title: Prediction of outcome in patients with low back pain--A prospective cohort study comparing clinicians' predictions with those of the Start Back Tool.
abstract: The clinical course of low back pain (LBP) cannot be accurately predicted by existing prediction tools. Therefore clinicians rely largely on their experience and clinical judgement. The objectives of this study were to investigate 1) which patient characteristics were associated with chiropractors' expectations of outcome from a LBP episode, 2) if clinicians' expectations related to outcome, 3) how accurate clinical predictions were as compared to those of the STarT Back Screening Tool (SBT), and 4) if accuracy was improved by combining clinicians' expectations and the SBT. Outcomes were measured as LBP intensity (0-10) and disability (RMDQ) after 2-weeks, 3-months, and 12-months. The course of LBP in 859 patients was predicted to be short (54%), prolonged (36%), or chronic (7%). Clinicians' expectations were most strongly associated with education, LBP history, radiating pain, and neurological signs at baseline and related to all outcomes. The accuracies of predictions made by clinicians (AUC .58-.63) and the SBT (AUC .50-.61) were comparable and low. No substantial increase in the predictive capability was achieved by combining clinicians' expectations and the SBT. In conclusion, chiropractors' predictions were associated with well-established prognostic factors but not simply a product of these. Chiropractors were able to predict differences in outcome on a group level, but prediction of individual patients' outcomes were inaccurate and not substantially improved by the SBT. It is worth investigating if more accurate tools can be developed to assist clinicians in prediction of outcome.
authors.affiliation: Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark; Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark. Electronic address: a.kongsted@nikkb.dk.
authors.forename: Alice
authors.initials: A
authors.lastname: Kongsted
authors.affiliation: Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
authors.forename: Cathrine Hedegaard
authors.initials: CH
authors.lastname: Andersen
authors.affiliation: Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
authors.forename: Martin Mørk
authors.initials: MM
authors.lastname: Hansen
authors.affiliation: Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark; Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
authors.forename: Lise
authors.initials: L
authors.lastname: Hestbaek
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002684:Chiropractic / Q000379:methods*; D002983:Clinical Competence; D015331:Cohort Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Chiropractic; Low back pain; Prediction; Primary care; Prognosis