Brief pain re-assessment provided more accurate prognosis than baseline information for low-back or shoulder pain

G Mansell; K P Jordan; G M Peat; K M Dunn; D Lasserson; T Kuijpers; I Swinkels-Meewisse; D A W M van der Windt

doi:10.1186/s12891-017-1502-8

Brief pain re-assessment provided more accurate prognosis than baseline information for low-back or shoulder pain

BMC Musculoskelet Disord. 2017 Apr 4;18(1):139. doi: 10.1186/s12891-017-1502-8.

Authors

G Mansell¹, K P Jordan², G M Peat², K M Dunn², D Lasserson³, T Kuijpers⁴, I Swinkels-Meewisse⁵, D A W M van der Windt²

Affiliations

¹ Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK. g.mansell@keele.ac.uk.
² Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK.
³ Nuffield Department of Medicine, University of Oxford and NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK.
⁴ Department for Guideline Development, The Dutch College of General Practitioners, PO Box 3231, 3502 GE, Utrecht, The Netherlands.
⁵ Centre for Physical Therapy and Rehabilitation, Geldrop, The Netherlands.

Abstract

Background: Research investigating prognosis in musculoskeletal pain conditions has only been moderately successful in predicting which patients are unlikely to recover. Clinical decision making could potentially be improved by combining information taken at baseline and re-consultation.

Methods: Data from four prospective clinical cohorts of adults presenting to UK and Dutch primary care with low-back or shoulder pain was analysed, assessing long-term disability at 6 or 12 months and including baseline and 4-6 week assessments of pain. Baseline versus short-term assessments of pain, and previously validated multivariable prediction models versus repeat assessment, were compared to assess predictive performance of long-term disability outcome. A hypothetical clinical scenario was explored which made efficient use of both baseline and repeated assessment to identify patients likely to have a poor prognosis and decide on further treatment.

Results: Short-term repeat assessment of pain was better than short-term change or baseline score at predicting long-term disability improvement across all cohorts. Short-term repeat assessment of pain was only slightly more predictive of long-term recovery (c-statistics 0.78, 95% CI 0.74 to 0.83 and 0.75, 95% CI 0.69 to 0.82) than a multivariable baseline prognostic model in the two cohorts presenting such a model (c-statistics 0.71, 95% CI 0.67 to 0.76 and 0.72, 95% CI 0.66 to 0.78). Combining optimal prediction at baseline using a multivariable prognostic model with short-term repeat assessment of pain in those with uncertain prognosis in a hypothetical clinical scenario resulted in reduction in the number of patients with an uncertain probability of recovery, thereby reducing the instances where patients may be inappropriately referred or reassured.

Conclusions: Incorporating short-term repeat assessment of pain into prognostic models could potentially optimise the clinical usefulness of prognostic information.

Keywords: Consultation; Low back pain; Musculoskeletal conditions; Primary care; Prognosis; Shoulder pain.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't

MeSH terms

Humans
Low Back Pain / diagnosis*
Pain Measurement*
Prognosis
Shoulder Pain / diagnosis*

Abstract

Publication types

MeSH terms

Grants and funding