Risk Factors Associated With Transition From Acute to Chronic Low Back Pain in US Patients Seeking Primary Care
Joel M. Stevans,Anthony Delitto,Samannaaz S. Khoja,Charity G. Patterson,Clair N. Smith,Michael Schneider,Janet K. Freburger,Carol M. Greco,Jennifer A. Freel,Gwendolyn Sowa,Ajay D. Wasan,Gerard P. Brennan,Stephen J. Hunter,Kate I. Minick,Stephen T. Wegener,Patti L. Ephraim,Michael Friedman,Jason M. Beneciuk,Steven Z. George,Robert B. Saper +19 more
- Vol. 4, Iss: 2
Reads0
Chats0
TLDR
The transition from acute to chronic low back pain (LBP) is highly prevalent, with a presumed favorable prognosis; however, once chronic, LBP becomes a disabling and expensive condition, and it is unknown whether a standardized prognostic tool (i.e., Subgroups for Targeted Treatment Back tool [SBT]) can estimate this transition or whether early non-guideline concordant treatment is associated with the transition as discussed by the authors.Abstract:
Importance Acute low back pain (LBP) is highly prevalent, with a presumed favorable prognosis; however, once chronic, LBP becomes a disabling and expensive condition. Acute to chronic LBP transition rates vary widely owing to absence of standardized operational definitions, and it is unknown whether a standardized prognostic tool (ie, Subgroups for Targeted Treatment Back tool [SBT]) can estimate this transition or whether early non–guideline concordant treatment is associated with the transition to chronic LBP. Objective To assess the associations between the transition from acute to chronic LBP with SBT risk strata; demographic, clinical, and practice characteristics; and guideline nonconcordant processes of care. Design, Setting, and Participants This inception cohort study was conducted alongside a multisite, pragmatic cluster randomized trial. Adult patients with acute LBP stratified by SBT risk were enrolled in 77 primary care practices in 4 regions across the United States between May 2016 and June 2018 and followed up for 6 months, with final follow-up completed by March 2019. Data analysis was conducted from January to March 2020. Exposures SBT risk strata and early LBP guideline nonconcordant processes of care (eg, receipt of opioids, imaging, and subspecialty referral). Main Outcomes and Measures Transition from acute to chronic LBP at 6 months using the National Institutes of Health Task Force on Research Standards consensus definition of chronic LBP. Patient demographic characteristics, clinical factors, and LBP process of care were obtained via electronic medical records. Results Overall, 5233 patients with acute LBP (3029 [58%] women; 4353 [83%] White individuals; mean [SD] age 50.6 [16.9] years; 1788 [34%] low risk; 2152 [41%] medium risk; and 1293 [25%] high risk) were included. Overall transition rate to chronic LBP at six months was 32% (1666 patients). In a multivariable model, SBT risk stratum was positively associated with transition to chronic LBP (eg, high-risk vs low-risk groups: adjusted odds ratio [aOR], 2.45; 95% CI, 2.00-2.98;P Conclusions and Relevance In this cohort study, the transition rate to chronic LBP was substantial and increased correspondingly with SBT stratum and early exposure to guideline nonconcordant care.read more
Citations
More filters
Journal ArticleDOI
Unintended consequences: quantifying the benefits, iatrogenic harms and downstream cascade costs of musculoskeletal MRI in UK primary care.
TL;DR: In this article, the authors evaluated practice to improve pathways and patient safety from early imaging overuse, with limited supporting evidence and potential harms from early diagnosis overuse and concluded that the largest proportion of general practitioner (GP) magnetic resonance imaging (MRI) is musculoskeletal (MSK), with consistent annual growth.
Posted ContentDOI
Low back pain care pathways and costs: association with the type of initial contact health care provider. A retrospective cohort study
David Elton,Thomas M. Kosloff,M. Zhang,Priya Advani,Y. Guo,Stephanie Shimotsu,S. Sy,Anne Feuer +7 more
TL;DR: Examination of the association between the type of initial contact health care provider, service utilization, and total episode cost for the management of LBP found initial contact with primary care or specialist HCPs is associated with second- and third-line services provided before first line services, with little indication of a guideline recommended stepped approach to managing LBP.
Journal ArticleDOI
Modifiable lifestyle-related prognostic factors for the onset of chronic spinal pain: a systematic review of longitudinal studies.
TL;DR: In this paper , a systematic review of longitudinal studies aimed to evaluate possible associations between the onset of chronic spinal pain (including low back, back and neck pain) and putative modifiable lifestyle-related risk or protective factors.
Journal ArticleDOI
The Role of Chiropractic Care in Providing Health Promotion and Clinical Preventive Services for Adult Patients with Musculoskeletal Pain: A Clinical Practice Guideline.
Cheryl Hawk,Lyndon G Amorin-Woods,Marion W Evans,James M. Whedon,Clinton J. Daniels,Ronald D. Williams,Gregory F. Parkin-Smith,David N. Taylor,Derek R. Anderson,Ronald J. Farabaugh,Sheryl Walters,Alec L. Schielke,Amy L. Minkalis,Louis S. Crivelli,Cameron Alpers,Nathan A. Hinkeldey,Johanna Hoang,Daniel Caraway,Wayne M. Whalen,Jason Cook,Daniel Redwood +20 more
TL;DR: The Delphi consensus process was conducted during January-February 2021 as discussed by the authors, and the 65-member Delphi panel reached a high level of consensus on appropriate application of clinical preventive services for screening and health promotion counseling within the chiropractic scope of practice.
Journal ArticleDOI
Systematic review of guideline-recommended medications prescribed for treatment of low back pain
Morgan Price,Zachary A. Cupler,Cheryl Hawk,Edward M. Bednarz,Sheryl Walters,Clinton J. Daniels +5 more
TL;DR: In this paper , the authors identify and descriptively compare medication recommendations among low back pain (LBP) clinical practice guidelines (CPGs) using PubMed, Cochrane Database of Systematic Review, Index to Chiropractic Literature, AMED, CINAHL, and PEDro.
References
More filters
Journal ArticleDOI
The Oswestry Disability Index.
Jeremy Fairbank,Paul Pynsent +1 more
TL;DR: The ODI remains a valid and vigorous measure and has been a worthwhile outcome measure, and the process of using the ODI is reviewed and should be the subject of further research.
Journal ArticleDOI
Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults - United States, 2016.
James M. Dahlhamer,Jacqueline W. Lucas,Carla E. Zelaya,Richard L. Nahin,Sean Mackey,Lynn DeBar,Robert D. Kerns,Michael Von Korff,Linda Porter,Charles G. Helmick +9 more
TL;DR: The prevalence of chronic pain and high-impact chronic pain in the United States is analyzed to help differentiate persons with limitations in major life domains from those who maintain normal life activities despite chronic pain, providing a better understanding of the population in need of pain services.
Journal ArticleDOI
Review of inverse probability weighting for dealing with missing data
Shaun R. Seaman,Ian R. White +1 more
TL;DR: How the bias in the complete-case analysis arises and how IPW can remove it is described and why, despite MI generally being more efficient, IPW may sometimes be preferred is explained.
Journal ArticleDOI
An updated overview of clinical guidelines for the management of non-specific low back pain in primary care
Bart W. Koes,Maurits W. van Tulder,Chung-Wei Christine Lin,Luciana G. Macedo,James B McAuley,Christopher G. Maher +5 more
TL;DR: The comparison of international clinical guidelines for the management of low back pain showed that diagnostic and therapeutic recommendations are generally similar, but there are some discrepancies for recommendations regarding spinal manipulation and drug treatment for acute and chronic low backPain.
Journal ArticleDOI
Comparison of stratified primary care management for low back pain with current best practice (STarT Back): a randomised controlled trial
Jonathan C. Hill,David G T Whitehurst,David G T Whitehurst,David G T Whitehurst,Martyn Lewis,Stirling Bryan,Stirling Bryan,Kate M. Dunn,Nadine E. Foster,Kika Konstantinou,Chris J. Main,Elizabeth Mason,Simon Somerville,Gail Sowden,Kanchan Vohora,Elaine M Hay +15 more
TL;DR: The results show that a stratified approach, by use of prognostic screening with matched pathways, will have important implications for the future management of back pain in primary care.