How is recovery defined and measured in patients with low back pain? A mixed study systematic review

Abstract

Background: Despite the burden of low back pain (LBP) there is no currently accepted definition for its recovery, nor is there a gold standard for measurement. In addition, it is currently unclear how the perspective of patients are used in making recovery determinations. The purpose of this mixed study systematic review across both quantitative and qualitative literature was to (1) explore how recovery has been defined and measured for patients experiencing LBP, and (2) examine how the perspectives of patients and providers for recovery of LBP align or differ.

Methods: This was a mixed study systematic review. Key databases were searched from inception until February 20, 2023: Medline, EMBASE, CINAHL, Cochrane, PEDro looking for sources examining definitions and measures of recovery in patients with LBP. Grey literature was identified through the ProQuest Thesis & Dissertation database. Two reviewers used the Mixed Methods Appraisal Tool for quality assessment of both qualitative and quantitative studies to explore definitions, measurements and perspective of recovery.

Results: 466 original studies were included: 12 qualitative studies, 88 quantitative randomized control trials, 348 quantitative non-randomized studies, 16 quantitative descriptive studies, and two mixed methods studies. Most of the time recovery was not defined, with six other themes identified: comparison of scores, in relation to a singular cut-off score, improvement of absence of clinical symptoms, a return to a pre-injury state, change/improvement score from baseline and as a process/trajectory. For recovery measurements, six themes described the data: multiple measures, single measure excluding recovery, a recovery measure, recovery and an additional measure, pain and an additional measure, or indirect/ not specified. Lastly recovery perspectives were made from either the patient, provider, or a combination of patient and provider.

Conclusion: For patients living with LBP, the concept of recovery continues to lack consensus for its definition and measurement in patients with LBP. The perspectives of patients were mostly not preserved in making recovery determinations. Urgent action is needed to generate consensus across clinicians, researchers, and patients regarding how recovery should be defined and measured. A multitude of study-specific definitions limit knowledge syntheses and definition of best practice.

Keywords: Low back pain; Mixed study systematic review; Recovery.

Fig. 1

Flow diagram of literature search

Fig. 2

Seven main themes of recovery definitions across entire synthesis. Results are presented in both counts and percentage of total synthesis

Fig. 3

Six main themes of recovery measurements across entire synthesis. Results are presented in both counts and percentage of total synthesis