Can treatment outcome of chronic low back pain be predicted? Psychological disease consequences clarifying the issue.
OBJECTIVE
To search for generalizable, psychological predictors of chronic pain treatment outcome.


METHODS
The prognostic power of the psychological predictors, classified into subareas of function, i.e., impairments, disabilities, and handicaps, was compared in predictive situations varying with the quality of patient samples, programs, and outcome measures.


METHODS
Four rehabilitation centers in Finland providing "functioning activation" or more passive "spa resort" treatment programs for low back pain patients.


METHODS
173 low back pain patients for whom the inpatient rehabilitation program was funded by the Finnish Social Insurance Institution.


METHODS
The measures were panel assessment of global functioning (DSM III Axis V), self-report of handicap (Million), panel assessment of handicap (WHO index), panel assessment of adherence (four rating scales), and self-report of well-being (Faces scale).


RESULTS
Multivariate, stepwise regression analyses suggested that the disability and handicap measures of functioning may be more effective predictors than impairment measures, which, however, add to the variance explained by the former. However, the predictive power of psychological impairments, disabilities, and handicaps varied with differences in patient group, outcome measure, and program.


CONCLUSIONS
The "general predictors" of chronic pain treatment outcome may be difficult to find. Therefore, planning treatment for the individual patient may always have to be based on accurate multiaxial and multidimensional assessment of patient functioning.
Talo
S
S
Social Insurance Institution, Research and Development Center, Turku, Finland.
Puukka
P
P
Rytökoski
U
U
Rönnemaa
T
T
Kallio
V
V
D000328:Adult; D002908:Chronic Disease; D006233:Persons with Disabilities; D005260:Female; D005544:Forecasting; D006294:Health Resorts; D006801:Humans; D008161:Lumbosacral Region; D008297:Male; D008962:Models, Theoretical; D010146:Pain / Q000503:physiopathology / Q000523:psychology* / Q000534:rehabilitation*; D010809:Physical Fitness; D011237:Predictive Value of Tests; D012044:Regression Analysis; D016896:Treatment Outcome