Top

European Spine Journal

Published in:

Open Access 01-04-2016 | Original Article

The added prognostic value of MRI findings for recovery in patients with low back pain in primary care: a 1-year follow-up cohort study

Authors: Evelien I. T. de Schepper, Bart W. Koes, Edwin H. G. Oei, Sita M. A. Bierma-Zeinstra, Pim A. J. Luijsterburg

Published in: European Spine Journal | Issue 4/2016

Abstract

Purpose

Information on the prognostic value of MRI findings in low back pain patients in primary care is lacking. The objective of this study is to investigate the added prognostic value of baseline MRI findings over known prognostic factors for recovery at 12-month follow-up in patients with low back pain referred to MRI by their general practitioner.

Methods

Patients referred by their general practitioner for MRI of the lumbar spine were recruited at the MRI Center. The questionnaires at baseline and at 3 and 12-months follow-up included potential clinical predictors from history taking and the outcome recovery. The MRI radiology reports were scored. Analysis was performed in 3 steps: derivation of a predictive model including characteristics of the patients and back pain only (history taking), including reported MRI findings only, and the addition of reported MRI findings to the characteristics of the patients and back pain.

Results

At 12-months follow-up 53 % of the patients reported recovery (n = 683). Lower age, better attitude/beliefs regarding back pain, acute back pain, presence of neurological symptoms of the leg(s), and presence of non-continuous back pain were significantly associated with recovery at 12-months follow-up: area under the curve (AUC) 0.77. Addition of the MRI findings resulted in an AUC of 0.78.

Conclusions

At 12-months follow-up, only 53 % of these patients with low back pain referred for MRI in general practice reported recovery. Five clinic baseline characteristics were associated with recovery at 12-months follow-up; adding the MRI findings did not result in a stronger prediction of recovery.

Available only for authorised users

Chou R, Deyo RA, Jarvik JG (2012) Appropriate use of lumbar imaging for evaluation of low back pain. Radiol Clin North Am 50:569–585. doi:10.1016/j.rcl.2012.04.005 CrossRefPubMed

Williams CM, Maher CG, Hancock MJ, McAuley JH, McLachlan AJ, Britt H, Fahridin S, Harrison C, Latimer J (2010) Low back pain and best practice care: a survey of general practice physicians. Arch Intern Med 170:271–277. doi:10.1001/archinternmed.2009.507 CrossRefPubMed

Koes BW, van Tulder MW, Peul WC (2007) Diagnosis and treatment of sciatica. Brit Med J 334:1313–1317. doi:10.1136/bmj.39223428495.BE CrossRefPubMedPubMedCentral

Verwoerd AJ, Luijsterburg PA, Lin CW, Jacobs WC, Koes BW, Verhagen AP (2013) Systematic review of prognostic factors predicting outcome in non-surgically treated patients with sciatica. Eur J Pain. doi:10.1002/j.1532-2149.2013.00301.x

Campbell P, Foster NE, Thomas E, Dunn KM (2013) Prognostic indicators of low back pain in primary care: five-year prospective study. J Pain. doi:10.1016/j.jpain.2013.03.013 PubMedPubMedCentral

Carragee EJ, Kim DH (1997) A prospective analysis of magnetic resonance imaging findings in patients with sciatica and lumbar disc herniation. Correlation of outcomes with disc fragment and canal morphology. Spine (Phila Pa 1976) 22:1650–1660CrossRef

Jensen TS, Albert HB, Sorensen JS, Manniche C, Leboeuf-Yde C (2007) Magnetic resonance imaging findings as predictors of clinical outcome in patients with sciatica receiving active conservative treatment. J Manipulative Physiol Ther 30:98–108. doi:10.1016/j.jmpt.2006.12.004 CrossRefPubMed

Komori H, Okawa A, Haro H, Shinomiya Ki K (2002) Factors predicting the prognosis of lumbar radiculopathy due to disc herniation. J Orthop Sci 7:56–61. doi:10.1007/s007760200009 CrossRefPubMed

Peul WC, Brand R, Thomeer RT, Koes BW (2008) Influence of gender and other prognostic factors on outcome of sciatica. Pain 138:180–191. doi:10.1016/j.pain.2007.12.014 CrossRefPubMed

10.

Takada E, Takahashi M, Shimada K (2001) Natural history of lumbar disc hernia with radicular leg pain: spontaneous MRI changes of the herniated mass and correlation with clinical outcome. J Orthop Surg (Hong Kong) 9:1–7

11.

Vroomen PC, Wilmink JT, de Krom MC (2002) Prognostic value of MRI findings in sciatica. Neuroradiology 44:59–63CrossRef

12.

Beurskens AJ, de Vet HC, Koke AJ (1996) Responsiveness of functional status in low back pain: a comparison of different instruments. Pain 65:71–76CrossRefPubMed

13.

Von Korff M, Jensen MP, Karoly P (2000) Assessing global pain severity by self-report in clinical and health services research. Spine (Phila Pa 1976) 25:3140–3151CrossRef

14.

Roland M, Morris R (1983) A study of the natural history of back pain Part I: development of a reliable and sensitive measure of disability in low-back pain. Spine (Phila Pa 1976) 8:141–144CrossRef

15.

Mehling WE, Gopisetty V, Acree M, Pressman A, Carey T, Goldberg H, Hecht FM, Avins AL (2011) Acute low back pain and primary care: how to define recovery and chronification? Spine (Phila Pa 1976) 36:2316–2323. doi:10.1097/BRS.0b013e31820c01a6 CrossRef

16.

Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR (1996) A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol 49:1373–1379CrossRefPubMed

17.

Symonds TL, Burton AK, Tillotson KM, Main CJ (1996) Do attitudes and beliefs influence work loss due to low back trouble? Occup Med (Lond) 46:25–32CrossRef

18.

Moons KG, Donders RA, Stijnen T, Harrell FE Jr (2006) Using the outcome for imputation of missing predictor values was preferred. J Clin Epidemiol 59:1092–1101. doi:10.1016/j.jclinepi.2006.01.009 CrossRefPubMed

19.

Harrell FE Jr (2001) Regression modeling strategies: with applications to linear models, logistic regression, and survival analysis. Springer, New YorkCrossRef

20.

DeLong ER, DeLong DM, Clarke-Pearson DL (1988) Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 44:837–845CrossRefPubMed

21.

Graves JM, Fulton-Kehoe D, Jarvik JG, Franklin GM (2012) Early imaging for acute low back pain: one-year health and disability outcomes among Washington State workers. Spine (Phila Pa 1976) 37:1617–1627. doi:10.1097/BRS.0b013e318251887b CrossRef

22.

Hill JC, Konstantinou K, Egbewale BE, Dunn KM, Lewis M, van der Windt D (2011) Clinical outcomes among low back pain consulters with referred leg pain in primary care. Spine (Phila Pa 1976) 36:2168–2175. doi:10.1097/BRS.0b013e31820712bb CrossRef

23.

Mehling WE, Gopisetty V, Bartmess E, Acree M, Pressman A, Goldberg H, Hecht FM, Carey T, Avins AL (2012) The prognosis of acute low back pain in primary care in the United States: a 2-year prospective cohort study. Spine (Phila Pa 1976) 37:678–684. doi:10.1097/BRS.0b013e318230ab20 CrossRef

24.

Jarvik JG, Hollingworth W, Martin B, Emerson SS, Gray DT, Overman S, Robinson D, Staiger T, Wessbecher F, Sullivan SD, Kreuter W, Deyo RA (2003) Rapid magnetic resonance imaging vs radiographs for patients with low back pain: a randomized controlled trial. JAMA 289:2810–2818. doi:10.1001/jama.289.21.2810 CrossRefPubMed

25.

Pengel LH, Herbert RD, Maher CG, Refshauge KM (2003) Acute low back pain: systematic review of its prognosis. BMJ 327:323. doi:10.1136/bmj.327.7410.323 CrossRefPubMedPubMedCentral

26.

Suri P, Rainville J, Fitzmaurice GM, Katz JN, Jamison RN, Martha J, Hartigan C, Limke J, Jouve C, Hunter DJ (2011) Acute low back pain is marked by variability: an internet-based pilot study. BMC Musculoskelet Disord 12:220. doi:10.1186/1471-2474-12-220 CrossRefPubMedPubMedCentral

27.

da CMCL, Maher CG, Hancock MJ, McAuley JH, Herbert RD, Costa LO (2012) The prognosis of acute and persistent low-back pain: a meta-analysis. CMAJ 184:613–624. doi:10.1503/cmaj.111271

28.

Modic MT, Obuchowski NA, Ross JS, Brant-Zawadzki MN, Grooff PN, Mazanec DJ, Benzel EC (2005) Acute low back pain and radiculopathy: mR imaging findings and their prognostic role and effect on outcome. Radiology 237:597–604. doi:10.1148/radiol.2372041509 CrossRefPubMed

29.

Henschke N, Maher CG, Refshauge KM, Herbert RD, Cumming RG, Bleasel J, York J, Das A, McAuley JH (2009) Prevalence of and screening for serious spinal pathology in patients presenting to primary care settings with acute low back pain. Arthritis Rheum 60:3072–3080. doi:10.1002/art.24853 CrossRefPubMed

30.

Hayden JA, Chou R, Hogg-Johnson S, Bombardier C (2009) Systematic reviews of low back pain prognosis had variable methods and results: guidance for future prognosis reviews. J Clin Epidemiol 62(781–796):e781. doi:10.1016/j.jclinepi.2008.09.004 CrossRef

31.

Elfering A, Mannion AF, Jacobshagen N, Tamcan O, Muller U (2009) Beliefs about back pain predict the recovery rate over 52 consecutive weeks. Scand J Work Environ Health 35:437–445CrossRefPubMed

32.

Urquhart DM, Bell RJ, Cicuttini FM, Cui J, Forbes A, Davis SR (2008) Negative beliefs about low back pain are associated with high pain intensity and high level disability in community-based women. BMC Musculoskelet Disord 9:148. doi:10.1186/1471-2474-9-148 CrossRefPubMedPubMedCentral

33.

Harms MC, Peers CE, Chase D (2010) Low back pain: what determines functional outcome at six months? An observational study. BMC Musculoskelet Disord 11:236. doi:10.1186/1471-2474-11-236 CrossRefPubMedPubMedCentral

34.

Konstantinou K, Hider SL, Jordan JL, Lewis M, Dunn KM, Hay EM (2013) The impact of low back-related leg pain on outcomes as compared with low back pain alone: a systematic review of the literature. Clin J Pain. doi:10.1097/AJP.0b013e31826f9a52 PubMed

Title: The added prognostic value of MRI findings for recovery in patients with low back pain in primary care: a 1-year follow-up cohort study
Authors: Evelien I. T. de Schepper
Bart W. Koes
Edwin H. G. Oei
Sita M. A. Bierma-Zeinstra
Pim A. J. Luijsterburg
Publication date: 01-04-2016
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 4/2016
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-016-4423-6

At a glance: The STEP trials

Springer Medicine

The added prognostic value of MRI findings for recovery in patients with low back pain in primary care: a 1-year follow-up cohort study

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 4/2016

The use of local vancomycin powder in degenerative spine surgery

Traumatic facet joint dislocation in Western Australia

Reviewer’s comment concerning “The surgical algorithm for the AOSpine thoracolumbar spine injury classification system” (by A.R. Vaccaro et al.: Eur Spine J, 2015; doi:10.1007/s00586-015-3982-2)

The association between a lifetime history of work-related low back injury and future low back pain: a population-based cohort study

Prospective study using anterior approach did not show association between Modic 1 changes and low grade infection in lumbar spine