DETERMINING PREDICTIVE OUTCOME FACTORS FOR A MULTIMODAL TREATMENT PROGRAM IN LOW BACK PAIN PATIENTS: A RETROSPECTIVE COHORT STUDY

Adnan` R.^1,2, Van Oosterwijck J.^1,3, Cagnie B.¹, Dhondt E.¹, Schouppe S.¹, Van Akeleyen J.⁴, Logghe T.⁴, Danneels L.¹

¹Ghent University, Dept. Rehabilitation Sciences and Physiotherapy, Ghent, Belgium, ²Faculty of Sports Science and Recreation UiTM, Shah Alam, Malaysia, ³Research Foundation - Flanders (FWO), Brussels, Belgium, ⁴General Hospital St. Dimpna Geel, Department Physical and Rehabilitation Medicine, Antwerpen, Belgium

Background: Multimodal treatment programs comprising a combination of therapeutic exercises, advise and education have proven to be superior to isolated treatments and form a widely recommended rehabilitation strategy for low back pain (LBP). While such a program provides significant advantages with respect to clinical outcomes, no studies have adequately explored the factors that may predict treatment outcome. However, it is known that baseline characteristics are important factors which can determine whether LBP patients will benefit from a specific intervention or not.

Purpose: The objective of this study was to determine the predictive outcome factors for a multifaceted rehabilitation program among acute and chronic low back pain (LBP) patients.

Methods: A retrospective analysis was performed to identify predictive outcome factors of treatment outcome from 153 acute and 412 chronic LBP patients who participated in a multimodal treatment program at a Belgian outpatient clinic. The predictive value of several factors including age, gender, body mass index, fat percentage, and scores on the Oswestry LBP Disability Index, Beck Depression Index, Numeric Rating Scale score for back and leg pain intensity, and Tampa Scale for Kinesiophobia on favorable treatment outcome was examined using logistic regression analysis.

Results: A higher score on the Tampa Scale for Kinesiophobia (OR=0.92) decreases the odds of a favorable outcome for acute LBP. Older age (OR=0.97), high LBP intensity (OR=1.191), and higher scores on the Beck Depression Index (OR=0.96) and the Oswestry LBP Disability Index (OR=0.93) decreased the odds for a favorable treatment outcome in chronic LBP.

Conclusion(s): The findings of this study indicate that predictive factors for (un)favorable treatment outcome differ between acute and chronic LBP. Specifically, the presence of kinesiophobia is predictive for poor treatment outcome in acute LBP. In chronic LBP, older age, low LBP intensity, and higher degrees of depression and LBP related disability levels are predictive for poor treatment outcome. Therefore, therapists should assess these prognostic factors at intake to optimize the content of the multimodal treatment program to individual patient needs.

Implications: These findings provide physicians and clinicians with more knowledge upon which factors should be assessed and taken into account when referring LBP patients to such a rehabilitation program. Furthermore, the study results point out that realistic treatment expectations and goals need to be determined together with these patients. Simultaneously, it is important to consider a different approach to tailor specific groups of LBP patients. Acute LBP patients with fear of movement and elderly chronic LBP patients with high levels of depression, back pain intensity and disability may need additional treatment approaches and strategies.

Topic: Musculoskeletal: spine

Ethics approval: Ethical approval was obtained from the ethics Committee of Ghent University Hospital/Ghent University

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