STUDY DESIGN: Prospective cohort study OBJECTIVE.: To identify treatment response trajectories in patients with low back pain (LBP) during and after multidisciplinary care in a tertiary spine center, and to examine baseline patient characteristics that can distinguish trajectories.
SUMMARY OF BACKGROUND DATA: Treatment response is often heterogeneous between patients with LBP. Knowledge on key characteristics that are associated with courses of disability could identify patients at risk for less favorable outcome. This knowledge will help improve shared decision making.
METHODS: Adult patients with LBP completed questionnaires on disability (Pain Disability Index) and LBP impact (Impact Stratification of the National Institutes of Health minimal dataset) at baseline, 6, 12, 18, and 24 months follow-up. Latent class analyses were applied to identify trajectories of disability and LBP impact. Baseline socio-demographic and clinical patient characteristics were compared between trajectory subgroups.
RESULTS: Follow-up was available for 996 patients on disability and 707 patients on LBP impact. Six trajectories were identified for both outcome measures. Three disability trajectories remained stable at distinct levels of severity (68% of patients) and three trajectories showed patterns of recovery (32%). For LBP impact there was one stable trajectory (17%), two slightly improving (59%), two recovering (15%), and one with a pattern of recovery and relapse (15%). Significant differences between trajectories were observed for almost all baseline patient characteristics.
CONCLUSIONS: On average, patients show moderate improvements in disability and LBP impact two years after visiting a multidisciplinary tertiary spine center. However, latent class analyses revealed that most patients belong to subgroups experiencing stable levels of disability and LBP impact. Differences in baseline patient characteristics were mostly associated with baseline levels of functioning, instead of (un)favorable outcome during follow-up.
LEVEL OF EVIDENCE: 2.
- chronic pain
- cohort study
- follow-up study
- functional limitation
- latent class analysis
- low back pain
- minimal clinically important difference
- multidisciplinary care
- responder analysis