Prognostic factors of a favorable outcome following a supervised exercise program for soldiers with sub-acute and chronic low back pain
Abstract Background Low back pain (LBP) encompasses heterogeneous patients unlikely to respond to a unique treatment. Identifying sub-groups of LBP may help to improve treatment outcomes. This is a hypothesis-setting study designed to create a clinical prediction rule (CPR) that will predict favorab...
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| Format: | Article |
| Language: | English |
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BMC
2018-04-01
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| Series: | BMC Musculoskeletal Disorders |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12891-018-2022-x |
| _version_ | 1811282435191603200 |
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| author | Marc Perron Chantal Gendron Pierre Langevin Jean Leblond Marianne Roos Jean-Sébastien Roy |
| author_facet | Marc Perron Chantal Gendron Pierre Langevin Jean Leblond Marianne Roos Jean-Sébastien Roy |
| author_sort | Marc Perron |
| collection | DOAJ |
| description | Abstract Background Low back pain (LBP) encompasses heterogeneous patients unlikely to respond to a unique treatment. Identifying sub-groups of LBP may help to improve treatment outcomes. This is a hypothesis-setting study designed to create a clinical prediction rule (CPR) that will predict favorable outcomes in soldiers with sub-acute and chronic LBP participating in a multi-station exercise program. Methods Military members with LBP participated in a supervised program comprising 7 stations each consisting of exercises of increasing difficulty. Demographic, impairment and disability data were collected at baseline. The modified Oswestry Disability Index (ODI) was administered at baseline and following the 6-week program. An improvement of 50% in the initial ODI score was considered the reference standard to determine a favorable outcome. Univariate associations with favorable outcome were tested using chi-square or paired t-tests. Variables that showed between-group (favorable/unfavorable) differences were entered into a logistic regression after determining the sampling adequacy. Finally, continuous variables were dichotomized and the sensitivity, specificity and positive and negative likelihood ratios were determined for the model and for each variable. Results A sample of 85 participants was included in analyses. Five variables contributed to prediction of a favorable outcome: no pain in lying down (p = 0.017), no use of antidepressants (p = 0.061), FABQ work score < 22.5 (p = 0.061), fewer than 5 physiotherapy sessions before entering the program (p = 0.144) and less than 6 months’ work restriction (p = 0.161). This model yielded a sensitivity of 0.78, specificity of 0.80, LR+ of 3.88, and LR- of 0.28. A 77.5% probability of favorable outcome can be predicted by the presence of more than three of the five variables, while an 80% probability of unfavorable outcome can be expected if only three or fewer variables are present. Conclusion The use of prognostic factors may guide clinicians in identifying soldiers with LBP most likely to have a favorable outcome. Further validation studies are needed to determine if the variables identified in our study are treatment effect modifiers that can predict success following participation in the multi-station exercise program. Trial registration ClinicalTrials.gov Identifier: NCT03464877 registered retrospectively on 14 March 2018. |
| first_indexed | 2024-04-13T01:52:37Z |
| format | Article |
| id | doaj.art-2c8f2d17e8124aa587495eed3b7e8eb6 |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-04-13T01:52:37Z |
| publishDate | 2018-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-2c8f2d17e8124aa587495eed3b7e8eb62022-12-22T03:07:51ZengBMCBMC Musculoskeletal Disorders1471-24742018-04-0119111010.1186/s12891-018-2022-xPrognostic factors of a favorable outcome following a supervised exercise program for soldiers with sub-acute and chronic low back painMarc Perron0Chantal Gendron1Pierre Langevin2Jean Leblond3Marianne Roos4Jean-Sébastien Roy5Department of Rehabilitation, Faculty of Medicine, Université LavalDepartment of Rehabilitation, Faculty of Medicine, Université LavalDepartment of Rehabilitation, Faculty of Medicine, Université LavalCentre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS)Department of Rehabilitation, Faculty of Medicine, Université LavalDepartment of Rehabilitation, Faculty of Medicine, Université LavalAbstract Background Low back pain (LBP) encompasses heterogeneous patients unlikely to respond to a unique treatment. Identifying sub-groups of LBP may help to improve treatment outcomes. This is a hypothesis-setting study designed to create a clinical prediction rule (CPR) that will predict favorable outcomes in soldiers with sub-acute and chronic LBP participating in a multi-station exercise program. Methods Military members with LBP participated in a supervised program comprising 7 stations each consisting of exercises of increasing difficulty. Demographic, impairment and disability data were collected at baseline. The modified Oswestry Disability Index (ODI) was administered at baseline and following the 6-week program. An improvement of 50% in the initial ODI score was considered the reference standard to determine a favorable outcome. Univariate associations with favorable outcome were tested using chi-square or paired t-tests. Variables that showed between-group (favorable/unfavorable) differences were entered into a logistic regression after determining the sampling adequacy. Finally, continuous variables were dichotomized and the sensitivity, specificity and positive and negative likelihood ratios were determined for the model and for each variable. Results A sample of 85 participants was included in analyses. Five variables contributed to prediction of a favorable outcome: no pain in lying down (p = 0.017), no use of antidepressants (p = 0.061), FABQ work score < 22.5 (p = 0.061), fewer than 5 physiotherapy sessions before entering the program (p = 0.144) and less than 6 months’ work restriction (p = 0.161). This model yielded a sensitivity of 0.78, specificity of 0.80, LR+ of 3.88, and LR- of 0.28. A 77.5% probability of favorable outcome can be predicted by the presence of more than three of the five variables, while an 80% probability of unfavorable outcome can be expected if only three or fewer variables are present. Conclusion The use of prognostic factors may guide clinicians in identifying soldiers with LBP most likely to have a favorable outcome. Further validation studies are needed to determine if the variables identified in our study are treatment effect modifiers that can predict success following participation in the multi-station exercise program. Trial registration ClinicalTrials.gov Identifier: NCT03464877 registered retrospectively on 14 March 2018.http://link.springer.com/article/10.1186/s12891-018-2022-xLow back painClinical prediction ruleExercises |
| spellingShingle | Marc Perron Chantal Gendron Pierre Langevin Jean Leblond Marianne Roos Jean-Sébastien Roy Prognostic factors of a favorable outcome following a supervised exercise program for soldiers with sub-acute and chronic low back pain BMC Musculoskeletal Disorders Low back pain Clinical prediction rule Exercises |
| title | Prognostic factors of a favorable outcome following a supervised exercise program for soldiers with sub-acute and chronic low back pain |
| title_full | Prognostic factors of a favorable outcome following a supervised exercise program for soldiers with sub-acute and chronic low back pain |
| title_fullStr | Prognostic factors of a favorable outcome following a supervised exercise program for soldiers with sub-acute and chronic low back pain |
| title_full_unstemmed | Prognostic factors of a favorable outcome following a supervised exercise program for soldiers with sub-acute and chronic low back pain |
| title_short | Prognostic factors of a favorable outcome following a supervised exercise program for soldiers with sub-acute and chronic low back pain |
| title_sort | prognostic factors of a favorable outcome following a supervised exercise program for soldiers with sub acute and chronic low back pain |
| topic | Low back pain Clinical prediction rule Exercises |
| url | http://link.springer.com/article/10.1186/s12891-018-2022-x |
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