Predicting long-term functional limitations among back pain patients in primary care settings

• Published in: Journal of clinical epidemiology Vol. 50; no. 1; pp. 31 - 43
• Main Authors: Dionne, Clermont E., Koepsell, Thomas D., Von Korff, Michael, Deyo, Richard A., Barlow, William E., Checkoway, Harvey
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 1997; Elsevier
• Subjects: Adult; Aged; Analysis of Variance; Back pain; Back Pain - classification; Back Pain - psychology; Back Pain - rehabilitation; Biological and medical sciences; Diseases of the osteoarticular system; Diseases of the spine; Epidemiology; Female; Follow-Up Studies; functional limitations; General aspects; Health Maintenance Organizations; Humans; Male; Mathematical Computing; Medical sciences; Methodology; Middle Aged; Models, Statistical; outcome prediction; Predictive Value of Tests; Primary Health Care; Public health. Hygiene; Public health. Hygiene-occupational medicine; recursive partitioning; Regression Analysis; Risk Factors; Treatment Outcome; Washington; Washington; outcome prediction; Back pain; functional limitations; recursive partitioning; Human; High risk; Primary health care; Diseases of the osteoarticular system; Functional deficit; Spine disease; Long term; Functional capacity; Pain; Regression model; Rachialgia; Predictive factor; Public health
• ISSN: 0895-4356; 1878-5921
• DOI: 10.1016/S0895-4356(96)00313-7

To identify predictors of back-related long-term functional limitations, 1213 adult enrollees of a Health Maintenance Organization (HMO) in Washington state were interviewed about a month after a consultation for back pain in a primary care setting in 1989–1990, and followed each year thereafter. Out of 100 factors documented at the one-month assessment, measures of somatization, depression, functional limitations, and pain were the strongest predictors of two-year modified Roland-Morris score among a random subsample of 569 subjects. A multiple regression model containing the Symptom Checklist Depression and Somatization scores, the one-month modified Roland-Morris score and the number of pain days in the past six months explained about 30% of the variance in the outcome. Using recursive partitioning, a very simple model was developed to identify patients at high risk of sustaining long-term significant functional limitations. The regression model and the recursive partitioning model were successfully tested in a fresh sample of patients ( n = 644). Clinical application of the recursive partitioning model and methodological aspects of this study are discussed.