Expectation of recovery from low back pain

A longitudinal cohort study investigating patient characteristics related to expectations and the association between expectations and 3-month outcome

Alice Kongsted, Werner Vach, Marie Axø, Rasmus Nørgaard Bech, Lise Hestbæk

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

Study Design. A prospective cohort study conducted in general practice (GP) and chiropractic practice (CP).Objectives. To explore which patient characteristics were associated with recovery expectations in low back pain (LBP) patients, whether expectations predicted 3-month outcome, and to what extent expectations were associated with empirical prognostic factors.Summary of Background Data. Patients' recovery expectations have been associated with prognosis, but it is largely unknown why patients expect what they do, and how expectations relate to other prognostic factors.Methods. 1169 participants completed questionnaires at their first consultation due to LBP and 78% were followed for 3 months. At baseline, recovery expectations were measured on a 0-10 scale. Outcome measures were LBP intensity and Global Perceived Effect (GPE). Associations were tested in regression models, and the predictive capacity of expectations described in terms of adjusted R and area under the ROC curve (AUC). Correlations between predicted expectations and prognosis were quantified by Spearman's rho.Results. Expectations were associated with known prognostic factors, mainly LBP history, but were only partly explained by measured factors (adj.R 35% (CP)/ 55% (GP)). Expectations had statistically significant associations with both outcomes after adjusting for other baseline factors, but explained only a little of the variance in LBP (adjusted R: 0.11 CP/0.32 GP) and did not add to the explained variance. The prediction of GPE was limited in CP (AUC 0.59), but more substantial in GP (AUC 0.77) patients. Correlations between predicted expectations and predicted outcome were strong.Conclusions. Patients' recovery expectations were associated mainly with LBP history and were generally, but not consistently, similar to an empirically predicted prognosis. Expectations were significantly associated with outcome, and may, at least for some outcomes, be a relevant proxy for more complex models. Future studies should explore the effect of addressing negative recovery expectations.
OriginalsprogEngelsk
TidsskriftSpine
Vol/bind39
Udgave nummer1
Sider (fra-til)81–90
Antal sider10
ISSN0362-2436
DOI
StatusUdgivet - 1. jan. 2014

Fingeraftryk

Low Back Pain
Longitudinal Studies
Chiropractic
Cohort Studies
General Practice
ROC Curve
Area Under Curve
R Factors
Proxy
Referral and Consultation
Outcome Assessment (Health Care)
Prospective Studies

Citer dette

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title = "Expectation of recovery from low back pain: A longitudinal cohort study investigating patient characteristics related to expectations and the association between expectations and 3-month outcome",
abstract = "Study Design. A prospective cohort study conducted in general practice (GP) and chiropractic practice (CP).Objectives. To explore which patient characteristics were associated with recovery expectations in low back pain (LBP) patients, whether expectations predicted 3-month outcome, and to what extent expectations were associated with empirical prognostic factors.Summary of Background Data. Patients' recovery expectations have been associated with prognosis, but it is largely unknown why patients expect what they do, and how expectations relate to other prognostic factors.Methods. 1169 participants completed questionnaires at their first consultation due to LBP and 78{\%} were followed for 3 months. At baseline, recovery expectations were measured on a 0-10 scale. Outcome measures were LBP intensity and Global Perceived Effect (GPE). Associations were tested in regression models, and the predictive capacity of expectations described in terms of adjusted R and area under the ROC curve (AUC). Correlations between predicted expectations and prognosis were quantified by Spearman's rho.Results. Expectations were associated with known prognostic factors, mainly LBP history, but were only partly explained by measured factors (adj.R 35{\%} (CP)/ 55{\%} (GP)). Expectations had statistically significant associations with both outcomes after adjusting for other baseline factors, but explained only a little of the variance in LBP (adjusted R: 0.11 CP/0.32 GP) and did not add to the explained variance. The prediction of GPE was limited in CP (AUC 0.59), but more substantial in GP (AUC 0.77) patients. Correlations between predicted expectations and predicted outcome were strong.Conclusions. Patients' recovery expectations were associated mainly with LBP history and were generally, but not consistently, similar to an empirically predicted prognosis. Expectations were significantly associated with outcome, and may, at least for some outcomes, be a relevant proxy for more complex models. Future studies should explore the effect of addressing negative recovery expectations.",
author = "Alice Kongsted and Werner Vach and Marie Ax{\o} and Bech, {Rasmus N{\o}rgaard} and Lise Hestb{\ae}k",
year = "2014",
month = "1",
day = "1",
doi = "10.1097/BRS.0000000000000059",
language = "English",
volume = "39",
pages = "81–90",
journal = "Spine",
issn = "0362-2436",
publisher = "Lippincott Williams & Wilkins",
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Expectation of recovery from low back pain : A longitudinal cohort study investigating patient characteristics related to expectations and the association between expectations and 3-month outcome. / Kongsted, Alice; Vach, Werner; Axø, Marie; Bech, Rasmus Nørgaard; Hestbæk, Lise .

I: Spine, Bind 39, Nr. 1, 01.01.2014, s. 81–90.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Expectation of recovery from low back pain

T2 - A longitudinal cohort study investigating patient characteristics related to expectations and the association between expectations and 3-month outcome

AU - Kongsted, Alice

AU - Vach, Werner

AU - Axø, Marie

AU - Bech, Rasmus Nørgaard

AU - Hestbæk, Lise

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Study Design. A prospective cohort study conducted in general practice (GP) and chiropractic practice (CP).Objectives. To explore which patient characteristics were associated with recovery expectations in low back pain (LBP) patients, whether expectations predicted 3-month outcome, and to what extent expectations were associated with empirical prognostic factors.Summary of Background Data. Patients' recovery expectations have been associated with prognosis, but it is largely unknown why patients expect what they do, and how expectations relate to other prognostic factors.Methods. 1169 participants completed questionnaires at their first consultation due to LBP and 78% were followed for 3 months. At baseline, recovery expectations were measured on a 0-10 scale. Outcome measures were LBP intensity and Global Perceived Effect (GPE). Associations were tested in regression models, and the predictive capacity of expectations described in terms of adjusted R and area under the ROC curve (AUC). Correlations between predicted expectations and prognosis were quantified by Spearman's rho.Results. Expectations were associated with known prognostic factors, mainly LBP history, but were only partly explained by measured factors (adj.R 35% (CP)/ 55% (GP)). Expectations had statistically significant associations with both outcomes after adjusting for other baseline factors, but explained only a little of the variance in LBP (adjusted R: 0.11 CP/0.32 GP) and did not add to the explained variance. The prediction of GPE was limited in CP (AUC 0.59), but more substantial in GP (AUC 0.77) patients. Correlations between predicted expectations and predicted outcome were strong.Conclusions. Patients' recovery expectations were associated mainly with LBP history and were generally, but not consistently, similar to an empirically predicted prognosis. Expectations were significantly associated with outcome, and may, at least for some outcomes, be a relevant proxy for more complex models. Future studies should explore the effect of addressing negative recovery expectations.

AB - Study Design. A prospective cohort study conducted in general practice (GP) and chiropractic practice (CP).Objectives. To explore which patient characteristics were associated with recovery expectations in low back pain (LBP) patients, whether expectations predicted 3-month outcome, and to what extent expectations were associated with empirical prognostic factors.Summary of Background Data. Patients' recovery expectations have been associated with prognosis, but it is largely unknown why patients expect what they do, and how expectations relate to other prognostic factors.Methods. 1169 participants completed questionnaires at their first consultation due to LBP and 78% were followed for 3 months. At baseline, recovery expectations were measured on a 0-10 scale. Outcome measures were LBP intensity and Global Perceived Effect (GPE). Associations were tested in regression models, and the predictive capacity of expectations described in terms of adjusted R and area under the ROC curve (AUC). Correlations between predicted expectations and prognosis were quantified by Spearman's rho.Results. Expectations were associated with known prognostic factors, mainly LBP history, but were only partly explained by measured factors (adj.R 35% (CP)/ 55% (GP)). Expectations had statistically significant associations with both outcomes after adjusting for other baseline factors, but explained only a little of the variance in LBP (adjusted R: 0.11 CP/0.32 GP) and did not add to the explained variance. The prediction of GPE was limited in CP (AUC 0.59), but more substantial in GP (AUC 0.77) patients. Correlations between predicted expectations and predicted outcome were strong.Conclusions. Patients' recovery expectations were associated mainly with LBP history and were generally, but not consistently, similar to an empirically predicted prognosis. Expectations were significantly associated with outcome, and may, at least for some outcomes, be a relevant proxy for more complex models. Future studies should explore the effect of addressing negative recovery expectations.

U2 - 10.1097/BRS.0000000000000059

DO - 10.1097/BRS.0000000000000059

M3 - Journal article

VL - 39

SP - 81

EP - 90

JO - Spine

JF - Spine

SN - 0362-2436

IS - 1

ER -