title: Predicting outcomes of neuroreflexotherapy in patients with subacute or chronic neck or low back pain.
abstract: BACKGROUND
  In the context of shared decision-making, a valid estimation of the probability that a given patient will improve after a specific treatment is valuable.
  
  
  OBJECTIVE
  To develop models that predict the improvement of spinal pain, referred pain, and disability in patients with subacute or chronic neck or low back pain undergoing a conservative treatment.
  
  
  METHODS
  Analysis of data from a prospective registry in routine practice.
  
  
  METHODS
  All patients who had been discharged after receiving a conservative treatment within the Spanish National Health Service (SNHS) (n=8,778).
  
  
  METHODS
  Spinal pain, referred pain, and disability were assessed before the conservative treatment and at discharge by the use of previously validated methods.
  
  
  METHODS
  Improvement in spinal pain, referred pain, and disability was defined as a reduction in score greater than the minimal clinically important change. A predictive model that included demographic, clinical, and work-related variables was developed for each outcome using multivariate logistic regression. Missing data were addressed using multiple imputation. Discrimination and calibration were assessed for each model. The models were validated by bootstrap, and nomograms were developed.
  
  
  RESULTS
  The following variables showed a predictive value in the three models: baseline scores for pain and disability, pain duration, having undergone X-ray, having undergone spine surgery, and receiving financial assistance for neck or low back pain. Discrimination of the three models ranged from slight to moderate, and calibration was good.
  
  
  CONCLUSIONS
  A registry in routine practice can be used to develop models that estimate the probability of improvement for each individual patient undergoing a specific form of treatment. Generalizing this approach to other treatments can be valuable for shared decision making.
authors.affiliation: CIBER Epidemiología y Salud Pública (CIBERESP), C/ Melchor Fernandez Almagro 3-5, 28029 Madrid, Spain; Unidad de Bioestadística Clínica, Hospital Ramón y Cajal, IRICYS, C/ Colmenar Viejo, 9, 28031 Madrid, Spain; Spanish Back Pain Research Network, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain. Electronic address: ana.royuela@hrc.es.
authors.forename: Ana
authors.initials: A
authors.lastname: Royuela
authors.affiliation: Spanish Back Pain Research Network, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Departamento Cientıfico, Fundación Kovacs, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain.
authors.forename: Francisco M
authors.initials: FM
authors.lastname: Kovacs
authors.affiliation: Servei de Salut de les Illes Balears (Ib-Salut), Calle Reina Esclaramunda 9, 07003 Palma de Majorca, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Campillo
authors.affiliation: Regió Sanitària de Barcelona | Consorci Sanitari de Barcelona, Servei Català de la Salut (CatSalut), Parc Sanitari Pere Virgili - Edifici Mestral - Esteve Terradas, 30 4ta planta, 08023 Barcelona, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Casamitjana
authors.affiliation: Unidad de Bioestadística Clínica, Hospital Ramón y Cajal, IRICYS, C/ Colmenar Viejo, 9, 28031 Madrid, Spain; Spanish Back Pain Research Network, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Muriel
authors.affiliation: CIBER Epidemiología y Salud Pública (CIBERESP), C/ Melchor Fernandez Almagro 3-5, 28029 Madrid, Spain; Unidad de Bioestadística Clínica, Hospital Ramón y Cajal, IRICYS, C/ Colmenar Viejo, 9, 28031 Madrid, Spain; Spanish Back Pain Research Network, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain.
authors.forename: Víctor
authors.initials: V
authors.lastname: Abraira
mesh_terms: D000328:Adult; D000368:Aged; D059350:Chronic Pain / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000503:physiopathology / Q000628:therapy*; D010147:Pain Measurement; D011379:Prognosis; D011446:Prospective Studies; D012028:Reflexotherapy / Q000379:methods*; D013030:Spain; D016896:Treatment Outcome; D061028:Trigger Points / Q000503:physiopathology*
keywords: Back pain; Calibration; Disability; Multiple imputation; Neuroreflexotherapy; Predictive model