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Predictive factors for 1-year outcome of chronic low back pain following manipulation, stabilizing exercises, and physician consultation or physician consultation alone
Niemisto L, Sarna S, Lahtinen-Suopanki T, Lindgren K, Hurri H
Journal of Rehabilitation Medicine 2004 May;36(3):104-109
clinical trial
3/10 [Eligibility criteria: No; Random allocation: Yes; Concealed allocation: No; Baseline comparability: No; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: No. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVES: To examine the relative influences of sociodemographic and episode-specific factors on change in low back pain intensity and self-rated disability. METHODS: Of 204 patients with chronic low back pain, 102 were randomized to a combined manipulation, exercise and physician consultation group and 102 to a consultation-alone group. These groups were each divided into 2 clusters based on change in both pain intensity and self-rated disability at 1 year. The first cluster included patients whose symptoms clearly decreased, and the second those whose trouble persisted. Association between sociodemographic and episode-specific factors and poor recovery from low back pain and disability were evaluated by univariate and multivariate analysis. RESULTS: Severe affective distress (OR 3.81; 95% CI 1.3 to 10.8) predicted poor response to the manipulative treatment. Over a 25-day sick leave during previous year (19.64; 3.8 to 102.5), poor life control (9.40; 1.9 to 47.0), and generalized somatic symptoms (3.18; 0.9 to 11.6) were the risk factors for not benefiting from the informative approach. CONCLUSIONS: Psychosocial differences seem to be important determinants for treatment outcomes, and should be the focus of future studies.

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