Classification of low back pain in primary care: using "bothersomeness" to identify the most severe cases

Abstract

Study design: Prospective inception cohort.

Objective: To investigate the validity and use of a single question on the bothersomeness of low back pain (LBP) as a method of classifying the severity of symptoms among patients seen in clinical practice.

Summary of background data: There is no widely accepted method for classifying patients with nonspecific LBP in clinical practice. There have been no previous reports of the validity and use of a question on bothersomeness as a method of classifying patients with LBP.

Methods: Consecutive patients (30-59 years old) with LBP consulting at 5 United Kingdom general practices (n = 1464) were mailed a questionnaire after consultation and 6 months later. Construct validity was assessed by comparing baseline responses on the single bothersomeness question with pain, disability, general health, and psychologic health measures. The ability of bothersomeness to predict outcomes at 6 months was assessed against pain, disability, work absence, and health care use.

Results: A total of 935 patients (65%) completed baseline questionnaires. There were 776 (83%) patients who consented to enter the follow-up study, and 447 returned the 6-month questionnaire. At baseline, bothersomeness correlated with pain, disability, and other measures (P < 0.001), and had 80% sensitivity (61% specificity) to detect people in the highest category of pain and disability. People with bothersome LBP at baseline evaluation had an increased risk of work absence or health care consultations for LBP 6 months later (relative risks 2.8 and 1.9, respectively).

Conclusions: There is evidence for the validity of a single bothersomeness question as a measure of LBP severity. It has the potential to provide a practical standard scheme for classifying patients with LBP in clinical practice. However, further work is needed to clarify its usefulness in a clinical setting.