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Innes SI, Simpson JK. Empathy levels in Australian chiropractic students. THE JOURNAL OF CHIROPRACTIC EDUCATION 2022; 36:110-116. [PMID: 35294012 PMCID: PMC9536223 DOI: 10.7899/jce-21-16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/12/2021] [Accepted: 09/13/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Empathy is an important modifiable quality of health care practitioners that relates to the quality of patient care. The educative process may adversely affect the empathy levels of health care students at key phases of training. This topic remains unexplored in chiropractic students to date. METHODS A voluntary and anonymous questionnaire was distributed to all chiropractic students in an Australian university-based program in April 2021. This questionnaire recorded age, sex, year of study, and Toronto Empathy Questionnaire scores. RESULTS Chiropractic student empathy scores approximated those of other Australian health care students. No statistical differences were found when comparing the mean scores of empathy levels across the 5 student cohorts. The empathy levels of female chiropractic students' were significantly higher than those of the male chiropractic students. CONCLUSION This study provides a baseline from which further explorations on empathy may be conducted in chiropractic students. This holds the potential to improve practitioners' quality of life and patient outcomes and for educators to identify subject matter that may negatively affect empathy levels.
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Jess MA, Hamilton S, Ryan C, Wellburn S, Alexanders J, Spence D, Martin D. Exploring the origin of pain subclassification, with emphasis on low back pain: a scoping review. JBI Evid Synth 2021; 19:308-340. [PMID: 32881730 DOI: 10.11124/jbisrir-d-19-00383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE This scoping review aimed to explore the different working definitions for the duration of acute, subacute, and chronic pain, with emphasis on low back pain, and to establish where these definitions originated and the rationale provided for the time frames used. INTRODUCTION From a global perspective, low back pain is a major social and economic problem. One of the most commonly used methods to stratify and manage low back pain is the traditional duration-based classification (acute, subacute, and chronic). Where these time points lie to differentiate these transitions continues to be debated within the scientific community, which may engender a degree of heterogeneity in study findings. Therefore, applying these findings to clinical practice may be somewhat challenging. This review encapsulates the historical origins of the different duration categories to provide an understanding of how these variations were derived. INCLUSION CRITERIA Studies that included participants with low back pain were the focus of this review. Sources that included children or other specific pain pathologies, such as cancer pain, were excluded. The main concept of interest was that the publication proposed an original definition of the duration of acute, subacute, or chronic low back pain. All study designs were included provided they gave a rationale for the duration that they used. METHODS The following databases were searched: MEDLINE, Embase, CINAHL, and PsycINFO, from the inception of each database until September 18, 2019. This review was limited to studies published in English. Two independent reviewers screened the retrieved articles against the eligibility criteria. Additional studies were searched from the reference lists of studies to find the original source. Some original sources overlapped with general pain duration literature. This led to a deviation from the scoping review protocol, which originally intended to focus on definitions of low back pain duration only. Data extraction was undertaken using a charting table developed specifically for the review objectives. The findings were presented using narrative synthesis. RESULTS Nineteen records were included in this review, and comprised three book chapters, four review articles, four articles that arose following pain expert group discussions, seven primary research studies, and a spinal guideline. Data were extracted from the included studies and categorized into four themes based on the origin of the classification of the duration. The themes included i) work/employment setting, ii) empirical studies, iii) expert reasoning, and iv) pathophysiological explanation. CONCLUSIONS This scoping review compiled the existing literature on the working definitions of the duration of acute, subacute, and chronic low back pain and found a wide variation. These ranged from seven days, 14 days, and seven weeks for the acute and subacute transition points, and seven weeks to three years for chronic low back pain. The duration definitions specifically referring to the general pain literature focused on three and/or six months for the transition to chronic. Better integration of reasoning between the identified themes could facilitate the establishment of more ideal duration definitions in the future. Although inconclusive, the definition most commonly cited, with most consensus, was three months for the transition to chronic low back pain.
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Affiliation(s)
- Mary-Anne Jess
- School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Sharon Hamilton
- School of Health and Social Care, Teesside University, Middlesbrough, UK
- Teesside Centre for Evidence-Informed Practice: A JBI Affiliated Group, Middlesbrough, UK
| | - Cormac Ryan
- School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Shaun Wellburn
- School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Jenny Alexanders
- School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Daniel Spence
- School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Denis Martin
- School of Health and Social Care, Teesside University, Middlesbrough, UK
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Molgaard Nielsen A, Binding A, Ahlbrandt-Rains C, Boeker M, Feuerriegel S, Vach W. Exploring conceptual preprocessing for developing prognostic models: a case study in low back pain patients. J Clin Epidemiol 2020; 122:27-34. [PMID: 32097713 DOI: 10.1016/j.jclinepi.2020.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 01/17/2020] [Accepted: 02/19/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES A conceptually oriented preprocessing of a large number of potential prognostic factors may improve the development of a prognostic model. This study investigated whether various forms of conceptually oriented preprocessing or the preselection of established factors was superior to using all factors as input. STUDY DESIGN AND SETTING We made use of an existing project that developed two conceptually oriented subgroupings of low back pain patients. Based on the prediction of six outcome variables by seven statistical methods, this type of preprocessing was compared with medical experts' preselection of established factors, as well as using all 112 available baseline factors. RESULTS Subgrouping of patients was associated with low prognostic capacity. Applying a Lasso-based variable selection to all factors or to domain-specific principal component scores performed best. The preselection of established factors showed a good compromise between model complexity and prognostic capacity. CONCLUSION The prognostic capacity is hard to improve by means of a conceptually oriented preprocessing when compared to purely statistical approaches. However, a careful selection of already established factors combined in a simple linear model should be considered as an option when constructing a new prognostic rule based on a large number of potential prognostic factors.
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Affiliation(s)
- Anne Molgaard Nielsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark.
| | - Adrian Binding
- Department of Management, Technology, and Economics, ETH Zurich, Weinbergstr. 56/58, 8092 Zurich, Switzerland
| | - Casey Ahlbrandt-Rains
- Faculty of Medicine and Medical Center, Institute of Medical Biometry and Statistics, University of Freiburg, Stefan-Meier-Str. 26, D-79104 Freiburg i. Br., Germany
| | - Martin Boeker
- Faculty of Medicine and Medical Center, Institute of Medical Biometry and Statistics, University of Freiburg, Stefan-Meier-Str. 26, D-79104 Freiburg i. Br., Germany
| | - Stefan Feuerriegel
- Department of Management, Technology, and Economics, ETH Zurich, Weinbergstr. 56/58, 8092 Zurich, Switzerland
| | - Werner Vach
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstr. 21, CH-4031 Basel, Switzerland; Nordic Institute of Chiropractic and Clinical Biomechanics, Campusvej 55, DK-5230 Odense M, Denmark
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Hartvigsen L, Kongsted A, Vach W, Salmi LR, Hestbaek L. Baseline Characteristics May Help Indicate the Best Choice of Health Care Provider for Back Pain Patients in Primary Care: Results From a Prospective Cohort Study. J Manipulative Physiol Ther 2020; 43:13-23. [PMID: 32081512 DOI: 10.1016/j.jmpt.2019.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 11/13/2019] [Accepted: 11/22/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Baseline characteristics of patients low back pain differ substantially between care settings, but it is largely unknown whether predictors are of equal importance across settings. The aim of this study was to investigate whether 8 known predictors relate differently to outcomes in chiropractic practice and in general practice and to which degree these factors may be helpful in selecting patients benefiting more from one setting or the other. METHODS Patient characteristics were collected at baseline, and outcomes of pain intensity (numeric rating scale 0-10) and activity limitation (Roland-Morris Disability Questionnaire 0-100) after 2, 12, and 52 weeks. Differences in the prognostic strength between settings were investigated for each prognostic factor separately by estimating the interaction between setting and the prognostic factor using regression models. Between-setting differences in outcome in high-risk and low-risk subgroups, formed by single prognostic factors, were assessed in similar models adjusted for a propensity score to take baseline differences between settings into account. RESULTS Prognostic factors were generally associated more strongly with outcomes in general practice compared with chiropractic practice. The difference was statistically significant for general health, duration of pain, and musculoskeletal comorbidity. After propensity score adjustment, differences in outcomes between settings were insignificant, but negative prognostic factors tended to be less influential in chiropractic practice except for leg pain and depression, which tended to have less negative impact in general practice. CONCLUSION Known prognostic factors related differently to outcomes in the 2 settings, suggesting that some subgroups of patients might benefit more from one setting than the other.
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Affiliation(s)
- Lisbeth Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
| | - Alice Kongsted
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
| | - Werner Vach
- Institute of Medical Biometry and Statistics, Medical Center and Medical Faculty, University of Freiburg, Freiburg, Germany; Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Louis-Rachid Salmi
- Université de Bordeaux, Institute of Public Health, Epidemiology and Development, INSERM, Bordeaux, France
| | - Lise Hestbaek
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
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Hestbaek L, Myburgh C, Lauridsen HH, Boyle E, Kongsted A. Contrasting real time quantitative measures (weekly SMS) to patients' retrospective appraisal of their one-year's course of low back pain; a probing mixed-methods study. Chiropr Man Therap 2019; 27:12. [PMID: 30891183 PMCID: PMC6390359 DOI: 10.1186/s12998-018-0222-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 12/13/2018] [Indexed: 11/10/2022] Open
Abstract
Background Due to the recurrent nature of low back pain (LBP), the traditional concepts of cure and recovery are challenged, and investigating the course rather than status at fixed time-points may help us understand prognosis as well as treatment effect. However, methods of frequent measuring still need development and validation. Therefore, this study aims to evaluate the agreement between continuous, quantitative self-assessment (weekly SMS) of the course of LBP over a one-year period and qualitatively derived retrospective patient self-appraisal of the same time-period. Methods Participants were 32 subjects with LBP from primary care. The quantitative measures consisted of weekly SMS questions for one-year about pain intensity, days with LBP, and activity limitations for that week. For each subject, the weekly responses were graphed and categorized into categories based on intensity, variation and overall change patterns. Qualitative measures were based on semi-structured telephone interviews one-year after a consultation for LBP, where two coders independently categorized the self-appraisal of LBP course into the same predefined categories as the SMS-based trajectories. Furthermore, patients' perceived overall recovery was related to variation patterns from SMS track. Results There was perfect agreement for 48% in the pain intensity domain, 53% in the variation domain and 63% in the change pattern domain. Most of the discordant cases were classified in neighboring categories with the majority relating to fluctuating patterns. The self-perceived overall recovery status seemed to be reflected quite well by the quantitative measures of pain intensity and days with pain in this study. Conclusion This study shows that a real time quantitative measure (weekly SMS) and the patient's retrospective appraisal do not fundamentally differ in their reflection of the one-year course of LBP.As a first investigation into this area, these results are promising, as longitudinal quantitatively derived trajectories of LBP seem to reflect the lived experience of the patient to a large degree. Furthermore, the patient's ability to retrospectively recall their one-year course of LBP appears to be quite good. Future studies should focus on refining the categories of trajectories.
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Affiliation(s)
- Lise Hestbaek
- 1Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,2Nordic Institute of Chiropractic and Clinical Biomechanics, Campusvej 55, 5230 Odense M, Denmark
| | - Cornelius Myburgh
- 1Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Henrik Hein Lauridsen
- 1Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Eleanor Boyle
- 1Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Alice Kongsted
- 1Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,2Nordic Institute of Chiropractic and Clinical Biomechanics, Campusvej 55, 5230 Odense M, Denmark
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Does a Diagnostic Classification Algorithm Help to Predict the Course of Low Back Pain? A Study of Danish Chiropractic Patients With 1-Year Follow-up. J Orthop Sports Phys Ther 2018; 48:837-846. [PMID: 29739300 DOI: 10.2519/jospt.2018.8083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND A diagnostic classification algorithm, "the Petersen classification," consisting of 12 categories based on a standardized examination protocol, was developed for the primary purpose of identifying clinically homogeneous subgroups of individuals with low back pain (LBP). OBJECTIVES To investigate whether a diagnostic classification algorithm is associated with activity limitation and LBP intensity at follow-up assessments of 2 weeks, 3 months, and 1 year, and whether the algorithm improves outcome prediction when added to a set of known predictors. METHODS This was a prospective observational study of 934 consecutive adult patients with new episodes of LBP who were visiting chiropractic practices in primary care and categorized according to the Petersen classification. Outcomes were disability and pain intensity measured with questionnaires at 2 weeks and 3 months, and 1-year trajectories of LBP based on weekly responses to text messages. Associations were analyzed with linear and logistic regression models. In a subgroup of patients, the numbers of visits to primary and secondary care were described. RESULTS The Petersen classification was statistically significantly associated with all outcomes (P<.001) but explained very little of the variance (R2 = 0.00-0.05). Patients in the nerve root involvement category had the most pain and activity limitation and the most visits to primary and secondary care. Patients in the myofascial pain category were the least affected. CONCLUSION The Petersen classification was not helpful in determining individual prognosis in patients with LBP receiving usual care in chiropractic practice. However, patients should be examined for potential nerve root involvement to improve prediction of likely outcomes. LEVEL OF EVIDENCE Prognosis, level 1b. J Orthop Sports Phys Ther 2018;48(11):837-846. Epub 8 May 2018. doi:10.2519/jospt.2018.8083.
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Clohesy NC, Schneiders AG, Eaton S. Utilization of Low Back Pain Patient Reported Outcome Measures Within Chiropractic Literature: A Descriptive Review. J Manipulative Physiol Ther 2018; 41:628-639. [DOI: 10.1016/j.jmpt.2017.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 10/23/2017] [Accepted: 11/14/2017] [Indexed: 01/19/2023]
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da Silva T, Macaskill P, Kongsted A, Mills K, Maher CG, Hancock MJ. Predicting pain recovery in patients with acute low back pain: Updating and validation of a clinical prediction model. Eur J Pain 2018; 23:341-353. [PMID: 30144211 DOI: 10.1002/ejp.1308] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 07/24/2018] [Accepted: 08/20/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND The prognosis of acute low back pain (LBP) is typically good; however, there is substantial variation in individual patient's outcomes. We recently developed a prediction model that was able to predict the likelihood of pain recovery in patients with acute LBP who continue to have pain approximately 1 week after initially seeking care. The aims of the current study were to (a) re-categorize the variables in the developmental dataset to be able to validate the model in the validation dataset; (b) refit the existing model in the developmental dataset; and (c) validate the model in the validation dataset. METHODS The validation study sample comprised 737 patients with acute LBP, with a pain score of ≥2/10, 1 week after initially seeking care and with duration of current episode of ≤4 weeks. The primary outcome measure was days to pain recovery. Some of the variables from the development dataset were re-categorized prior to refitting the existing model in the developmental dataset using Cox regression. The performance (calibration and discrimination) of the prediction model was then tested in the validation dataset. RESULTS Three variables of the development dataset were re-categorized. The performance of the prediction model with re-categorized variables in the development dataset was good (C-statistic = 0.76, 95% CI 0.70-0.82). The discrimination of the model using the validation dataset resulted in a C-statistic of 0.71 (95% CI 0.63-0.78). The calibration for the validation sample was acceptable at 1 month. However, at 1 week the predicted proportions within quintiles tended to overestimate the observed recovery proportions, and at 3 months, the predicted proportions tended to underestimate the observed recovery proportions. CONCLUSIONS The updated prediction model demonstrated reasonably good external validity and may be useful in practice, but further validation and impact studies in relevant populations should be conducted. SIGNIFICANCE A clinical prediction model based on five easily collected variables demonstrated reasonable external validity. The prediction model has the potential to inform patients and clinicians of the likely prognosis of individuals with acute LBP but requires impact studies to assess its clinical usefulness.
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Affiliation(s)
- Tatiane da Silva
- Department of Health Professions, Macquarie University, Sydney, Australia
| | - Petra Macaskill
- Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Alice Kongsted
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Kathryn Mills
- Department of Health Professions, Macquarie University, Sydney, Australia
| | - Chris G Maher
- Institute for Musculoskeletal Health, Sydney, Australia
| | - Mark J Hancock
- Department of Health Professions, Macquarie University, Sydney, Australia
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Beliveau PJH, Wong JJ, Sutton DA, Simon NB, Bussières AE, Mior SA, French SD. The chiropractic profession: a scoping review of utilization rates, reasons for seeking care, patient profiles, and care provided. Chiropr Man Therap 2017; 25:35. [PMID: 29201346 PMCID: PMC5698931 DOI: 10.1186/s12998-017-0165-8] [Citation(s) in RCA: 174] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 10/31/2017] [Indexed: 12/31/2022] Open
Abstract
Background Previous research has investigated utilization rates, who sees chiropractors, for what reasons, and the type of care that chiropractors provide. However, these studies have not been comprehensively synthesized. We aimed to give a global overview by summarizing the current literature on the utilization of chiropractic services, reasons for seeking care, patient profiles, and assessment and treatment provided. Methods Systematic searches were conducted in MEDLINE, CINAHL, and Index to Chiropractic Literature using keywords and subject headings (MeSH or ChiroSH terms) from database inception to January 2016. Eligible studies: 1) were published in English or French; 2) were case series, descriptive, cross-sectional, or cohort studies; 3) described patients receiving chiropractic services; and 4) reported on the following theme(s): utilization rates of chiropractic services; reasons for attending chiropractic care; profiles of chiropractic patients; or, types of chiropractic services provided. Paired reviewers independently screened all citations and data were extracted from eligible studies. We provided descriptive numerical analysis, e.g. identifying the median rate and interquartile range (e.g., chiropractic utilization rate) stratified by study population or condition. Results The literature search retrieved 14,149 articles; 328 studies (reported in 337 articles) were relevant and reported on chiropractic utilization (245 studies), reason for attending chiropractic care (85 studies), patient demographics (130 studies), and assessment and treatment provided (34 studies). Globally, the median 12-month utilization of chiropractic services was 9.1% (interquartile range (IQR): 6.7%-13.1%) and remained stable between 1980 and 2015. Most patients consulting chiropractors were female (57.0%, IQR: 53.2%-60.0%) with a median age of 43.4 years (IQR: 39.6-48.0), and were employed (median: 77.3%, IQR: 70.3%-85.0%). The most common reported reasons for people attending chiropractic care were (median) low back pain (49.7%, IQR: 43.0%-60.2%), neck pain (22.5%, IQR: 16.3%-24.5%), and extremity problems (10.0%, IQR: 4.3%-22.0%). The most common treatment provided by chiropractors included (median) spinal manipulation (79.3%, IQR: 55.4%-91.3%), soft-tissue therapy (35.1%, IQR: 16.5%-52.0%), and formal patient education (31.3%, IQR: 22.6%-65.0%). Conclusions This comprehensive overview on the world-wide state of the chiropractic profession documented trends in the literature over the last four decades. The findings support the diverse nature of chiropractic practice, although common trends emerged.
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Affiliation(s)
| | - Jessica J. Wong
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, Canada
- Department of Research, Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, ON M2H 3J1 Canada
| | - Deborah A. Sutton
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, Canada
| | - Nir Ben Simon
- Department of Research, Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, ON M2H 3J1 Canada
| | - André E. Bussières
- School of Physical and Occupational Therapy, McGill University, Montréal, Canada
- Département chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
- Centre de recherche interdisciplinaire en réadaptation (CRIR), Montréal, Canada
| | - Silvano A. Mior
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, Canada
- Department of Research, Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, ON M2H 3J1 Canada
| | - Simon D. French
- Department of Public Health Sciences, Queen’s University, Kingston, Canada
- School of Rehabilitation Therapy, Queen’s University, Kingston, Canada
- Department of Chiropractic, Macquarie University, Sydney, Australia
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Molgaard Nielsen A, Hestbaek L, Vach W, Kent P, Kongsted A. Latent class analysis derived subgroups of low back pain patients - do they have prognostic capacity? BMC Musculoskelet Disord 2017; 18:345. [PMID: 28793903 PMCID: PMC5551030 DOI: 10.1186/s12891-017-1708-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 08/02/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Heterogeneity in patients with low back pain is well recognised and different approaches to subgrouping have been proposed. One statistical technique that is increasingly being used is Latent Class Analysis as it performs subgrouping based on pattern recognition with high accuracy. Previously, we developed two novel suggestions for subgrouping patients with low back pain based on Latent Class Analysis of patient baseline characteristics (patient history and physical examination), which resulted in 7 subgroups when using a single-stage analysis, and 9 subgroups when using a two-stage approach. However, their prognostic capacity was unexplored. This study (i) determined whether the subgrouping approaches were associated with the future outcomes of pain intensity, pain frequency and disability, (ii) assessed whether one of these two approaches was more strongly or more consistently associated with these outcomes, and (iii) assessed the performance of the novel subgroupings as compared to the following variables: two existing subgrouping tools (STarT Back Tool and Quebec Task Force classification), four baseline characteristics and a group of previously identified domain-specific patient categorisations (collectively, the 'comparator variables'). METHODS This was a longitudinal cohort study of 928 patients consulting for low back pain in primary care. The associations between each subgroup approach and outcomes at 2 weeks, 3 and 12 months, and with weekly SMS responses were tested in linear regression models, and their prognostic capacity (variance explained) was compared to that of the comparator variables listed above. RESULTS The two previously identified subgroupings were similarly associated with all outcomes. The prognostic capacity of both subgroupings was better than that of the comparator variables, except for participants' recovery beliefs and the domain-specific categorisations, but was still limited. The explained variance ranged from 4.3%-6.9% for pain intensity and from 6.8%-20.3% for disability, and highest at the 2 weeks follow-up. CONCLUSIONS Latent Class-derived subgroups provided additional prognostic information when compared to a range of variables, but the improvements were not substantial enough to warrant further development into a new prognostic tool. Further research could investigate if these novel subgrouping approaches may help to improve existing tools that subgroup low back pain patients.
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Affiliation(s)
- Anne Molgaard Nielsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.
| | - Lise Hestbaek
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.,Nordic Institute of Chiropractic and Clinical Biomechanics, University of Southern Denmark, 5230, Odense M, Denmark
| | - Werner Vach
- Institute for Medical Biometry and Statistics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, 79104, Freiburg, Germany.,Department of Orthopaedics and Traumatology, University Hospital Basel, 4031, Basel, Switzerland
| | - Peter Kent
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.,School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Alice Kongsted
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.,Nordic Institute of Chiropractic and Clinical Biomechanics, University of Southern Denmark, 5230, Odense M, Denmark
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Petersen T, Laslett M, Juhl C. Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews. BMC Musculoskelet Disord 2017; 18:188. [PMID: 28499364 PMCID: PMC5429540 DOI: 10.1186/s12891-017-1549-6] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 05/05/2017] [Indexed: 12/13/2022] Open
Abstract
Background Clinical examination findings are used in primary care to give an initial diagnosis to patients with low back pain and related leg symptoms. The purpose of this study was to develop best evidence Clinical Diagnostic Rules (CDR] for the identification of the most common patho-anatomical disorders in the lumbar spine; i.e. intervertebral discs, sacroiliac joints, facet joints, bone, muscles, nerve roots, muscles, peripheral nerve tissue, and central nervous system sensitization. Methods A sensitive electronic search strategy using MEDLINE, EMBASE and CINAHL databases was combined with hand searching and citation tracking to identify eligible studies. Criteria for inclusion were: persons with low back pain with or without related leg symptoms, history or physical examination findings suitable for use in primary care, comparison with acceptable reference standards, and statistical reporting permitting calculation of diagnostic value. Quality assessments were made independently by two reviewers using the Quality Assessment of Diagnostic Accuracy Studies tool. Clinical examination findings that were investigated by at least two studies were included and results that met our predefined threshold of positive likelihood ratio ≥ 2 or negative likelihood ratio ≤ 0.5 were considered for the CDR. Results Sixty-four studies satisfied our eligible criteria. We were able to construct promising CDRs for symptomatic intervertebral disc, sacroiliac joint, spondylolisthesis, disc herniation with nerve root involvement, and spinal stenosis. Single clinical test appear not to be as useful as clusters of tests that are more closely in line with clinical decision making. Conclusions This is the first comprehensive systematic review of diagnostic accuracy studies that evaluate clinical examination findings for their ability to identify the most common patho-anatomical disorders in the lumbar spine. In some diagnostic categories we have sufficient evidence to recommend a CDR. In others, we have only preliminary evidence that needs testing in future studies. Most findings were tested in secondary or tertiary care. Thus, the accuracy of the findings in a primary care setting has yet to be confirmed. Electronic supplementary material The online version of this article (doi:10.1186/s12891-017-1549-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tom Petersen
- Back Center Copenhagen, Mimersgade 41, 2200, Copenhagen N, Denmark.
| | - Mark Laslett
- PhysioSouth Ltd, 7 Baltimore Green, Shirley, Christchurch, 8061, New Zealand.,Southern Musculoskeletal Seminars, Christchurch, New Zealand
| | - Carsten Juhl
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Rehabilitation, University Hospital of Copenhagen, Herlev and Gentofte, Niels Andersen Vej 65, 2900, Hellerup, Denmark
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Hartvigsen L, Hestbaek L, Lebouef-Yde C, Vach W, Kongsted A. Leg pain location and neurological signs relate to outcomes in primary care patients with low back pain. BMC Musculoskelet Disord 2017; 18:133. [PMID: 28359275 PMCID: PMC5374567 DOI: 10.1186/s12891-017-1495-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 03/20/2017] [Indexed: 01/28/2023] Open
Abstract
Background Low back pain (LBP) patients with related leg pain and signs of nerve root involvement are considered to have a worse prognosis than patients with LBP alone. However, it is unclear whether leg pain location above or below the knee and the presence of neurological signs are important in primary care patients. The objectives of this study were to explore whether the four Quebec Task Force categories (QTFC) based on the location of pain and on neurological signs have different characteristics at the time of care seeking, whether these QTFC are associated with outcome, and if so whether there is an obvious ranking of the four QTFC on the severity of outcomes. Method Adult patients seeking care for LBP in chiropractic or general practice were classified into the four QTFC based on self-reported information and clinical findings. Analyses were performed to test the associations between the QTFC and baseline characteristics as well as the outcomes global perceived effect and activity limitation after 2 weeks, 3 months, and 1 year and also 1-year trajectories of LBP intensity. Results The study comprised 1271 patients; 947 from chiropractic practice and 324 from general practice. The QTFC at presentation were statistically significantly associated with most of the baseline characteristics, with activity limitation at all follow-up time points, with global perceived effect at 2 weeks but not 3 months and 1 year, and with trajectories of LBP. Severity of outcomes in the QTFC increased from LBP alone, across LBP with leg pain above the knee and below the knee to LBP with nerve root involvement. However, the variation within the categories was considerable. Conclusion The QTFC identify different LBP subgroups at baseline and there is a consistent ranking of the four categories with respect to outcomes. The differences between outcomes appear to be large enough for the QTFC to be useful for clinicians in the communication with patients. However, due to variation of outcomes within each category individuals’ outcome cannot be precisely predicted from the QTFC alone. It warrants further investigation to find out if the QTFC can improve existing prediction tools and guide treatment decisions. Electronic supplementary material The online version of this article (doi:10.1186/s12891-017-1495-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lisbeth Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
| | - Lise Hestbaek
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
| | - Charlotte Lebouef-Yde
- Research Department, Spine Center of Southern Denmark, Hospital Lillebælt, Middelfart, Denmark.,Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Werner Vach
- Institute for Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Alice Kongsted
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
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13
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Nielsen AM, Kent P, Hestbaek L, Vach W, Kongsted A. Identifying subgroups of patients using latent class analysis: should we use a single-stage or a two-stage approach? A methodological study using a cohort of patients with low back pain. BMC Musculoskelet Disord 2017; 18:57. [PMID: 28143458 PMCID: PMC5286735 DOI: 10.1186/s12891-017-1411-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 01/16/2017] [Indexed: 12/19/2022] Open
Abstract
Background Heterogeneity in patients with low back pain (LBP) is well recognised and different approaches to subgrouping have been proposed. Latent Class Analysis (LCA) is a statistical technique that is increasingly being used to identify subgroups based on patient characteristics. However, as LBP is a complex multi-domain condition, the optimal approach when using LCA is unknown. Therefore, this paper describes the exploration of two approaches to LCA that may help improve the identification of clinically relevant and interpretable LBP subgroups. Methods From 928 LBP patients consulting a chiropractor, baseline data were used as input to the statistical subgrouping. In a single-stage LCA, all variables were modelled simultaneously to identify patient subgroups. In a two-stage LCA, we used the latent class membership from our previously published LCA within each of six domains of health (activity, contextual factors, pain, participation, physical impairment and psychology) (first stage) as the variables entered into the second stage of the two-stage LCA to identify patient subgroups. The description of the results of the single-stage and two-stage LCA was based on a combination of statistical performance measures, qualitative evaluation of clinical interpretability (face validity) and a subgroup membership comparison. Results For the single-stage LCA, a model solution with seven patient subgroups was preferred, and for the two-stage LCA, a nine patient subgroup model. Both approaches identified similar, but not identical, patient subgroups characterised by (i) mild intermittent LBP, (ii) recent severe LBP and activity limitations, (iii) very recent severe LBP with both activity and participation limitations, (iv) work-related LBP, (v) LBP and several negative consequences and (vi) LBP with nerve root involvement. Conclusions Both approaches identified clinically interpretable patient subgroups. The potential importance of these subgroups needs to be investigated by exploring whether they can be identified in other cohorts and by examining their possible association with patient outcomes. This may inform the selection of a preferred LCA approach. Electronic supplementary material The online version of this article (doi:10.1186/s12891-017-1411-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anne Molgaard Nielsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense M, Denmark.
| | - Peter Kent
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense M, Denmark.,School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Lise Hestbaek
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense M, Denmark.,Nordic Institute of Chiropractic and Clinical Biomechanics, University of Southern Denmark, 5230, Odense M, Denmark
| | - Werner Vach
- Institute for Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, 79104, Freiburg, Germany
| | - Alice Kongsted
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense M, Denmark.,Nordic Institute of Chiropractic and Clinical Biomechanics, University of Southern Denmark, 5230, Odense M, Denmark
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Flavell CA, Gordon S, Marshman L. Classification characteristics of a chronic low back pain population using a combined McKenzie and patho-anatomical assessment. ACTA ACUST UNITED AC 2016; 26:201-207. [PMID: 27744135 DOI: 10.1016/j.math.2016.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 09/27/2016] [Accepted: 10/04/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND Physiotherapists use musculo-skeletal classification systems for patient assessment. Since its early development, the McKenzie lumbar spine assessment (MK) has been incorporated into examination algorithms and combined with a series of patho-anatomical diagnostic tests. No previous studies have used a MK and a combined examination (MK-C) to provide a detailed profile of patients, report and compare the classification characteristics of a chronic low back pain (CLBP) population. OBJECTIVE To report the classification characteristics of a CLBP population using MK and MK-C examinations, and conduct inter-classification comparison of the MK-C for demographics, the Oswestry Disability Index (ODI), Roland Morris Disability Index (RM), Modified Somatic Perceptions Questionnaire (MSPQ), symptom duration and intensity. METHOD A prospective cross-sectional study conducted in a spinal clinic by a MK trained physiotherapist. RESULTS Results were obtained in 150 patients. Using MK, 31% (n = 47) of participants were classified as inconclusive. Following MK-C only 6% of participants remained inconclusive (n = 9). The most frequent MK-C classification was facet joint syndrome (FJS) (49%). Participants with FJS were significantly older than those classified as discogenic (p < 0.001; CI 3.96 ̶ 19.74), or mixed (p < 0.001; CI 5.98 ̶ 36.41). Participants classified as discogenic had significantly higher RM (p = 0.022) and MSPQ (p = 0.005) scores than FJS. CONCLUSION Results indicated that 94% of CLBP patients could be classified using a MK-C. The most common presentation in CLBP was facet joint syndrome. Age, RM and MSPQ appeared to be distinguishing characteristics of this population. Future studies should be conducted to establish the validity and reliability of the MK-C.
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Affiliation(s)
- Carol Ann Flavell
- College of Healthcare Sciences, James Cook University, Douglas Campus, Townsville, Qld, 4811, Australia.
| | - Susan Gordon
- School of Health Sciences, Rehabilitation and Aged Care, Flinders University, Adelaide, SA, 5000, Australia.
| | - Laurence Marshman
- The Townsville Hospital, Angus Smith Drive, Townsville, Qld, 4811, Australia.
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Nielsen AM, Vach W, Kent P, Hestbaek L, Kongsted A. Using existing questionnaires in latent class analysis: should we use summary scores or single items as input? A methodological study using a cohort of patients with low back pain. Clin Epidemiol 2016; 8:73-89. [PMID: 27217797 PMCID: PMC4853143 DOI: 10.2147/clep.s103330] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Latent class analysis (LCA) is increasingly being used in health research, but optimal approaches to handling complex clinical data are unclear. One issue is that commonly used questionnaires are multidimensional, but expressed as summary scores. Using the example of low back pain (LBP), the aim of this study was to explore and descriptively compare the application of LCA when using questionnaire summary scores and when using single items to subgrouping of patients based on multidimensional data. Materials and methods Baseline data from 928 LBP patients in an observational study were classified into four health domains (psychology, pain, activity, and participation) using the World Health Organization’s International Classification of Functioning, Disability, and Health framework. LCA was performed within each health domain using the strategies of summary-score and single-item analyses. The resulting subgroups were descriptively compared using statistical measures and clinical interpretability. Results For each health domain, the preferred model solution ranged from five to seven subgroups for the summary-score strategy and seven to eight subgroups for the single-item strategy. There was considerable overlap between the results of the two strategies, indicating that they were reflecting the same underlying data structure. However, in three of the four health domains, the single-item strategy resulted in a more nuanced description, in terms of more subgroups and more distinct clinical characteristics. Conclusion In these data, application of both the summary-score strategy and the single-item strategy in the LCA subgrouping resulted in clinically interpretable subgroups, but the single-item strategy generally revealed more distinguishing characteristics. These results 1) warrant further analyses in other data sets to determine the consistency of this finding, and 2) warrant investigation in longitudinal data to test whether the finer detail provided by the single-item strategy results in improved prediction of outcomes and treatment response.
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Affiliation(s)
- Anne Molgaard Nielsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Werner Vach
- Center for Medical Biometry and Medical Informatics, Medical Center, University of Freiburg, Freiburg, Germany
| | - Peter Kent
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Lise Hestbaek
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Nordic Institute of Chiropractic and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Alice Kongsted
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Nordic Institute of Chiropractic and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Kongsted A, Davies L, Axen I. Low back pain patients in Sweden, Denmark and the UK share similar characteristics and outcomes: a cross-national comparison of prospective cohort studies. BMC Musculoskelet Disord 2015; 16:367. [PMID: 26612459 PMCID: PMC4661941 DOI: 10.1186/s12891-015-0824-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 11/21/2015] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Low back pain (LBP) is the world's leading cause of disability and yet poorly understood. Cross-national comparisons may motivate hypotheses about outcomes being condition-specific or related to cultural differences and can inform whether observations from one country may be generalised to another. This analysis of data from three cohort studies explored whether characteristics and outcomes differed between LBP patients visiting chiropractors in Sweden, Denmark and the UK. METHODS LBP patients completed a baseline questionnaire and were followed up after 3, 5, 12 and 26 weeks. Outcomes were LBP intensity (0-10 scales) and LBP frequency (0-7 days the previous week). Cohort differences were tested in mixed models accounting for repeated measures. It was investigated if any differences were explained by different baseline characteristics, and interaction terms between baseline factors and nations tested if strength of prognostic factors differed across countries. RESULTS The study sample consisted of 262, 947 and 453 patients from Sweden, Denmark and the UK respectively. Patient characteristics were largely similar across cohorts although some statistically significant differences were observed. The clinical course followed almost identical patterns across nations and small observed differences were not present after adjusting for baseline factors. The associations of LBP intensity and episode duration with outcome differed in strength between countries. CONCLUSIONS Chiropractic patients with low back pain had similar characteristics and clinical course across three Northern European countries. It is unlikely that culture have substantially different impacts on the course of LBP in these countries and the results support knowledge transfer between the investigated countries.
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Affiliation(s)
- Alice Kongsted
- The Nordic Institute for Chiropractic and Clinical Biomechanics, Odense, Denmark.
- Departments of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense, M, Denmark.
| | - Laura Davies
- Anglo-European College of Chiropractic, Bournemouth, UK
| | - Iben Axen
- Institutet för Miljömedicin, Karolinska Institutet, Stockholm, Sweden
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Prediction of outcome in patients with low back pain--A prospective cohort study comparing clinicians' predictions with those of the Start Back Tool. ACTA ACUST UNITED AC 2015; 21:120-7. [PMID: 26144686 DOI: 10.1016/j.math.2015.06.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 05/27/2015] [Accepted: 06/12/2015] [Indexed: 11/22/2022]
Abstract
The clinical course of low back pain (LBP) cannot be accurately predicted by existing prediction tools. Therefore clinicians rely largely on their experience and clinical judgement. The objectives of this study were to investigate 1) which patient characteristics were associated with chiropractors' expectations of outcome from a LBP episode, 2) if clinicians' expectations related to outcome, 3) how accurate clinical predictions were as compared to those of the STarT Back Screening Tool (SBT), and 4) if accuracy was improved by combining clinicians' expectations and the SBT. Outcomes were measured as LBP intensity (0-10) and disability (RMDQ) after 2-weeks, 3-months, and 12-months. The course of LBP in 859 patients was predicted to be short (54%), prolonged (36%), or chronic (7%). Clinicians' expectations were most strongly associated with education, LBP history, radiating pain, and neurological signs at baseline and related to all outcomes. The accuracies of predictions made by clinicians (AUC .58-.63) and the SBT (AUC .50-.61) were comparable and low. No substantial increase in the predictive capability was achieved by combining clinicians' expectations and the SBT. In conclusion, chiropractors' predictions were associated with well-established prognostic factors but not simply a product of these. Chiropractors were able to predict differences in outcome on a group level, but prediction of individual patients' outcomes were inaccurate and not substantially improved by the SBT. It is worth investigating if more accurate tools can be developed to assist clinicians in prediction of outcome.
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Hestbaek L, Munck A, Hartvigsen L, Jarbøl DE, Søndergaard J, Kongsted A. Low back pain in primary care: a description of 1250 patients with low back pain in danish general and chiropractic practice. INTERNATIONAL JOURNAL OF FAMILY MEDICINE 2014; 2014:106102. [PMID: 25436149 PMCID: PMC4236958 DOI: 10.1155/2014/106102] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 10/11/2014] [Indexed: 05/25/2023]
Abstract
Study Design. Baseline description of a multicenter cohort study. Objective. To describe patients with low back pain (LBP) in both chiropractic and general practice in Denmark. Background. To optimize standards of care in the primary healthcare sector, detailed knowledge of the patient populations in different settings is needed. In Denmark, most LBP-patients access primary healthcare through chiropractic or general practice. Methods. Chiropractors and general practitioners recruited adult patients seeking care for LBP. Extensive baseline questionnaires were obtained and descriptive analyses presented separately for general and chiropractic practice patients, Mann-Whitney rank sum test and Pearson's chi-square test, were used to test for differences between the two populations. Results. Questionnaires were returned from 934 patients in chiropractic practice and 319 patients from general practice. Four out of five patients had had previous episodes, one-fourth were on sick leave, and the LBP considerably limited daily activities. The general practice patients were slightly older and less educated, more often females, and generally worse on all disease-related parameters than chiropractic patients. All differences were statistically significant. Conclusions. LBP in primary care was recurrent, causing sick leave and activity limitations. There were clear differences between the chiropractic and general practice populations in this study.
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Affiliation(s)
- Lise Hestbaek
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense, Denmark
- Nordic Institute of Chiropractic and Clinical Biomechanics, Campusvej 55, 5230 Odense, Denmark
| | - Anders Munck
- Audit Project Odense, Institute of Regional Health Services Research, University of Southern Denmark, 5000 Odense C, Denmark
| | - Lisbeth Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense, Denmark
| | - Dorte Ejg Jarbøl
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, 5000 Odense C, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, 5000 Odense C, Denmark
| | - Alice Kongsted
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense, Denmark
- Nordic Institute of Chiropractic and Clinical Biomechanics, Campusvej 55, 5230 Odense, Denmark
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A comparison of three clustering methods for finding subgroups in MRI, SMS or clinical data: SPSS TwoStep Cluster analysis, Latent Gold and SNOB. BMC Med Res Methodol 2014; 14:113. [PMID: 25272975 PMCID: PMC4192340 DOI: 10.1186/1471-2288-14-113] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 09/24/2014] [Indexed: 12/25/2022] Open
Abstract
Background There are various methodological approaches to identifying clinically important subgroups and one method is to identify clusters of characteristics that differentiate people in cross-sectional and/or longitudinal data using Cluster Analysis (CA) or Latent Class Analysis (LCA). There is a scarcity of head-to-head comparisons that can inform the choice of which clustering method might be suitable for particular clinical datasets and research questions. Therefore, the aim of this study was to perform a head-to-head comparison of three commonly available methods (SPSS TwoStep CA, Latent Gold LCA and SNOB LCA). Methods The performance of these three methods was compared: (i) quantitatively using the number of subgroups detected, the classification probability of individuals into subgroups, the reproducibility of results, and (ii) qualitatively using subjective judgments about each program’s ease of use and interpretability of the presentation of results. We analysed five real datasets of varying complexity in a secondary analysis of data from other research projects. Three datasets contained only MRI findings (n = 2,060 to 20,810 vertebral disc levels), one dataset contained only pain intensity data collected for 52 weeks by text (SMS) messaging (n = 1,121 people), and the last dataset contained a range of clinical variables measured in low back pain patients (n = 543 people). Four artificial datasets (n = 1,000 each) containing subgroups of varying complexity were also analysed testing the ability of these clustering methods to detect subgroups and correctly classify individuals when subgroup membership was known. Results The results from the real clinical datasets indicated that the number of subgroups detected varied, the certainty of classifying individuals into those subgroups varied, the findings had perfect reproducibility, some programs were easier to use and the interpretability of the presentation of their findings also varied. The results from the artificial datasets indicated that all three clustering methods showed a near-perfect ability to detect known subgroups and correctly classify individuals into those subgroups. Conclusions Our subjective judgement was that Latent Gold offered the best balance of sensitivity to subgroups, ease of use and presentation of results with these datasets but we recognise that different clustering methods may suit other types of data and clinical research questions.
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Kongsted A, Aambakk B, Bossen S, Hestbaek L. Brief screening questions for depression in chiropractic patients with low back pain: identification of potentially useful questions and test of their predictive capacity. Chiropr Man Therap 2014; 22:4. [PMID: 24438448 PMCID: PMC3902415 DOI: 10.1186/2045-709x-22-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 01/15/2014] [Indexed: 11/28/2022] Open
Abstract
Background Depression is an important prognostic factor in low back pain (LBP) that appears to be infrequent in chiropractic populations. Identification of depression in few patients would consequently implicate screening of many. It is therefore desirable to have brief screening tools for depression. The objective of this study was to investigate if one or two items from the Major Depression Inventory (MDI) could be a reasonable substitute for the complete scale. Methods The MDI was completed by 925 patients consulting a chiropractor due to a new episode of LBP. Outcome measures were LBP intensity and activity limitation at 3-months and 12-months follow-up. Single items on the MDI that correlated strongest and explained most variance in the total score were tested for associations with outcome. Finally, the predictive capacity was compared between the total scale and the items that showed the strongest associations with outcome measures. Results In this cohort 9% had signs of depression. The total MDI was significantly associated with outcome but explained very little of the variance in outcome. Four single items performed comparable to the total scale as prognostic factors. Items 1 and 3 explained the most variance in all outcome measures, and their predictive accuracies in terms of area under the curve were at least as high as for the categorised complete scale. Conclusions Baseline depression measured by the MDI was associated with a worse outcome in chiropractic patients with LBP. A single item (no. 1 or 3) was a reasonable substitute for the entire scale when screening for depression as a prognostic factor.
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Affiliation(s)
- Alice Kongsted
- The Nordic Institute of Chiropractic and Clinical Biomechanics, Campusvej 55, 5230 Odense, M, Denmark.
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