CLINICAL CLASSIFICATION AND RISK OF CHRONIFICATION AMONG PEOPLE PRESENTING WITH LOW BACK PAIN AT TERTIARY CARE LEVEL IN TANZANIA

Background: Low Back Pain (LBP), is the leading cause of  years lived with disability globally.    It is  the reason for work absenteeism, early retirement and  loss of social identity due to inability to participate in the expected social roles. The cost of care for people with LBP is unbearable particularly in the low and middle income countries where resources are constrained. Therefore, it is imperative that the correct diagnosis be made in early stages to avoid improper treatment, chronification   and misuse of resources.  

Purpose: This study was aimed at classifying people presenting with LBP into different clinical sub-groups.  Secondly, determining the levels of risk of chronification among people with Low back pain.  Finally, establishing the relationship between the different LBP subgroups and the levels of risk of chronification.  

Methods: This cross-sectional study was conducted at Physiotherapy outpatient clinics within two tertiary hospitals in Tanzania during the months of July, August and September 2019.  Both verbal and written consent was sought from participants.  Prior to history taking, they filled in the socio-demographic and STarT Back screening questionnaires.    After physical assessment, the researcher classified participants using the diagnostic checklist.  The diagnostic checklist was used to identify different LBP subgroups while the STarT Back Screening Tool was used to identify the levels of risk of chronification among participants.   The descriptive and inferential statistics were analysed using SPSS version 25.  Chi-square statistical test was performed to test association between clinical subgroups and levels of risk of chronification.

Results: Low Back Pain was classified into mainly four categories namely Nociceptive pain (n=122, 39.35%), Neuropathic pain (n= 57, 18.39%), Functional instability (n=89, 28.71%) and Other diagnoses (n= 42, 13.55%).   The main LBP categories were further classified into subcategories; Discogenic pain (n=24 7.74%), Zygapophyseal joint pain (n=55, 17.74%), Sacroiliac joint pain (n= 103, 33.23%), Myofascial pain (n=45, 14.51%), Compressive radiculopathy (n=29, 9.35%), Non compressive radiculopathy (n=3, 0.97%), neurogenic claudication ( n=3, 0.97%), Central pain ( n= 10,3.23%), Lumbar segmental instability (n=17, 5.48%) and other diagnoses (n=21,6.77%).   Regarding the levels of risk of   chronification, 49.03% were at low risk, 24.2% medium risk and 26.77% were at high risk of developing chronic LBP.  Furthermore,  results indicated that there was significantly strong and positive (r=0.899, p-value= 0.001) relationship between Neuropathic Pain and high risk of LBP chronification    Similarly Functional Instability (r=0.873, p-value=0.002) was associated with high risk of LBP chronification. Also,  Nociceptive Pain (r=0.680, p-value=0.031) and other diagnosis (r=0.705, p-value=0.013), had significantly strong and positive relationship with low risk of LBP chronification. 

Conclusion(s): This study has established cost-effective, noninvasive and context-specific strategies to classify and assess risk of chronicity in people with LBP in Tanzania. Thus, minimizing the likelihood of poor treatment outcome and improving healthcare efficiency in Tanzania.

Implications: This practice will enable practitioners to match the right treatment to the right patient at the right time.  Thus improving  treatment outcome, health care efficiency and patient’s satisfaction.  

Funding, acknowledgements: This project was not funded.

Keywords: Chronification, Classification, Low back pain

Topic: Musculoskeletal: spine

Did this work require ethics approval? Yes

Institution: Jomo Kenyatta University of Agriculture and Technology

Committee: Jomo Kenyatta University of Agriculture and Technology ethical review committee

Ethics number: JKU/2/4/896B