title: Five questions predicted long-term, severe, back-related functional limitations: evidence from three large prospective studies.
abstract: OBJECTIVE
  The objectives of the study were as follows: (1) to investigate whether the predictive validity of a previously developed back pain prediction rule could be improved; (2) to determine if the rule can be shortened without loss of predictive validity; (3) to compare the rule with the physician's judgment; (4) to assess, in a different population, its 2-year predictive validity; and (5) to evaluate the clinical applicability of the rule in a first-line care setting.
  
  
  METHODS
  One thousand two hundred and sixty-two participants were enrolled in the study (participation: 91%) before a medical consultation for nonspecific back pain in a large emergency room and were followed up for 2 years (follow-up: 92.5%). The effects of adding new items and deleting any one of the original items were evaluated. The predictions by the rule and the physicians were compared with the 2-year actual functional limitations (measured with the Roland-Morris Disability Questionnaire).
  
  
  RESULTS
  Although the final prediction rule included only five items (feeling everything is an effort, trouble getting breath, hot/cold spells, numbness/tingling in parts of body, and pain in heart/chest), its predictive validity was greater than that of the original 17-item version and was superior to the physician's prediction. The rule was easily applied.
  
  
  CONCLUSIONS
  A five-item clinical prediction rule of long-term back-related functional limitations could help first-line care physicians to concentrate the clinical attention on patients at higher risk.
authors.affiliation: Unité de recherche en santé des populations, Centre de recherche FRSQ du CHA Universitaire de Québec, Hôpital du Saint-Sacrement, Québec, Canada. clermont.dionne@uresp.ulaval.ca
authors.forename: Clermont E
authors.initials: CE
authors.lastname: Dionne
authors.forename: Natalie
authors.initials: N
authors.lastname: Le Sage
authors.forename: Renée-Louise
authors.initials: RL
authors.lastname: Franche
authors.forename: Michel
authors.initials: M
authors.lastname: Dorval
authors.forename: Claire
authors.initials: C
authors.lastname: Bombardier
authors.forename: Richard A
authors.initials: RA
authors.lastname: Deyo
mesh_terms: D001416:Back Pain / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D003657:Decision Making; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D010147:Pain Measurement; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011795:Surveys and Questionnaires / Q000592:standards*