Risk stratification of patients with low back pain seen in physical therapy practice.
METHODS
A secondary analysis of a retrospective cohort was conducted using data obtained from a commercial outcomes database.


OBJECTIVE
To identify predictive characteristics related to patients with lumbar impairments who have a high risk of a bad prognosis (lowest functional recovery compared to visit utilization) as well as those who are at low risk of a bad prognosis (highest functional recovery compared to visit utilization).


BACKGROUND
Lumbar impairments are highly prevalent and routinely cause people to seek medical care, including physiotherapy. Most prognostic studies focus solely on good outcomes but do not factor in the intensity of care needed to achieve the outcome. Understanding care intensity needed per outcome achieved could help assign appropriate care quantities.


METHODS
Data from 6379 patients with lumbar impairments were analyzed to determine predictive characteristics that identify patients who either have a low or high risk of a bad prognosis to physiotherapy care. Multinomial regression was used to identify significant patient characteristics predictive of treatment response.


RESULTS
Statistically significant predictors for high risk categorization included older age, longer duration of symptoms, surgical history, current use of medications, lower levels of disability at baseline, and insurance categorization. Statistically significant predictors of low risk categorization included younger age, male gender, shorter duration of symptoms, no surgical history, higher levels of disability at baseline, and insurance status.


CONCLUSIONS
Selected variables were associated with both poor and good recovery. Further research on prognosis, efficacy of physiotherapy care, and cost appear warranted for patients with lumbar impairments.
OSF Saint James - John W. Albrecht Medical Center, 2500 W. Reynolds St. Pontiac, IL 61764, USA. Electronic address: Jason.R.Rodeghero@osfhealthcare.org.
J R
JR
Rodeghero
2200 W. Main Street, Durham, NC 27708, USA.
C E
CE
Cook
Physical Therapy Program, Franklin Pierce University, 670 N. Commercial St. Suite 301, Manchester, NH 03101, USA.
J A
JA
Cleland
University of Colorado School of Medicine, Department of Physical Therapy, 13121 East 17th Ave C-244, Aurora, CO 80045, USA.
P E
PE
Mintken
D000328:Adult; D000367:Age Factors; D000368:Aged; D059350:Chronic Pain / Q000175:diagnosis / Q000534:rehabilitation*; D015331:Cohort Studies; D016001:Confidence Intervals; D016208:Databases, Factual; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D026741:Physical Therapy Modalities; D011237:Predictive Value of Tests; D011379:Prognosis; D020127:Recovery of Function / Q000502:physiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D055815:Young Adult
Low back pain; Physiotherapy; Risk stratification