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Differences among primary care patients with different mechanical patterns of low back pain: a cross-sectional investigation
OBJECTIVES: To characterise and compare a persistent low back pain (LBP) population based on 4 clinical pain patterns. DESIGN: Cross-sectional analysis of patient-reported data. SETTING: Patients from 220 primary care practitioners in 3 cities in Ontario, Canada. PARTICIPANTS: 1020 individuals seeki...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5168682/ https://www.ncbi.nlm.nih.gov/pubmed/27927661 http://dx.doi.org/10.1136/bmjopen-2016-013060 |
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author | Della Mora, Lauren S Perruccio, Anthony V Badley, Elizabeth M Rampersaud, Y Raja |
author_facet | Della Mora, Lauren S Perruccio, Anthony V Badley, Elizabeth M Rampersaud, Y Raja |
author_sort | Della Mora, Lauren S |
collection | PubMed |
description | OBJECTIVES: To characterise and compare a persistent low back pain (LBP) population based on 4 clinical pain patterns. DESIGN: Cross-sectional analysis of patient-reported data. SETTING: Patients from 220 primary care practitioners in 3 cities in Ontario, Canada. PARTICIPANTS: 1020 individuals seeking LBP care. Inclusion criteria: LBP symptoms lasting 1½–12 months, or unmanageable recurrent symptoms; ages 18+years. Exclusion criteria: pregnant/1-year postpartum; involved in active litigation or motor vehicle injury; emergent spinal presentations; pain disorder diagnosis; work injury claim; or constant symptoms persisting >12 months postonset. MAIN OUTCOME MEASURE: Hall pain pattern subgroups: back dominant pain aggravated by flexion (P1) or extension (P2), or leg dominant constant (P3) or intermittent (P4) pain (multinomial logistic outcome; referent: P1). RESULTS: Groups P1 and P2 had the highest proportion of women. P2 and P4 had higher mean ages and comorbidity counts. P3 and P4 had higher proportions of overweight/obese individuals and lower general health scores. Adjusted models: being male and overweight/obese was associated with increased odds of being in P3 (OR 1.64 (95% CI 1.10 to 2.46), and OR 1.74 (1.13 to 2.68), respectively) and P4 (OR 1.87 (1.11 to 3.15) and OR 1.91 (1.06 to 3.42), respectively), and increasing age with increased odds of being in P2 (OR 1.02 (1.01 to 1.03)) and P4 (OR 1.06 (1.04 to 1.08)). Increasing comorbidity count was associated with increased odds of being in P2 (OR 1.14 (1.0 to 1.3)), and better general health scores with decreased odds of being in P3 (OR 0.40 (0.18 to 0.93)). CONCLUSIONS: This is the first study to examine the ‘Hall system’ in a non-rehab primary care population. Subgroups classified according to this system appear to have distinct profiles. Further research is needed to better characterise and determine the prognostic implication of these clinically derived subgroups. |
format | Online Article Text |
id | pubmed-5168682 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-51686822016-12-22 Differences among primary care patients with different mechanical patterns of low back pain: a cross-sectional investigation Della Mora, Lauren S Perruccio, Anthony V Badley, Elizabeth M Rampersaud, Y Raja BMJ Open Epidemiology OBJECTIVES: To characterise and compare a persistent low back pain (LBP) population based on 4 clinical pain patterns. DESIGN: Cross-sectional analysis of patient-reported data. SETTING: Patients from 220 primary care practitioners in 3 cities in Ontario, Canada. PARTICIPANTS: 1020 individuals seeking LBP care. Inclusion criteria: LBP symptoms lasting 1½–12 months, or unmanageable recurrent symptoms; ages 18+years. Exclusion criteria: pregnant/1-year postpartum; involved in active litigation or motor vehicle injury; emergent spinal presentations; pain disorder diagnosis; work injury claim; or constant symptoms persisting >12 months postonset. MAIN OUTCOME MEASURE: Hall pain pattern subgroups: back dominant pain aggravated by flexion (P1) or extension (P2), or leg dominant constant (P3) or intermittent (P4) pain (multinomial logistic outcome; referent: P1). RESULTS: Groups P1 and P2 had the highest proportion of women. P2 and P4 had higher mean ages and comorbidity counts. P3 and P4 had higher proportions of overweight/obese individuals and lower general health scores. Adjusted models: being male and overweight/obese was associated with increased odds of being in P3 (OR 1.64 (95% CI 1.10 to 2.46), and OR 1.74 (1.13 to 2.68), respectively) and P4 (OR 1.87 (1.11 to 3.15) and OR 1.91 (1.06 to 3.42), respectively), and increasing age with increased odds of being in P2 (OR 1.02 (1.01 to 1.03)) and P4 (OR 1.06 (1.04 to 1.08)). Increasing comorbidity count was associated with increased odds of being in P2 (OR 1.14 (1.0 to 1.3)), and better general health scores with decreased odds of being in P3 (OR 0.40 (0.18 to 0.93)). CONCLUSIONS: This is the first study to examine the ‘Hall system’ in a non-rehab primary care population. Subgroups classified according to this system appear to have distinct profiles. Further research is needed to better characterise and determine the prognostic implication of these clinically derived subgroups. BMJ Publishing Group 2016-12-07 /pmc/articles/PMC5168682/ /pubmed/27927661 http://dx.doi.org/10.1136/bmjopen-2016-013060 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ |
spellingShingle | Epidemiology Della Mora, Lauren S Perruccio, Anthony V Badley, Elizabeth M Rampersaud, Y Raja Differences among primary care patients with different mechanical patterns of low back pain: a cross-sectional investigation |
title | Differences among primary care patients with different mechanical patterns of low back pain: a cross-sectional investigation |
title_full | Differences among primary care patients with different mechanical patterns of low back pain: a cross-sectional investigation |
title_fullStr | Differences among primary care patients with different mechanical patterns of low back pain: a cross-sectional investigation |
title_full_unstemmed | Differences among primary care patients with different mechanical patterns of low back pain: a cross-sectional investigation |
title_short | Differences among primary care patients with different mechanical patterns of low back pain: a cross-sectional investigation |
title_sort | differences among primary care patients with different mechanical patterns of low back pain: a cross-sectional investigation |
topic | Epidemiology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5168682/ https://www.ncbi.nlm.nih.gov/pubmed/27927661 http://dx.doi.org/10.1136/bmjopen-2016-013060 |
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