Article

Characterizing the course of low back pain: A latent class analysis

Primary Care Sciences Research Centre, Keele University, Keele, United Kingdom.
American Journal of Epidemiology (Impact Factor: 4.98). 05/2006; 163(8):754-61. DOI: 10.1093/aje/kwj100
Source: PubMed

ABSTRACT Understanding the course of back pain is important for clinicians and researchers, but analyses of longitudinal data from multiple time points are lacking. A prospective cohort study of consecutive back pain consulters from five general practices in the United Kingdom was carried out between 2001 and 2003 to identify groups defined by their pain pathways. Patients were sent monthly questionnaires for a year. Longitudinal latent class analysis was performed by using pain intensity scores for 342 consulters. Analysis yielded four clusters representing different pathways of back pain. Cluster 1 ("persistent mild"; n = 122) patients had stable, low levels of pain. Patients in cluster 2 ("recovering"; n = 104) started with mild pain, progressing quickly to no pain. Cluster 3 ("severe chronic"; n = 71) patients had permanently high pain. For patients in cluster 4 ("fluctuating"; n = 45), pain varied between mild and high levels. Distinctive patterns for each cluster were maintained throughout follow-up. Clusters showed statistically significant differences in disability, psychological status, and work absence (p < 0.001). This is the first time, to the authors' knowledge, that latent class analysis has been applied to longitudinal data on back pain patients. Identification of four distinct groups of patients improves understanding of the course of back pain and may provide a basis of classification for intervention.

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    • "LCGA assumes that the heterogeneity in a single outcome repeatedly assessed can be summarized by a certain number of clusters with distinct cluster-specific trajectories [9]. Quadratic growth models were applied that allow for one inflexion point, as the course of musculoskeletal pain is often non-linear and is known to be associated with depression and anxiety [18] [34]. This method requires a minimum of four time points. "
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    ABSTRACT: Distinguishing transient from persistent anxiety and depression symptoms in older people presenting to general practice with musculoskeletal pain is potentially important for effective management. This study sought to identify distinct post-consultation depression and anxiety symptom trajectories in adults aged over 50years consulting general practice for non-inflammatory musculoskeletal pain. Self-completion questionnaires, containing measures of anxiety and depressive symptoms, age, gender, pain status, coping and social status were mailed within 1week of the consultation and at 3, 6 and 12months. Latent class growth analysis was used to identify anxiety and depression symptoms trajectories, which were ascertained with cut-off score ≥8 on Hospital Anxiety and Depression Scale subscales. Associations between baseline characteristics and cluster membership were examined using multivariate multinomial logistic regression analysis (the 3-step approach). Latent class growth analyses determined a 3-cluster anxiety model (n=499) and a 3-cluster depression model (n=501). Clusters identified were: no anxiety problem (44.1%), persistent anxiety problem (33.9%) and transient anxiety symptoms (22.2%); no depression problem (74.1%), persistent depression problem (22.0%) and gradual depression symptom recovery (4.0%). Widespread pain, interference with valued activities, coping by increased behavioral activities, catastrophizing, perceived lack of instrumental support, age ≥70years, being female, and performing manual/routine work were associated with anxiety and/or depression clusters. Older people with non-inflammatory musculoskeletal pain are at high risk of persistent anxiety and/or depression problems. Biopsychosocial factors, such as pain status, coping strategies, instrumental support, performing manual/routine work, being female and age ≥70years, may help identify patients with persistent anxiety and/or depression. Copyright © 2015 Elsevier Inc. All rights reserved.
    Journal of Psychosomatic Research 06/2015; DOI:10.1016/j.jpsychores.2015.05.016 · 2.84 Impact Factor
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    • "In our study, the pain measurements and classifications were to a great extent different and the follow-up longer. Dunn et al. (2006) concluded that the optimal number of trajectories is either four or six for longitudinal latent class analysis. We also tried a two-step cluster analysis, which is available in SPSS, and this gave two different classifications: four and five clusters. "
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    ABSTRACT: Purpose To investigate the prevalence of low back pain among Finnish firefighters and to examine whether sleep disturbances predict membership of low back pain trajectories. Methods In this prospective study, 360 actively working firefighters responded to a questionnaire in 1996, 1999 and 2009. The outcome variables were radiating and local low back pain during the preceding year. Using logistic regression modeling, the likelihood of membership of pain trajectories was predicted by sleep disturbances at baseline. Results During the 13-year follow-up, the prevalence of radiating low back pain increased from 16 to 29 % (p < 0.0001) and that of local low back pain from 28 to 40 % (p < 0.001). The following trajectories were identified: “pain free,” “recovering,” “new pain,” “fluctuating” and “chronic.” More than one-fifth of the participants belonged to the new pain trajectory as regards both pain types, 6 % of the participants belonged to the chronic radiating and 12 % to the chronic local low back pain trajectory. Those with sleep disturbances at baseline had a 2.4-fold risk (adjusted OR 2.4; 95 % CI 1.2–4.7) of belonging to the new pain or chronic radiating pain cluster compared to pain-free participants. Conclusions This is the first prospective study to show that low back symptoms are common and persistent among firefighters and that sleep disturbances strongly predict membership of a radiating pain trajectory. Occupational health and safety personnel, as well as the firefighters themselves, should recognize sleep problems early enough in order to prevent back pain and its development into chronic pain.
    International Archives of Occupational and Environmental Health 08/2014; 88(3). DOI:10.1007/s00420-014-0968-z · 2.20 Impact Factor
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    • "The study examined what parents do to comfort their infants during immunization, a procedure known to cause significant short-term pain and distress to infants and potential longer term consequences, including fear of needles and reluctance to seek medical care [14]. As per the methods of this naturalistic study, no strategies were put into place to ensure that the standard of care included known effective interventions that reduce immunization pain [5] [7] [12] [13] that are recommended by relevant national and international organizations [1] [2] [4] and the Public Health Agency of Canada [11]. "
    Pain 04/2013; 154(8). DOI:10.1016/j.pain.2013.04.031 · 5.84 Impact Factor
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