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. 2014 Jan;23(1):102-12.
doi: 10.1007/s00586-013-2844-z. Epub 2013 Jun 16.

Predictive factors for successful clinical outcome 1 year after an intensive combined physical and psychological programme for chronic low back pain

Miranda L van Hooff  1 , Maarten Spruit, John K O'Dowd, Wim van Lankveld, Jeremy C T Fairbank, Jacques van Limbeek
Affiliations

Predictive factors for successful clinical outcome 1 year after an intensive combined physical and psychological programme for chronic low back pain

Miranda L van Hooff et al. Eur Spine J. 2014 Jan.

Abstract

Purpose: The aim of this longitudinal study is to determine the factors which predict a successful 1-year outcome from an intensive combined physical and psychological (CPP) programme in chronic low back pain (CLBP) patients.

Methods: A prospective cohort of 524 selected consecutive CLBP patients was followed. Potential predictive factors included demographic characteristics, disability, pain and cognitive behavioural factors as measured at pre-treatment assessment. The primary outcome measure was the oswestry disability index (ODI). A successful 1-year follow-up outcome was defined as a functional status equivalent to 'normal' and healthy populations (ODI ≤22). The 2-week residential programme fulfills the recommendations in international guidelines. For statistical analysis we divided the database into two equal samples. A random sample was used to develop a prediction model with multivariate logistic regression. The remaining cases were used to validate this model.

Results: The final predictive model suggested being 'in employment' at pre-treatment [OR 3.61 (95 % CI 1.80-7.26)] and an initial 'disability score' [OR 0.94 (95 % CI 0.92-0.97)] as significant predictive factors for a successful 1-year outcome (R (2) = 22 %; 67 % correctly classified). There was no predictive value from measures of psychological distress.

Conclusion: CLBP patients who are in work and mild to moderately disabled at the start of a CPP programme are most likely to benefit from it and to have a successful treatment outcome. In these patients, the disability score falls to values seen in healthy populations. This small set of factors is easily identified, allowing selection for programme entry and triage to alternative treatment regimes.

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Figures

Fig. 1
Fig. 1
Flow diagram of CLBP patients recruited by the spine surgeons at the outpatient orthopaedic department for the CPP programme and handling of the data of these patients
Fig. 2
Fig. 2
Functional status as measured with the ODI (0–100) in the study sample (n = 524). Oswestry disability index, with high values indicating high disability ∆ employed; ο unemployed at pre-treatment assessment; red case: pre-treatment ODI is 0, employed, and 1-year follow-up ODI is 24 (worsened); green case: pre-treatment ODI is 20, employed, and 1-year follow-up ODI is 0 (improved); black dashed horizontal line indicates the 22 point threshold for functional status [25] Grey dotted diagonal line is a reference line
See this image and copyright information in PMC

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