Publications (2)5.8 Total impact
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Article: Predicting the evolution of low back pain patients in routine clinical practice: results from a registry within the Spanish National Health Service.
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ABSTRACT: BACKGROUND CONTEXT: The Spanish National Health Service (SNHS) is a tax-funded public organization that provides free health care to every resident in Spain. PURPOSE: To develop models for predicting the evolution of low back pain (LBP) in routine clinical practice within SNHS. STUDY DESIGN: Analysis of a prospective registry in routine clinical practice, in 17 centers across SNHS. PATIENT SAMPLE: Patient sample includes 4,477 acute and chronic LBP patients treated in primary and hospital care. OUTCOME MEASURES: Pain and disability, measured through validated instruments. METHODS: Patients treated for LBP were assessed at baseline and 3 months later. Data gathered were the following: sex, age, employment status, duration of pain, severity of LBP, pain down to the leg (LP) and disability, history of lumbar surgery, diagnostic procedures undertaken, imaging findings, and treatments used throughout the study period. Three separate multivariate logistic regression models were developed for predicting a clinically relevant improvement in LBP, LP, and disability at 3 months. RESULTS: In total, 4,261 patients (95.2%) attended follow-up. For all the models, calibration was reasonable and the area under the receiver operating characteristic curve was ≥0.640. For LBP, LP, and disability, factors associated with a higher probability of improvement at 3 months were the following: not having undergone lumbar surgery, higher baseline scores for the corresponding variable, lower ones for the rest, and being treated with neuroreflexotherapy. Additional factors were the following: for LBP, shorter pain duration; for LP, not undergoing electromyography; and for disability, shorter pain duration, not being diagnosed with disc degeneration, and being treated with muscle relaxants and not opioids. CONCLUSIONS: A prospective registry can be used for developing predictive models to quantify the odds that a given LBP patient will experience a clinically relevant improvement. This may empower patients for an informed shared decision making.The spine journal: official journal of the North American Spine Society 11/2012; · 2.90 Impact Factor -
Article: The prognostic value of catastrophizing for predicting the clinical evolution of low back pain patients: a study in routine clinical practice within the Spanish National Health Service.
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ABSTRACT: Experimental studies suggest that catastrophizing may worsen the prognosis of low back pain (LBP) and LBP-related disability and increase the risk of chronicity. To assess the prognostic value of baseline catastrophizing for predicting the clinical evolution of LBP patients in routine clinical practice and the association between the evolution of pain and catastrophizing. Prospective study in routine clinical practice of the Spanish National Health Service. One thousand four hundred twenty-two acute and chronic adult LBP patients treated in primary and hospital care. Pain, disability, and catastrophizing measured through validated instruments. Patients were managed according to routine clinical practice. Outcome measures were assessed at baseline and 3 months later. Logistic regression models were developed to estimate the association between baseline catastrophizing score and the improvement of LBP and disability, adjusting for baseline LBP and leg pain (LP) severity, disability, duration of the pain episode, workers' compensation coverage, radiological findings, failed back surgery, and diagnostic procedures and treatments undertaken throughout the study. Another model was developed to estimate the association between the evolution of LBP and the change in catastrophizing, adjusting for the same possible confounders plus the evolution of LP and disability. Models were repeated excluding the treatments undergone after the baseline assessment. Regression models showed that the degree of baseline catastrophizing does not predict the evolution of LBP and disability. Conversely, as the degree of pain improvement increases, so does the odds ratio for improvement in catastrophizing, ranging from three (95% confidence interval [95% CI], 2.00-4.50; p<.001) for improvements in pain between 1.1 and 4 visual analog scale (VAS) points, to 7.3 (95% CI, 3.49-15.36; p<.001) for improvements in pain more than 6.1 VAS points. Similar results were obtained when treatments were excluded from the models. In routine practice, assessing the baseline score for catastrophizing does not help clinicians to predict the evolution of LBP and disability at 3 months.The spine journal: official journal of the North American Spine Society 07/2012; 12(7):545-55. · 2.90 Impact Factor
