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What have we learned from ten years of trajectory research in low back pain?

BACKGROUND: Non-specific low back pain (LBP) is often categorised as acute, subacute or chronic by focusing on the duration of the current episode. However, more than twenty years ago this concept was challenged by a recognition that LBP is often an episodic condition. This episodic nature also mean...

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Autores principales: Kongsted, Alice, Kent, Peter, Axen, Iben, Downie, Aron S., Dunn, Kate M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4875630/
https://www.ncbi.nlm.nih.gov/pubmed/27209166
http://dx.doi.org/10.1186/s12891-016-1071-2
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author Kongsted, Alice
Kent, Peter
Axen, Iben
Downie, Aron S.
Dunn, Kate M.
author_facet Kongsted, Alice
Kent, Peter
Axen, Iben
Downie, Aron S.
Dunn, Kate M.
author_sort Kongsted, Alice
collection PubMed
description BACKGROUND: Non-specific low back pain (LBP) is often categorised as acute, subacute or chronic by focusing on the duration of the current episode. However, more than twenty years ago this concept was challenged by a recognition that LBP is often an episodic condition. This episodic nature also means that the course of LBP is not well described by an overall population mean. Therefore, studies have investigated if specific LBP trajectories could be identified which better reflect individuals’ course patterns. Following a pioneering study into LBP trajectories published by Dunn et al. in 2006, a number of subsequent studies have also identified LBP trajectories and it is timely to provide an overview of their findings and discuss how insights into these trajectories may be helpful for improving our understanding of LBP and its clinical management. DISCUSSION: LBP trajectories in adults have been identified by data driven approaches in ten cohorts, and these have consistently demonstrated that different trajectory patterns exist. Despite some differences between studies, common trajectories have been identified across settings and countries, which have associations with a number of patient characteristics from different health domains. One study has demonstrated that in many people such trajectories are stable over several years. LBP trajectories seem to be recognisable by patients, and appealing to clinicians, and we discuss their potential usefulness as prognostic factors, effect moderators, and as a tool to support communication with patients. CONCLUSIONS: Investigations of trajectories underpin the notion that differentiation between acute and chronic LBP is overly simplistic, and we believe it is time to shift from this paradigm to one that focuses on trajectories over time. We suggest that trajectory patterns may represent practical phenotypes of LBP that could improve the clinical dialogue with patients, and might have a potential for supporting clinical decision making, but their usefulness is still underexplored.
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spelling pubmed-48756302016-05-22 What have we learned from ten years of trajectory research in low back pain? Kongsted, Alice Kent, Peter Axen, Iben Downie, Aron S. Dunn, Kate M. BMC Musculoskelet Disord Debate BACKGROUND: Non-specific low back pain (LBP) is often categorised as acute, subacute or chronic by focusing on the duration of the current episode. However, more than twenty years ago this concept was challenged by a recognition that LBP is often an episodic condition. This episodic nature also means that the course of LBP is not well described by an overall population mean. Therefore, studies have investigated if specific LBP trajectories could be identified which better reflect individuals’ course patterns. Following a pioneering study into LBP trajectories published by Dunn et al. in 2006, a number of subsequent studies have also identified LBP trajectories and it is timely to provide an overview of their findings and discuss how insights into these trajectories may be helpful for improving our understanding of LBP and its clinical management. DISCUSSION: LBP trajectories in adults have been identified by data driven approaches in ten cohorts, and these have consistently demonstrated that different trajectory patterns exist. Despite some differences between studies, common trajectories have been identified across settings and countries, which have associations with a number of patient characteristics from different health domains. One study has demonstrated that in many people such trajectories are stable over several years. LBP trajectories seem to be recognisable by patients, and appealing to clinicians, and we discuss their potential usefulness as prognostic factors, effect moderators, and as a tool to support communication with patients. CONCLUSIONS: Investigations of trajectories underpin the notion that differentiation between acute and chronic LBP is overly simplistic, and we believe it is time to shift from this paradigm to one that focuses on trajectories over time. We suggest that trajectory patterns may represent practical phenotypes of LBP that could improve the clinical dialogue with patients, and might have a potential for supporting clinical decision making, but their usefulness is still underexplored. BioMed Central 2016-05-21 /pmc/articles/PMC4875630/ /pubmed/27209166 http://dx.doi.org/10.1186/s12891-016-1071-2 Text en © Kongsted et al. 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Debate
Kongsted, Alice
Kent, Peter
Axen, Iben
Downie, Aron S.
Dunn, Kate M.
What have we learned from ten years of trajectory research in low back pain?
title What have we learned from ten years of trajectory research in low back pain?
title_full What have we learned from ten years of trajectory research in low back pain?
title_fullStr What have we learned from ten years of trajectory research in low back pain?
title_full_unstemmed What have we learned from ten years of trajectory research in low back pain?
title_short What have we learned from ten years of trajectory research in low back pain?
title_sort what have we learned from ten years of trajectory research in low back pain?
topic Debate
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4875630/
https://www.ncbi.nlm.nih.gov/pubmed/27209166
http://dx.doi.org/10.1186/s12891-016-1071-2
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