Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2020

01-12-2020 | Care | Research article

A multisite longitudinal evaluation of patient characteristics associated with a poor response to non-surgical multidisciplinary management of low back pain in an advanced practice physiotherapist-led tertiary service

Authors: Shaun O’Leary, Maree Raymer, Peter Window, Patrick Swete Kelly, Darryl Lee, Linda Garsden, Rebecca Tweedy, Ben Phillips, Will O’Sullivan, Anneke Wake, Alison Smith, Sheryl Pahor, Luen Pearce, Rod McLean, David Thompson, Erica Williams, Damien Nolan, Jody Anning, Ian Seels, Daniel Wickins, Darryn Marks, Brendan Diplock, Vicki Parravicini, Linda Parnwell, Bill Vicenzino, Tracy Comans, Michelle Cottrell, Asaduzzaman Khan, Steven McPhail

Published in: BMC Musculoskeletal Disorders | Issue 1/2020

Login to get access

Abstract

Background

Non-surgical multidisciplinary management is often the first pathway of care for patients with chronic low back pain (LBP). This study explores if patient characteristics recorded at the initial service examination have an association with a poor response to this pathway of care in an advanced practice physiotherapist-led tertiary service.

Methods

Two hundred and forty nine patients undergoing non-surgical multidisciplinary management for their LBP across 8 tertiary public hospitals in Queensland, Australia participated in this prospective longitudinal study. Generalised linear models (logistic family) examined the relationship between patient characteristics and a poor response at 6 months follow-up using a Global Rating of Change measure.

Results

Overall 79 of the 178 (44%) patients completing the Global Rating of Change measure (28.5% loss to follow-up) reported a poor outcome. Patient characteristics retained in the final model associated with a poor response included lower Formal Education Level (ie did not complete school) (Odds Ratio (OR (95% confidence interval)) (2.67 (1.17–6.09), p = 0.02) and higher self-reported back disability (measured with the Oswestry Disability Index) (OR 1.33 (1.01–1.77) per 10/100 point score increase, p = 0.046).

Conclusions

A low level of formal education and high level of self-reported back disability may be associated with a poor response to non-surgical multidisciplinary management of LBP in tertiary care. Patients with these characteristics may need greater assistance with regard to their comprehension of health information, and judicious monitoring of their response to facilitate timely alternative care if no benefits are attained.
Literature
1.
Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the global burden of disease study 2010. Lancet. 2012;380:2163–96 Epub 2012/12/19.PubMedPubMedCentralCrossRef
2.
Standfield L, Comans T, Raymer M, O'Leary S, Moretto N, Scuffham P. The efficiency of increasing the capacity of physiotherapy screening clinics or traditional medical services to address unmet demand in Orthopaedic outpatients: a practical application of discrete event simulation with dynamic queuing. Appl Health Econ Health Policy. 2016;14:479–91 Epub 2016/04/27.PubMedCrossRef
3.
Kamper SJ, Apeldoorn AT, Chiarotto A, Smeets RJ, Ostelo RW, Guzman J, et al. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis. BMJ. 2015;350:h444 Epub 2015/02/20.PubMedPubMedCentralCrossRef
4.
Waddell G. The back pain revolution. 2nd ed: Churchill Livingstone; London: 2004.
5.
Saragiotto BT, de Almeida MO, Yamato TP, Maher CG. Multidisciplinary biopsychosocial rehabilitation for nonspecific chronic low Back pain. Phys Ther. 2016;96:759–63 Epub 2015/12/08.PubMedCrossRef
6.
O'Leary S, Cottrell M, Raymer M, Smith D, Khan A. General health factors may be a barrier to effective non-surgical multidisciplinary rehabilitation of common orthopaedic conditions in tertiary care settings. BMC Musculoskelet Disord. 2018;19:348 Epub 2018/09/29.PubMedPubMedCentralCrossRef
7.
Kent PM, Keating JL. Can we predict poor recovery from recent-onset nonspecific low back pain? A systematic review. Man Ther. 2008;13:12–28 Epub 2007/07/31.PubMedCrossRef
8.
9.
Pincus T, Burton AK, Vogel S, Field AP. A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain. Spine. 2002;27:E109–20 Epub 2002/03/07.PubMedCrossRef
10.
Chen Y, Campbell P, Strauss VY, Foster NE, Jordan KP, Dunn KM. Trajectories and predictors of the long-term course of low back pain: cohort study with 5-year follow-up. Pain. 2018;159:252–60 Epub 2017/11/08.PubMedCrossRef
11.
Gurung T, Ellard DR, Mistry D, Patel S, Underwood M. Identifying potential moderators for response to treatment in low back pain: a systematic review. Physiotherapy. 2015;101:243–51 Epub 2015/03/15.PubMedCrossRef
12.
von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Int J Surg. 2014;12:1495–9 Epub 2014/07/22.CrossRef
13.
Spitzer W, LeBlanc F, DuPuis M. Scientific approach to the assessment and management of activity-related spinal disorders. A monograph for clinicians. Spine. 1987;12:S1–S59.CrossRef
14.
Vittinghoff E, McCulloch CE. Relaxing the rule of ten events per variable in logistic and cox regression. Am J Epidemiol. 2007;165:710–8 Epub 2006/12/22.PubMedCrossRef
15.
Bolton JE. Sensitivity and specificity of outcome measures in patients with neck pain: detecting clinically significant improvement. Spine. 2004;29:2410–7 discussion 8.PubMedCrossRef
16.
Farrar JT, Young JP Jr, LaMoreaux L, Werth JL, Poole RM. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain. 2001;94:149–58.PubMedCrossRef
17.
Hurst H, Bolton J. Assessing the clinical significance of change scores recorded on subjective outcome measures. J Manip Physiol Ther. 2004;27:26–35.CrossRef
18.
Richardson JR, Peacock SJ, Hawthorne G, Iezzi A, Elsworth G, Day NA. Construction of the descriptive system for the assessment of quality of life AQoL-6D utility instrument. Health Qual Life Outcomes. 2012;10:38 Epub 2012/04/18.PubMedPubMedCentralCrossRef
19.
Henry JD, Crawford JR. The short-form version of the depression anxiety stress scales (DASS-21): construct validity and normative data in a large non-clinical sample. B J Clin Psychol. 2005;44:227–39.CrossRef
20.
Nicholas M. The pain self-efficacy questionnaire: taking pain into account. Eur J Pain. 2007;11:153–63.PubMedCrossRef
21.
Lorig K, Chastain RL, Ung E, Shoor S, Holman HR. Development and evaluation of a scale to measure perceived self-efficacy in people with arthritis. Arthritis Rheum. 1989;32:37–44 Epub 1989/01/01.PubMedCrossRef
22.
Linton SJ, Nicholas M, MacDonald S. Development of a short form of the Orebro Musculoskeletal Pain Screening Questionnaire. Spine. 2011;36:1891–5 Epub 2010/12/31.PubMedCrossRef
23.
Beales D, Kendell M, Chang RP, Hamso M, Gregory L, Richardson K, et al. Association between the 10 item Orebro musculoskeletal pain screening questionnaire and physiotherapists' perception of the contribution of biopsychosocial factors in patients with musculoskeletal pain. Man Ther. 2016;23:48–55 Epub 2016/05/18.PubMedCrossRef
24.
25.
Lauridsen HH, Hartvigsen J, Manniche C, Korsholm L, Grunnet-Nilsson N. Responsiveness and minimal clinically important difference for pain and disability instruments in low back pain patients. BMC Musculoskelet Disord. 2006;7:82 Epub 2006/10/27.PubMedPubMedCentralCrossRef
26.
Stratford P, Gill C, Westaway M, Binkley J. Assessing disability and change on individual patients: a report of a patient specific measure. Physiother Can. 1995;47:258–63.CrossRef
27.
Horn KK, Jennings S, Richardson G, Vliet DV, Hefford C, Abbott JH. The patient-specific functional scale: psychometrics, clinimetrics, and application as a clinical outcome measure. J Orthop Sports Phys Ther. 2012;42:30–42 Epub 2011/10/28.PubMedCrossRef
28.
Bennett M, Smith B, Torrance N, Potter J. The S-LANSS score for identifying pain of predominantly neuropathic origin: validation for use in clinical and postal research. J Pain. 2005;6:149–58.PubMedCrossRef
29.
Borge JA, Leboeuf-Yde C, Lothe J. Prognostic values of physical examination findings in patients with chronic low Back pain treated conservatively: a systematic literature review. J Manip Physiol Therap. 2001;24:292–5.CrossRef
30.
Waddell G, Somerville D, Henderson I, Newton M. Objective clinical evaluation of physical impairment in chronic low Back pain. Spine. 1992;17:617–28.PubMedCrossRef
31.
32.
Butler D. The sensitive nervous system. Adelaide: NOIgroup Publications; 2000.
33.
Nee R, Jull G, Vicenzino B, Coppieters M. The validity of upper-limb neurodynamic tests for detecting peripheral neuropathic pain. J Orthop Sports Phys Ther. 2012;42:413–24.PubMedCrossRef
34.
Walsh J, Hall T. Agreement and correlation between the straight leg raise and slump tests in subjects with leg pain. J Manip Physiol Ther. 2009;32:184–92 Epub 2009/04/14.CrossRef
35.
Billis E, McCarthy CJ, Gliatis J, Gittins M, Papandreou M, Oldham JA. Inter-tester reliability of discriminatory examination items for sub-classifying non-specific low back pain. J Rehabil Med. 2012;44:851–7 Epub 2012/09/11.PubMedCrossRef
36.
Freedman DA. A note on screening regression equations. Am Stat. 1983;37:152–5.
37.
Liu Q, Li C, Wanga V, Shepherd BE. Covariate-adjusted Spearman's rank correlation with probability-scale residuals. Biometrics. 2018;74:595–605 Epub 2017/11/14.PubMedCrossRef
38.
39.
Dancey CP, Reidy J. Statistics without Maths for psychology: Pearson education; 2007.
40.
Bozdogan H. Model selection and Akaike’s information criterion (AIC): the general theory and its analytical extensions. Psychometrika. 1987;52:345–70.CrossRef
41.
Adler NE, Newman K. Socioeconomic disparities in health: pathways and policies. Health Aff (Millwood). 2002;21:60–76 Epub 2002/03/20.CrossRef
42.
Kunst AE, Bos V, Lahelma E, Bartley M, Lissau I, Regidor E, et al. Trends in socioeconomic inequalities in self-assessed health in 10 European countries. Int J Epidemiol. 2005;34:295–305 Epub 2004/11/26.PubMedCrossRef
43.
Mackenbach JP, Stirbu I, Roskam AJ, Schaap MM, Menvielle G, Leinsalu M, et al. Socioeconomic inequalities in health in 22 European countries. N Engl J Med. 2008;358:2468–81 Epub 2008/06/06.PubMedCrossRef
44.
Witt CM, Schutzler L, Ludtke R, Wegscheider K, Willich SN. Patient characteristics and variation in treatment outcomes: which patients benefit most from acupuncture for chronic pain? Clin J Pain. 2011;27:550–5 Epub 2011/02/15.PubMedCrossRef
45.
Lamb SE, Lall R, Hansen Z, Castelnuovo E, Withers EJ, Nichols V, et al. A multicentred randomised controlled trial of a primary care-based cognitive behavioural programme for low Back pain. The Back skills training (BeST) trial. Health Technol Assess. 2010;14:1–253 iii-iv. Epub 2010/09/03.PubMedCrossRef
46.
van der Heide I, Wang J, Droomers M, Spreeuwenberg P, Rademakers J, Uiters E. The relationship between health, education, and health literacy: results from the Dutch adult literacy and life skills survey. J Health Commun. 2013;18(Suppl 1):172–84 Epub 2013/10/08.PubMedPubMedCentralCrossRef
47.
Briggs AM, Jordan JE, Buchbinder R, Burnett AF, O'Sullivan PB, Chua JY, et al. Health literacy and beliefs among a community cohort with and without chronic low back pain. Pain. 2010;150:275–83 Epub 2010/07/07.PubMedCrossRef
48.
Jordan JE, Buchbinder R, Osborne RH. Conceptualising health literacy from the patient perspective. Patient Educ Couns. 2010;79:36–42 Epub 2009/11/10.PubMedCrossRef
49.
Briggs AM, Jordan JE, O'Sullivan PB, Buchbinder R, Burnett AF, Osborne RH, et al. Individuals with chronic low back pain have greater difficulty in engaging in positive lifestyle behaviours than those without back pain: an assessment of health literacy. BMC Musculoskelet Disord. 2011;12:161 Epub 2011/07/16.PubMedPubMedCentralCrossRef
50.
BEAM U. United Kingdom back pain exercise and manipulation (UKBEAM) randomised trial: effectiveness of physical treatments for backpain in primary care. BMJ. 2004;329:1377.CrossRef
51.
Cherkin DC, Sherman KJ, Avins AL, Erro JH, Ichikawa L, Barlow WE, et al. A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain. Arch Intern Med. 2009;169:858–66 Epub 2009/05/13.PubMedPubMedCentralCrossRef
52.
Goossens ME, Vlaeyen JW, Hidding A, Kole-Snijders A, Evers SM. Treatment expectancy affects the outcome of cognitive-behavioral interventions in chronic pain. Clin J Pain. 2005;21:18–26 discussion 69-72. Epub 2004/12/16.PubMedCrossRef
53.
Liddle SD, Baxter GD, Gracey JH. Chronic low back pain: patients’ experiences, opinions and expectations for clinical management. Disabil Rehabil. 2007;29:1899–909 Epub 2007/09/14.PubMedCrossRef
54.
van der Hulst M, Vollenbroek-Hutten MM, Ijzerman MJ. A systematic review of sociodemographic, physical, and psychological predictors of multidisciplinary rehabilitation-or, back school treatment outcome in patients with chronic low back pain. Spine. 2005;30:813–25 Epub 2005/04/02.PubMedCrossRef
55.
Brinjikji W, Diehn FE, Jarvik JG, Carr CM, Kallmes DF, Murad MH, et al. MRI findings of disc degeneration are more prevalent in adults with low Back pain than in asymptomatic controls: a systematic review and meta-analysis. AJNR Am J Neuroradiol. 2015;36:2394–9 Epub 2015/09/12.PubMedCrossRefPubMedCentral
56.
Brinjikji W, Luetmer PH, Comstock B, Bresnahan BW, Chen LE, Deyo RA, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36:811–6 Epub 2014/11/29.PubMedCrossRefPubMedCentral
57.
Jarvik JG, Hollingworth W, Heagerty PJ, Haynor DR, Boyko EJ, Deyo RA. Three-year incidence of low back pain in an initially asymptomatic cohort: clinical and imaging risk factors. Spine. 2005;30:1541–8 discussion 9. Epub 2005/07/02.PubMedCrossRef
58.
Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, et al. What low back pain is and why we need to pay attention. Lancet. 2018;391:2356–67 Epub 2018/03/27.PubMedCrossRef
59.
Australian Commission on Safety and Quality in Health Care. Health literacy: Taking action to improve safety and quality. Sydney: ACSQHC. 2014. ISBN Print: 978-1-921983-61-0 Electronic: 978-1-921983-62-7.
60.
Wittink H, Oosterhaven J. Patient education and health literacy. Musculoskelet Sci Pract. 2018;38:120–7 Epub 2018/07/19.PubMedCrossRef
61.
Dunn P, Conard S. Improving health literacy in patients with chronic conditions: a call to action. Int J Cardiol. 2018;273:249–51 Epub 2018/09/09.PubMedCrossRef
62.
Klingbeil C, Gibson C. The teach Back project: a system-wide evidence based practice implementation. J Pediatr Nurs. 2018;42:81–5 Epub 2018/09/17.PubMedCrossRef
63.
Nutbeam D, Levin-Zamir D, Rowlands G. Health literacy in context. Int J Environ Res Public Health. 2018;15:2657 Epub 2018/11/30.PubMedCentralCrossRef
64.
Kamper SJ, Maher CG, Mackay G. Global rating of change scales: a review of strengths and weaknesses and considerations for design. J Man Manip Ther. 2009;17:163–70 Epub 2010/01/05.PubMedPubMedCentralCrossRef
Metadata
Title
A multisite longitudinal evaluation of patient characteristics associated with a poor response to non-surgical multidisciplinary management of low back pain in an advanced practice physiotherapist-led tertiary service
Authors
Shaun O’Leary
Maree Raymer
Peter Window
Patrick Swete Kelly
Darryl Lee
Linda Garsden
Rebecca Tweedy
Ben Phillips
Will O’Sullivan
Anneke Wake
Alison Smith
Sheryl Pahor
Luen Pearce
Rod McLean
David Thompson
Erica Williams
Damien Nolan
Jody Anning
Ian Seels
Daniel Wickins
Darryn Marks
Brendan Diplock
Vicki Parravicini
Linda Parnwell
Bill Vicenzino
Tracy Comans
Michelle Cottrell
Asaduzzaman Khan
Steven McPhail
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2020
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-020-03839-5

Other articles of this Issue 1/2020

BMC Musculoskeletal Disorders 1/2020 Go to the issue

Research article

Patients’ and clinicians’ perspectives on a ‘fast-track’ pathway for patients with sciatica in primary care: qualitative findings from the SCOPiC stratified care trial

Study protocol

Effectiveness and cost-effectiveness of stratified blended physiotherapy in patients with non-specific low back pain: study protocol of a cluster randomized controlled trial

Research article

Relationship between nerve conduction studies and the Functional Dexterity Test in workers with carpal tunnel syndrome

Research article

Reliability of two different measuring techniques with computer tomography for penetration and distribution of cement in the proximal tibia after total knee arthroplasty

Correction

Correction to: On-site multi-component intervention to improve productivity and reduce the economic and personal burden of neck pain in Swiss office-workers (NEXpro): protocol for a cluster-randomized controlled trial

Research article

A novel method for measurement of the occipital-cervical distance via the occiput-C4 distance