous year (19.64; 3.8-102.5), poor life control (9.40; 1.9-47.0), and generalized somatic symptoms (3.18; 0.9-11.6) were the risk factors for not benefiting from the informative approach.Conclusions: Psychosocial differences seem to be important determinants for treatment outcomes, and should be the focus of future studies.