Predictive factors for 1-year outcome of chronic low back pain following manipulation, stabilizing exercises, and physician consultation or physician consultation alone.
OBJECTIVE
To examine the relative influences of sociodemographic and episode-specific factors on change in low back pain intensity and self-rated disability.


METHODS
Of 204 patients with chronic low back pain, 102 were randomized to a combined manipulation, exercise and physician consultation group and 102 to a consultation-alone group. These groups were each divided into 2 clusters based on change in both pain intensity and self-rated disability at 1 year. The first cluster included patients whose symptoms clearly decreased, and the second those whose trouble persisted. Association between sociodemographic and episode-specific factors and poor recovery from low back pain and disability were evaluated by univariate and multivariate analysis.


RESULTS
Severe affective distress (OR 3.81; 95% CI 1.3-10.8) predicted poor response to the manipulative treatment. Over a 25-day sick leave during previous year (19.64; 3.8-102.5), poor life control (9.40; 1.9-47.0), and generalized somatic symptoms (3.18; 0.9-11.6) were the risk factors for not benefiting from the informative approach.


CONCLUSIONS
Psychosocial differences seem to be important determinants for treatment outcomes, and should be the focus of future studies.
Niemistö
Leena
L
Rehabilitation Unit of Orthopaedic Hospital ORTON, Invalid Foundation, Helsinki, Finland. leena.niemisto@invalidisaatio.fi
Sarna
Seppo
S
Lahtinen-Suopanki
Tiina
T
Lindgren
Karl-August
KA
Hurri
Heikki
H
D000328:Adult; D002908:Chronic Disease; D003710:Demography; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000534:rehabilitation* / Q000628:therapy; D008297:Male; D008349:Manipulation, Orthopedic / Q000379:methods*; D008875:Middle Aged; D011237:Predictive Value of Tests; D012017:Referral and Consultation; D016896:Treatment Outcome