The use of nonorganic signs and symptoms as a screening tool for return-to-work in patients with acute low back pain

被引:22
作者
Fritz, JM
Wainner, RS
Hicks, GE
机构
[1] Univ Pittsburgh, Dept Phys Therapy, Pittsburgh, PA USA
[2] Univ Pittsburgh, Sch Hlth & Rehabil Sci, Pittsburgh, PA USA
关键词
nonorganic signs; abnormal illness behavior; prediction; screening tests;
D O I
10.1097/00007632-200008010-00010
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Study Design. A longitudinal cohort study of patients with acute, work-related low back pain undergoing physical therapy treatment. Objective. To determine cut-off values maximizing the predictive ability of the nonorganic signs and symptoms fn patients with acute, work-related low back pain and to It;calculate the predictive validity of the signs and symptoms, alone and in combination, using an outcome of f return to work within 4 weeks of initiating treatment. Summary of Background Data. Waddell et al have proposed nonorganic signs and symptoms as screening tools in patients with chronic low back pain for detecting the presence of abnormal illness behavior and identifying patients in need of further evaluation to improve the likelihood of a successful treatment outcome. Methods. Consecutive patients referred to physical therapy with work-related low back pain of less than 2 weeks' duration were examined for the presence of nonorganic signs and symptoms before initiating physical therapy treatment. The outcome measure used was the ability to return to work without restrictions within 4 weeks of the initial evaluation. Results. Sensitivity, specificity, and likelihood ratios were calculated for all possible cut-off values for the nonorganic signs, symptoms, and the nonorganic index (signs and symptoms). The best cut-off values were two or more signs (negative likelihood ratio = 0.75), three or more symptoms (negative likelihood ratio = 0.62), and an index score of three or more (negative likelihood ratio = 0.59). Area under a receiver operator characteristic curve for the signs, symptoms, and index were 0.60, 0.63, and 0.63, respectively. Conclusions, Because the nonorganic tests are purported to serve as screening tests, cut-off values were selected that minimized false-negative results. Even with optimal cut-off values, none of the nonorganic tests served as effective screening tools. Other screening tools may prove more effective for the early identification of patients at increased risk for delay in returning to work after an episode of acute low back pain.
引用
收藏
页码:1925 / 1931
页数:7
相关论文
共 37 条
  • [1] [Anonymous], SPINE S
  • [2] Bigos S., 1994, Clinical practice guideline
  • [3] RULING OUT OR RULING IN DISEASE WITH THE MOST SENSITIVE OR SPECIFIC DIAGNOSTIC-TEST - SHORT-CUT OR WRONG TURN
    BOYKO, EJ
    [J]. MEDICAL DECISION MAKING, 1994, 14 (02) : 175 - 179
  • [4] DO NONORGANIC SIGNS HELP TO PREDICT THE RETURN TO ACTIVITY OF PATIENTS WITH LOW-BACK-PAIN
    BRADISH, CF
    LLOYD, GJ
    ALDAM, CH
    ALBERT, J
    DYSON, P
    DOXEY, NCS
    MITSON, GL
    [J]. SPINE, 1988, 13 (05) : 557 - 560
  • [5] Back injury and work loss - Biomechanical and psychosocial influences
    Burton, AK
    [J]. SPINE, 1997, 22 (21) : 2575 - 2580
  • [6] PSYCHOSOCIAL PREDICTORS OF OUTCOME IN ACUTE AND SUBCHRONIC LOW-BACK TROUBLE
    BURTON, AK
    TILLOTSON, KM
    MAIN, CJ
    HOLLIS, S
    [J]. SPINE, 1995, 20 (06) : 722 - 728
  • [7] Predicting poor outcomes for back pain seen in primary care using patients' own criteria
    Cherkin, DC
    Deyo, RA
    Street, JH
    Barlow, W
    [J]. SPINE, 1996, 21 (24) : 2900 - 2907
  • [8] CLINICAL COURSE AND PROGNOSTIC FACTORS IN ACUTE LOW-BACK-PAIN - AN INCEPTION COHORT STUDY IN PRIMARY-CARE PRACTICE
    COSTE, J
    DELECOEUILLERIE, G
    DELARA, AC
    LEPARC, JM
    PAOLAGGI, JB
    [J]. BRITISH MEDICAL JOURNAL, 1994, 308 (6928) : 577 - 580
  • [9] A TREATMENT-BASED CLASSIFICATION APPROACH TO LOW-BACK SYNDROME - IDENTIFYING AND STAGING PATIENTS FOR CONSERVATIVE TREATMENT
    DELITTO, A
    ERHARD, RE
    BOWLING, R
    [J]. PHYSICAL THERAPY, 1995, 75 (06): : 470 - 485
  • [10] OUTCOME MEASURES FOR STUDYING PATIENTS WITH LOW-BACK-PAIN
    DEYO, RA
    ANDERSSON, G
    BOMBARDIER, C
    CHERKIN, DC
    KELLER, RB
    LEE, CK
    LIANG, MH
    LIPSCOMB, B
    SHEKELLE, P
    SPRATT, KF
    WEINSTEIN, JN
    [J]. SPINE, 1994, 19 (18) : S2032 - S2036