期刊
SPINE JOURNAL
卷 15, 期 7, 页码 1577-1586出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.spinee.2015.03.003
关键词
Low back pain; Chronic pain; Acute pain; Clinical decision rule; Prediction; Primary care
资金
- National Institutes for Health/National Center for Complementary and Alternative Medicine (NIH/NCCAM) [K23 AT002298, R21 AT004467]
- NIH/NCCAM [K24 AT007827]
- Research Evaluation and Allocation Committee of the University of California-San Francisco
- Mount Zion Health Fund
- San Francisco
BACKGROUND CONTEXT: Primary care clinicians need to identify candidates for early interventions to prevent patients with acute pain from developing chronic pain. PURPOSE: We conducted a 2-year prospective cohort study of risk factors for the progression to chronic pain and developed and internally validated a clinical decision rule (CDR) that stratifies patients into low-, medium-, and high-risk groups for chronic pain. STUDY DESIGN/SETTING: This is a prospective cohort study in primary care. PATIENT SAMPLE: Patients with acute low back pain (LBP, <= 30 days duration) were included. OUTCOME MEASURES: Outcome measures were self-reported perceived nonrecovery and chronic pain. METHODS: Patients were surveyed at baseline, 6 months, and 2 years. We conducted bivariate and multivariate regression analyses of demographic, clinical, and psychosocial variables for chronic pain outcomes, developed a CDR, and assessed its performance by calculating the bootstrapped areas under the receiver-operating characteristic curve (AUC) and likelihood ratios. RESULTS: Six hundred five patients enrolled: 13% had chronic pain at 6 months and 19% at 2 years. An eight-item CDR was most parsimonious for classifying patients into three risk levels. Bootstrapped AUC was 0.76 (0.70-0.82) for the 6-month CDR. Each 10-point score increase (60-point range) was associated with an odds ratio of 11.1 (10.8-11.4) for developing chronic pain. Using a less than 5% probability of chronic pain as the cutoff for low risk and a greater than 40% probability for high risk, likelihood ratios were 0.26 (0.14-0.48) and 4.4 (3.0-6.3) for these groups, respectively. CONCLUSIONS: A CDR was developed that may help primary care clinicians classify patients with strictly defined acute LBP into low-, moderate-, and high-risk groups for developing chronic pain and performed acceptably in 1,000 bootstrapped replications. Validation in a separate sample is needed. (C) 2015 Elsevier Inc. All rights reserved.
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