title: Level of distress in a recurrent low back pain population referred for physical therapy.
abstract: METHODS
  Recruitment phase of a randomized clinical trial.
  
  
  OBJECTIVE
  To review the published literature on the use of the distress risk assessment method in different back pain populations and healthcare settings and compare results with those obtained from the current trial.
  
  
  BACKGROUND
  Psychological distress in low back pain is commonplace, and distress increases the relative risk of poor outcome with physical treatment alone. The Distress and Risk Assessment Method is a tool for use in the clinical setting to assist in the identification of distress and clinical decision-making.
  
  
  METHODS
  The Distress Risk Assessment Method and Roland Morris Disability Questionnaire were used to assess eligibility of patients with recurrent low back pain for recruitment into a randomized clinical trial examining different physical therapy approaches.
  
  
  RESULTS
  In total, 221 patients were assessed, resulting in 212 correctly complete questionnaires. Of those 212, 71 (33%) showed evidence of marked distress (41 depressed and 30 somatic). Functional disability, measured using the Roland Morris Disability Questionnaire, was higher for the distressed group (mean 14.1, SD 4.8, range 3-23) than the nondistressed group (mean 8.0, SD 5.1, range 0-21). Distress and anxiety measured using the distress risk assessment method were correlated to self-reported back-related functional disability.
  
  
  CONCLUSIONS
  Distress associated with low back pain is common with one third of patients referred for physical therapy at the units studied exhibiting a level of distress that increased their relative risk of poor outcome by 3 to 4 times. Clinically, screening this group of patients may help indicate when liaison with other professionals is appropriate and possibly identify those patients who may be too distressed to respond to physical therapy intervention alone.
authors.affiliation: Department of Allied Health Professions-Physiotherapy, University of Hertfordshire, College Lane, Hatfield, Herts AL10 9AB, United Kingdom. M.Cairns@herts.ac.uk
authors.forename: Melinda C
authors.initials: MC
authors.lastname: Cairns
authors.forename: Nadine E
authors.initials: NE
authors.lastname: Foster
authors.forename: Christine C
authors.initials: CC
authors.lastname: Wright
authors.forename: Donald
authors.initials: D
authors.lastname: Pennington
mesh_terms: D000293:Adolescent; D000328:Adult; D001007:Anxiety / Q000175:diagnosis; D004185:Disability Evaluation; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis* / Q000628:therapy*; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D018579:Patient Selection; D026741:Physical Therapy Modalities; D012008:Recurrence; D018570:Risk Assessment / Q000379:methods; D013315:Stress, Psychological / Q000175:diagnosis*; D011795:Surveys and Questionnaires; D006113:United Kingdom