Abstract
Introduction
There is a gap in the knowledge regarding the ideal time point to screen patients at risk of developing persistent LBP. Therefore, our research question was, “what is the best time point to identify patients with acute/subacute LBP at risk of developing persistent LBP at 6 months”? The aim of our study was to identify, in a group of patients presenting to a health practitioner with a new episode of LBP, the key time point at which those at risk of developing persistent LBP can be best detected.
Materials and Methods
Prospective cohort study of patients presenting to a health practitioner with a new episode of acute/subacute LBP. Patients were assessed at baseline and at 3, 6, 12 weeks and 6 months looking at factors of “maladaptive cognition” (fear-avoidance beliefs, magnification, helplessness) as potential predictors. Multivariate logistic regression analysis was performed for all time points.
Results
The best time point to predict the development of persistent LBP at 6 months was the 12-week follow-up (sensitivity 52%; overall predictive value 75%). The odds ratio of predicting persistent LBP was 1.77 for the index “maladaptive cognition” (95% CI, 1.04–3.03). The 6-week follow-up assessment was the next best time point (sensitivity 43%; overall predictive value 73%). The odds of predicting persistent LBP were 1.63 for the index “maladaptive cognition” (95% CI, 1.02–2.62). Even after 3 weeks, maladaptive cognitions were predictive whereas cognitions assessed at first visit to a health practitioner were not.
Conclusion
Our study revealed that maladaptive cognitions at 12 and at 6 weeks are suitable predictors for a transition from acute to persistent LBP in primary care. After 3 weeks, patients were present to a health care practitioner with an episode of acute/subacute, LBP cognitions influence the development of persistent LBP. Consequently, according to our results, patients at risk of developing persistent LBP should not be screened at baseline but rather at a later time point such as the 12- or 6-week follow-up for a better overall predictive value. Furthermore, cognitive behavioral interventions should be considered as early adjuvant LBP treatment in patients at risk of developing persistent LBP.
Yes
None declared