Identification of Patients With Chronic Low Back Pain Who Might Benefit From Additional Psychological Assessment
OBJECTIVESTo identify signs and symptoms that should alert clinicians to the need for additional psychological assessment in patients with chronic low back pain (CLBP). METHODSIn this prospective cohort study, 229 consecutive patients with CLBP who attended an outpatient rehabilitation center were a...
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| Veröffentlicht in: | The Clinical journal of pain 2012-01, Vol.28 (1), p.23-31 |
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| container_title | The Clinical journal of pain |
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| creator | Apeldoorn, Adri T Bosselaar, Henk Ostelo, Raymond W Blom-Luberti, Tanja van der Ploeg, Tjeerd Fritz, Julie M de Vet, Henrica C W van Tulder, Maurits W |
| description | OBJECTIVESTo identify signs and symptoms that should alert clinicians to the need for additional psychological assessment in patients with chronic low back pain (CLBP).
METHODSIn this prospective cohort study, 229 consecutive patients with CLBP who attended an outpatient rehabilitation center were assessed by psychologists and physical therapists before their treatment started. The signs and symptoms assessed by the physical therapists were compared with the assessments made by the psychologists, which were considered to be the reference standard (relevant psychological disturbances, yes or no). Univariable and multivariable regression methods were applied to investigate which signs and symptoms were associated with the reference standard. A receiver operator characteristic (ROC) curve was constructed to assess the overall accuracy of the final model.
RESULTSThe psychologists classified 53% of the patients as having relevant psychological disturbances. Univariable analysis revealed statistically significant differences (P |
| doi_str_mv | 10.1097/AJP.0b013e31822019d0 |
| format | Article |
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METHODSIn this prospective cohort study, 229 consecutive patients with CLBP who attended an outpatient rehabilitation center were assessed by psychologists and physical therapists before their treatment started. The signs and symptoms assessed by the physical therapists were compared with the assessments made by the psychologists, which were considered to be the reference standard (relevant psychological disturbances, yes or no). Univariable and multivariable regression methods were applied to investigate which signs and symptoms were associated with the reference standard. A receiver operator characteristic (ROC) curve was constructed to assess the overall accuracy of the final model.
RESULTSThe psychologists classified 53% of the patients as having relevant psychological disturbances. Univariable analysis revealed statistically significant differences (P<0.05) between the 2 patient groups (relevant psychological disturbances, yes or no) for 10 of the 17 signs and symptoms. Multivariate analysis yielded a screening instrument consisting of the following 4 signs and symptomspresence of Waddell signs, elevated scores on the pain drawing, absence of a directional preference, and daily use of analgesic medication for CLBP [area under the ROC curve, 0.81 (95% confidence interval0.75, 0.87)].
DISCUSSIONThis study established a clinically useful screening instrument for the identification of patients with CLBP who might benefit from additional psychological assessment in an outpatient rehabilitation setting. Further research is needed to confirm our preliminary results.</description><identifier>ISSN: 0749-8047</identifier><identifier>EISSN: 1536-5409</identifier><identifier>DOI: 10.1097/AJP.0b013e31822019d0</identifier><identifier>PMID: 21677570</identifier><identifier>CODEN: CJPAEU</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins, Inc</publisher><subject>Activities of Daily Living ; Adult ; Biological and medical sciences ; Chronic Disease ; Cohort Studies ; Female ; Fundamental and applied biological sciences. Psychology ; Humans ; Low Back Pain - complications ; Low Back Pain - diagnosis ; Low Back Pain - rehabilitation ; Male ; Medical sciences ; Middle Aged ; Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis ; Neurology ; Pain Measurement ; Physical Therapists ; Predictive Value of Tests ; Psychological Tests ; Psychophysiologic Disorders - diagnosis ; Psychophysiologic Disorders - etiology ; Psychophysiologic Disorders - psychology ; Psychophysiologic Disorders - rehabilitation ; Reference Values ; Rehabilitation Centers ; Retrospective Studies ; ROC Curve ; Somesthesis and somesthetic pathways (proprioception, exteroception, nociception); interoception; electrolocation. Sensory receptors ; Surveys and Questionnaires ; Vertebrates: nervous system and sense organs</subject><ispartof>The Clinical journal of pain, 2012-01, Vol.28 (1), p.23-31</ispartof><rights>2012 Lippincott Williams & Wilkins, Inc.</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3850-c38f9e1fbba6c7092bd94c728907b6f6a1dad528eb66f3ec398356299bebf0943</citedby><cites>FETCH-LOGICAL-c3850-c38f9e1fbba6c7092bd94c728907b6f6a1dad528eb66f3ec398356299bebf0943</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,4023,27922,27923,27924</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25493770$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21677570$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Apeldoorn, Adri T</creatorcontrib><creatorcontrib>Bosselaar, Henk</creatorcontrib><creatorcontrib>Ostelo, Raymond W</creatorcontrib><creatorcontrib>Blom-Luberti, Tanja</creatorcontrib><creatorcontrib>van der Ploeg, Tjeerd</creatorcontrib><creatorcontrib>Fritz, Julie M</creatorcontrib><creatorcontrib>de Vet, Henrica C W</creatorcontrib><creatorcontrib>van Tulder, Maurits W</creatorcontrib><title>Identification of Patients With Chronic Low Back Pain Who Might Benefit From Additional Psychological Assessment</title><title>The Clinical journal of pain</title><addtitle>Clin J Pain</addtitle><description>OBJECTIVESTo identify signs and symptoms that should alert clinicians to the need for additional psychological assessment in patients with chronic low back pain (CLBP).
METHODSIn this prospective cohort study, 229 consecutive patients with CLBP who attended an outpatient rehabilitation center were assessed by psychologists and physical therapists before their treatment started. The signs and symptoms assessed by the physical therapists were compared with the assessments made by the psychologists, which were considered to be the reference standard (relevant psychological disturbances, yes or no). Univariable and multivariable regression methods were applied to investigate which signs and symptoms were associated with the reference standard. A receiver operator characteristic (ROC) curve was constructed to assess the overall accuracy of the final model.
RESULTSThe psychologists classified 53% of the patients as having relevant psychological disturbances. Univariable analysis revealed statistically significant differences (P<0.05) between the 2 patient groups (relevant psychological disturbances, yes or no) for 10 of the 17 signs and symptoms. Multivariate analysis yielded a screening instrument consisting of the following 4 signs and symptomspresence of Waddell signs, elevated scores on the pain drawing, absence of a directional preference, and daily use of analgesic medication for CLBP [area under the ROC curve, 0.81 (95% confidence interval0.75, 0.87)].
DISCUSSIONThis study established a clinically useful screening instrument for the identification of patients with CLBP who might benefit from additional psychological assessment in an outpatient rehabilitation setting. Further research is needed to confirm our preliminary results.</description><subject>Activities of Daily Living</subject><subject>Adult</subject><subject>Biological and medical sciences</subject><subject>Chronic Disease</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Humans</subject><subject>Low Back Pain - complications</subject><subject>Low Back Pain - diagnosis</subject><subject>Low Back Pain - rehabilitation</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis</subject><subject>Neurology</subject><subject>Pain Measurement</subject><subject>Physical Therapists</subject><subject>Predictive Value of Tests</subject><subject>Psychological Tests</subject><subject>Psychophysiologic Disorders - diagnosis</subject><subject>Psychophysiologic Disorders - etiology</subject><subject>Psychophysiologic Disorders - psychology</subject><subject>Psychophysiologic Disorders - rehabilitation</subject><subject>Reference Values</subject><subject>Rehabilitation Centers</subject><subject>Retrospective Studies</subject><subject>ROC Curve</subject><subject>Somesthesis and somesthetic pathways (proprioception, exteroception, nociception); interoception; electrolocation. Sensory receptors</subject><subject>Surveys and Questionnaires</subject><subject>Vertebrates: nervous system and sense organs</subject><issn>0749-8047</issn><issn>1536-5409</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kEFv2yAUx9G0ac26fYNp4jLtlPZhjDHHNGrXTpmaQ6ceLcCPmtU2GTiK-u1HmmyTetgFEPzen_d-hHxkcMZAyfPFt_UZGGAcOauLAphq4RWZMcGruShBvSYzkKWa11DKE_IupZ8ATBQ1vCUnBaukFBJmZHPT4jh5562efBhpcHSdT_ku0Xs_dXTZxTB6S1dhRy-0fczPfqT3XaDf_UM30Qsc0fmJXsUw0EXb-n2M7uk6Pdku9OEhJ_d0kRKmNOTY9-SN033CD8f9lPy4urxbXs9Xt19vlovV3PJawH51CpkzRldWgipMq0ori1qBNJWrNGt1m6dBU1WOo-Wq5qIqlDJoHKiSn5Ivh9xNDL-2mKZm8Mli3-sRwzY1ikkmlKghk-WBtDGkFNE1m-gHHZ8aBs1edZNVNy9V57JPxw-2ZsD2b9Eftxn4fAR0yg5c1KP16R8nSsXlM1cfuF3oJ4zpsd_uMDYd6n7q_t_Db106mgE</recordid><startdate>201201</startdate><enddate>201201</enddate><creator>Apeldoorn, Adri T</creator><creator>Bosselaar, Henk</creator><creator>Ostelo, Raymond W</creator><creator>Blom-Luberti, Tanja</creator><creator>van der Ploeg, Tjeerd</creator><creator>Fritz, Julie M</creator><creator>de Vet, Henrica C W</creator><creator>van Tulder, Maurits W</creator><general>Lippincott Williams & Wilkins, Inc</general><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201201</creationdate><title>Identification of Patients With Chronic Low Back Pain Who Might Benefit From Additional Psychological Assessment</title><author>Apeldoorn, Adri T ; Bosselaar, Henk ; Ostelo, Raymond W ; Blom-Luberti, Tanja ; van der Ploeg, Tjeerd ; Fritz, Julie M ; de Vet, Henrica C W ; van Tulder, Maurits W</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3850-c38f9e1fbba6c7092bd94c728907b6f6a1dad528eb66f3ec398356299bebf0943</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Activities of Daily Living</topic><topic>Adult</topic><topic>Biological and medical sciences</topic><topic>Chronic Disease</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Humans</topic><topic>Low Back Pain - complications</topic><topic>Low Back Pain - diagnosis</topic><topic>Low Back Pain - rehabilitation</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis</topic><topic>Neurology</topic><topic>Pain Measurement</topic><topic>Physical Therapists</topic><topic>Predictive Value of Tests</topic><topic>Psychological Tests</topic><topic>Psychophysiologic Disorders - diagnosis</topic><topic>Psychophysiologic Disorders - etiology</topic><topic>Psychophysiologic Disorders - psychology</topic><topic>Psychophysiologic Disorders - rehabilitation</topic><topic>Reference Values</topic><topic>Rehabilitation Centers</topic><topic>Retrospective Studies</topic><topic>ROC Curve</topic><topic>Somesthesis and somesthetic pathways (proprioception, exteroception, nociception); interoception; electrolocation. Sensory receptors</topic><topic>Surveys and Questionnaires</topic><topic>Vertebrates: nervous system and sense organs</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Apeldoorn, Adri T</creatorcontrib><creatorcontrib>Bosselaar, Henk</creatorcontrib><creatorcontrib>Ostelo, Raymond W</creatorcontrib><creatorcontrib>Blom-Luberti, Tanja</creatorcontrib><creatorcontrib>van der Ploeg, Tjeerd</creatorcontrib><creatorcontrib>Fritz, Julie M</creatorcontrib><creatorcontrib>de Vet, Henrica C W</creatorcontrib><creatorcontrib>van Tulder, Maurits W</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Clinical journal of pain</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Apeldoorn, Adri T</au><au>Bosselaar, Henk</au><au>Ostelo, Raymond W</au><au>Blom-Luberti, Tanja</au><au>van der Ploeg, Tjeerd</au><au>Fritz, Julie M</au><au>de Vet, Henrica C W</au><au>van Tulder, Maurits W</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Identification of Patients With Chronic Low Back Pain Who Might Benefit From Additional Psychological Assessment</atitle><jtitle>The Clinical journal of pain</jtitle><addtitle>Clin J Pain</addtitle><date>2012-01</date><risdate>2012</risdate><volume>28</volume><issue>1</issue><spage>23</spage><epage>31</epage><pages>23-31</pages><issn>0749-8047</issn><eissn>1536-5409</eissn><coden>CJPAEU</coden><abstract>OBJECTIVESTo identify signs and symptoms that should alert clinicians to the need for additional psychological assessment in patients with chronic low back pain (CLBP).
METHODSIn this prospective cohort study, 229 consecutive patients with CLBP who attended an outpatient rehabilitation center were assessed by psychologists and physical therapists before their treatment started. The signs and symptoms assessed by the physical therapists were compared with the assessments made by the psychologists, which were considered to be the reference standard (relevant psychological disturbances, yes or no). Univariable and multivariable regression methods were applied to investigate which signs and symptoms were associated with the reference standard. A receiver operator characteristic (ROC) curve was constructed to assess the overall accuracy of the final model.
RESULTSThe psychologists classified 53% of the patients as having relevant psychological disturbances. Univariable analysis revealed statistically significant differences (P<0.05) between the 2 patient groups (relevant psychological disturbances, yes or no) for 10 of the 17 signs and symptoms. Multivariate analysis yielded a screening instrument consisting of the following 4 signs and symptomspresence of Waddell signs, elevated scores on the pain drawing, absence of a directional preference, and daily use of analgesic medication for CLBP [area under the ROC curve, 0.81 (95% confidence interval0.75, 0.87)].
DISCUSSIONThis study established a clinically useful screening instrument for the identification of patients with CLBP who might benefit from additional psychological assessment in an outpatient rehabilitation setting. Further research is needed to confirm our preliminary results.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins, Inc</pub><pmid>21677570</pmid><doi>10.1097/AJP.0b013e31822019d0</doi><tpages>9</tpages></addata></record> |
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| subjects | Activities of Daily Living Adult Biological and medical sciences Chronic Disease Cohort Studies Female Fundamental and applied biological sciences. Psychology Humans Low Back Pain - complications Low Back Pain - diagnosis Low Back Pain - rehabilitation Male Medical sciences Middle Aged Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis Neurology Pain Measurement Physical Therapists Predictive Value of Tests Psychological Tests Psychophysiologic Disorders - diagnosis Psychophysiologic Disorders - etiology Psychophysiologic Disorders - psychology Psychophysiologic Disorders - rehabilitation Reference Values Rehabilitation Centers Retrospective Studies ROC Curve Somesthesis and somesthetic pathways (proprioception, exteroception, nociception) interoception electrolocation. Sensory receptors Surveys and Questionnaires Vertebrates: nervous system and sense organs |
| title | Identification of Patients With Chronic Low Back Pain Who Might Benefit From Additional Psychological Assessment |
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