Clinical decision rule for primary care patient with acute low back pain at risk of developing chronic pain

The Spine Journal : Official Journal of the North American Spine Society
Wolf E MehlingFrederick M Hecht

Abstract

Primary care clinicians need to identify candidates for early interventions to prevent patients with acute pain from developing chronic pain. We conducted a 2-year prospective cohort study of risk factors for the progression to chronic pain and developed and internally validated a clinical decision rule (CDR) that stratifies patients into low-, medium-, and high-risk groups for chronic pain. This is a prospective cohort study in primary care. Patients with acute low back pain (LBP, ≤30 days duration) were included. Outcome measures were self-reported perceived nonrecovery and chronic pain. Patients were surveyed at baseline, 6 months, and 2 years. We conducted bivariate and multivariate regression analyses of demographic, clinical, and psychosocial variables for chronic pain outcomes, developed a CDR, and assessed its performance by calculating the bootstrapped areas under the receiver-operating characteristic curve (AUC) and likelihood ratios. Six hundred five patients enrolled: 13% had chronic pain at 6 months and 19% at 2 years. An eight-item CDR was most parsimonious for classifying patients into three risk levels. Bootstrapped AUC was 0.76 (0.70-0.82) for the 6-month CDR. Each 10-point score increase (60-point range) was a...Continue Reading

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Feb 18, 2016·Biological Research for Nursing·Angela R StarkweatherSusan G Dorsey
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May 14, 2021·Pain Reports·Linda Karoliina NieminenMarkku Juhani Kankaanpää

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