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BMC Musculoskeletal Disorders

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Open Access 01-12-2020 | Neck Pain | Research article

A prospective observational study on trajectories and prognostic factors of mid back pain

Authors: Christina Knecht, Sonja Hartnack, Beate Sick, Fabienne Riner, Petra Schweinhardt, Brigitte Wirth

Published in: BMC Musculoskeletal Disorders | Issue 1/2020

Abstract

Background

Although mid back pain (MBP) is a common condition that causes significant disability, it has received little attention in research and knowledge about trajectories and prognosis of MBP is limited. The purpose of this study was to identify trajectories of MBP and baseline risk factors for an unfavorable outcome in MBP patients undergoing chiropractic treatment.

Methods

This prospective-observational study analyzes outcome data of 90 adult MBP patients (mean age = 37.0 ± 14.6 years; 49 females) during one year (at baseline, after 1 week, 1 month, 3, 6 and 12 months) after start of chiropractic treatment. Patients completed an 11-point (0 to 10) numeric pain rating scale (NRS) at baseline and one week, one month, three, six and twelve months after treatment start and the Patient’s Global Impression of Change (PGIC) questionnaire at all time points except baseline. To determine trajectories, clustering with the package kml (software R), a variant of k-means clustering adapted for longitudinal data, was performed using the NRS-data. The identified NRS-clusters and PGIC data after three months were tested for association with baseline variables using univariable logistic regression analyses, conditional inference trees and random forest plots.

Results

Two distinct NRS-clusters indicating a favourable (rapid improvement within one month from moderate pain to persistent minor pain or recovery after one year, 80% of patients) and an unfavourable trajectory (persistent moderate to severe pain, 20% of patients) were identified. Chronic (> 3 months) pain duration at baseline significantly predicted that a patient was less likely to follow a favourable trajectory [OR = 0.16, 95% CI = 0.05–0.50, p = 0.002] and to report subjective improvement after twelve months [OR = 0.19, 95% CI = 0.07–0.51, p = 0.001], which was confirmed by the conditional inference tree and the random forest analyses.

Conclusions

This prospective exploratory study identified two distinct MBP trajectories, representing a favourable and an unfavourable outcome over the course of one year after chiropractic treatment. Pain chronicity was the factor that influenced outcome measures using NRS or PGIC.

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Title: A prospective observational study on trajectories and prognostic factors of mid back pain
Authors: Christina Knecht
Sonja Hartnack
Beate Sick
Fabienne Riner
Petra Schweinhardt
Brigitte Wirth
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Neck Pain
Back Pain
Back Pain
Back Pain
Published in: BMC Musculoskeletal Disorders / Issue 1/2020
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-020-03534-5

At a glance: The STEP trials

Springer Medicine

A prospective observational study on trajectories and prognostic factors of mid back pain

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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