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The Need for Multidimensional Stratification of Chronic Low Back Pain (LBP)

MINI: The authors wanted to determine which existing primary-care low back pain stratification schema is associated with distinct subpopulations. Initial stratification by DMPP identified potentially distinct epidemiological groups. DMPP stratification resulted in discrimination beyond that provided...

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Autores principales: Rampersaud, Yoga Raja, Bidos, Andrew, Fanti, Caroline, Perruccio, Anthony V.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5671794/
https://www.ncbi.nlm.nih.gov/pubmed/28538598
http://dx.doi.org/10.1097/BRS.0000000000002237
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author Rampersaud, Yoga Raja
Bidos, Andrew
Fanti, Caroline
Perruccio, Anthony V.
author_facet Rampersaud, Yoga Raja
Bidos, Andrew
Fanti, Caroline
Perruccio, Anthony V.
author_sort Rampersaud, Yoga Raja
collection PubMed
description MINI: The authors wanted to determine which existing primary-care low back pain stratification schema is associated with distinct subpopulations. Initial stratification by DMPP identified potentially distinct epidemiological groups. DMPP stratification resulted in discrimination beyond that provided by disability or chronicity risk stratification alone. STUDY DESIGN. A cross-sectional study of Canadian patients suffering from low back pain (LBP) seeking primary care. OBJECTIVE. The aim of this study was to determine which existing primary care LBP stratification schema is associated with distinct subpopulations as characterized by easily identifiable primary epidemiological factors. SUMMARY OF BACKGROUND DATA. LBP is among the most frequent reasons for visits to primary care physicians and a leading cause of years lived with disability. In an effort to improve treatment response/outcomes in LBP primary care, different classification systems have been proposed in an effort to provide more tailored treatment with the intent of improving outcomes. Group-specific risk factors and underlying etiology might suggest a need for, or inform, changes to treatment approaches to optimize LBP outcomes. METHODS. Stratification by dominant mechanical pain patterns; chronicity risk; disability severity. Multinomial logistic regression was used to identify the system showing greatest variability in associations with age, sex, obesity, and comorbidity. Once identified, the remaining schemas were incorporated into the model. RESULTS. N = 970; mean age: 50 years (range: 18–93); 56% female. Stratification by pain pattern revealed greater variability. Adjusted analysis: Increasing age was associated with greater odds of intermittent, extension-based back- or leg-dominant pain [odds ratio (OR): 1.02 and 1.06; P < 0.01]; being male with leg-dominant pain (ORs > 2; P < 0.01). Overweight/obesity was associated with extension-based leg-dominant pain (OR = 2.6; P < 0.02) and increasing comorbidity with extension-based back-dominant pain (OR = 1.3; P < 0.01). Severe disability was associated only with constant leg pain (OR = 3.9; P < 0.01), and high chronicity risk with extension-based leg-dominant pain (OR = 0.4; P = 0.03). CONCLUSION. Dominant mechanical symptom stratification resulted in further discrimination of an epidemiologically distinct and a large subgroup of LBP patients not identified by disability or chronicity risk stratification alone. Findings suggest a need for primary care initiated multidimensional stratification in chronic LBP. Level of Evidence: 3
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spelling pubmed-56717942017-11-22 The Need for Multidimensional Stratification of Chronic Low Back Pain (LBP) Rampersaud, Yoga Raja Bidos, Andrew Fanti, Caroline Perruccio, Anthony V. Spine (Phila Pa 1976) Epidemiology MINI: The authors wanted to determine which existing primary-care low back pain stratification schema is associated with distinct subpopulations. Initial stratification by DMPP identified potentially distinct epidemiological groups. DMPP stratification resulted in discrimination beyond that provided by disability or chronicity risk stratification alone. STUDY DESIGN. A cross-sectional study of Canadian patients suffering from low back pain (LBP) seeking primary care. OBJECTIVE. The aim of this study was to determine which existing primary care LBP stratification schema is associated with distinct subpopulations as characterized by easily identifiable primary epidemiological factors. SUMMARY OF BACKGROUND DATA. LBP is among the most frequent reasons for visits to primary care physicians and a leading cause of years lived with disability. In an effort to improve treatment response/outcomes in LBP primary care, different classification systems have been proposed in an effort to provide more tailored treatment with the intent of improving outcomes. Group-specific risk factors and underlying etiology might suggest a need for, or inform, changes to treatment approaches to optimize LBP outcomes. METHODS. Stratification by dominant mechanical pain patterns; chronicity risk; disability severity. Multinomial logistic regression was used to identify the system showing greatest variability in associations with age, sex, obesity, and comorbidity. Once identified, the remaining schemas were incorporated into the model. RESULTS. N = 970; mean age: 50 years (range: 18–93); 56% female. Stratification by pain pattern revealed greater variability. Adjusted analysis: Increasing age was associated with greater odds of intermittent, extension-based back- or leg-dominant pain [odds ratio (OR): 1.02 and 1.06; P < 0.01]; being male with leg-dominant pain (ORs > 2; P < 0.01). Overweight/obesity was associated with extension-based leg-dominant pain (OR = 2.6; P < 0.02) and increasing comorbidity with extension-based back-dominant pain (OR = 1.3; P < 0.01). Severe disability was associated only with constant leg pain (OR = 3.9; P < 0.01), and high chronicity risk with extension-based leg-dominant pain (OR = 0.4; P = 0.03). CONCLUSION. Dominant mechanical symptom stratification resulted in further discrimination of an epidemiologically distinct and a large subgroup of LBP patients not identified by disability or chronicity risk stratification alone. Findings suggest a need for primary care initiated multidimensional stratification in chronic LBP. Level of Evidence: 3 Lippincott Williams & Wilkins 2017-11-15 2017-05-22 /pmc/articles/PMC5671794/ /pubmed/28538598 http://dx.doi.org/10.1097/BRS.0000000000002237 Text en Copyright © 2017 The Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by-nc-nd/4.0 This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0
spellingShingle Epidemiology
Rampersaud, Yoga Raja
Bidos, Andrew
Fanti, Caroline
Perruccio, Anthony V.
The Need for Multidimensional Stratification of Chronic Low Back Pain (LBP)
title The Need for Multidimensional Stratification of Chronic Low Back Pain (LBP)
title_full The Need for Multidimensional Stratification of Chronic Low Back Pain (LBP)
title_fullStr The Need for Multidimensional Stratification of Chronic Low Back Pain (LBP)
title_full_unstemmed The Need for Multidimensional Stratification of Chronic Low Back Pain (LBP)
title_short The Need for Multidimensional Stratification of Chronic Low Back Pain (LBP)
title_sort need for multidimensional stratification of chronic low back pain (lbp)
topic Epidemiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5671794/
https://www.ncbi.nlm.nih.gov/pubmed/28538598
http://dx.doi.org/10.1097/BRS.0000000000002237
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