Worldwide, low back pain has been the leading cause of disability since 1990. Although most people recover rather quickly, one in five adults develops chronic low back pain (CLBP). The main aim of this thesis was to gain more insight into the impact and course of CLBP in patients referred to a multidisciplinary spine center. The results showed that for these patients the personal and societal impact of CLBP is very high. Specifically, quality of life and work ability were very poor. Moreover, average health care costs in the year before referral to the spine center were twice as high compared to patients seeking primary LBP care. Furthermore, the studies in this thesis show that most patients that are referred to multidisciplinary spine care are likely to belong to subgroups that experience a pattern of little to no improvement in LBP symptoms during two years follow-up. However, predicting the course of CLBP symptoms remains challenging. Finally, the thesis contains several messages with regards to CLBP research. In order to really understand both the (natural) course of CLBP and results of interventions over time, frequent measurements of relevant patient-centered outcomes are needed, as well as the use of complete core outcome sets that reflect the multidimensionality of CLBP. Furthermore, since the population-averaged course of CLBP and summary measures of treatment effects do not adequately reflect the underlying patterns of CLBP, research should focus on clinically relevant patient subgroups.
|Kwalificatie||Doctor of Philosophy|
|Datum van toekenning||16-mei-2022|
|Plaats van publicatie||[Groningen]|
|Status||Published - 2022|