Pain response classification does not predict long-term outcome in patients with low back pain who are sick-listed.
METHODS
Prospective cohort study nested in a randomized clinical trial.


OBJECTIVE
To investigate the prognostic value of pain response classification at initial physiotherapy examination in patients with low back pain (LBP) who are sick-listed.


BACKGROUND
Recurrent and chronic LBP accounts for a substantial proportion of all absence from work. In predicting outcome in patients with LBP, psychosocial factors are thought to play an important role, while findings from clinical examination seem to be of more limited value. Mechanical evaluation, using repeated end range spinal movements that result in specific pain responses, has been shown to be of some value.


METHODS
The study included 351 patients sick-listed because of LBP with or without sciatica. Prior to clinical examination, the patients completed a comprehensive questionnaire including questions on pain, function, and psychosocial factors. The physiotherapy examination included a standardized mechanical evaluation. Patients were classified into 3 groups according to their pain response: centralization, peripheralization, or no response. Outcomes were obtained by national register data, medical records, and a postal questionnaire at 1 year.


RESULTS
At 1-year follow-up, 65% of the patients had returned to work. All pain response groups showed significant and clinically important improvements in both pain and disability. No significant differences were found between pain response groups in any outcome measure. Results remained unchanged after adjustment for potential confounders.


CONCLUSIONS
The prognostic value of pain response classification seems limited in patients sick-listed from work because of LBP.
Christiansen
David
D
Danish Ramazzini Center, Department of Occupational Medicine, Herning Regional Hospital, Herning, Denmark. David.Christiansen@vest.rm.dk
Larsen
Kristian
K
Jensen
Ole Kudsk
OK
Nielsen
Claus Vinther
CV
D000328:Adult; D004185:Disability Evaluation; D005081:Exercise Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods*; D020127:Recovery of Function; D018582:Sick Leave