40342
2017
2017
eng
11
postprint
1
--
2017-11-10
--
Development of a risk stratification and prevention index for stratified care in chronic low back pain. Focus: yellow flags (MiSpEx network)
Introduction: Chronic low back pain (LBP) is a major cause of disability; early diagnosis and stratification of care remain challenges.
Objectives: This article describes the development of a screening tool for the 1-year prognosis of patients with high chronic LBP risk (risk stratification index) and for treatment allocation according to treatment-modifiable yellow flag indicators (risk prevention indices, RPI-S).
Methods: Screening tools were derived from a multicentre longitudinal study (n = 1071, age >18, intermittent LBP). The greatest prognostic predictors of 4 flag domains ("pain," "distress," "social-environment," "medical care-environment") were determined using least absolute shrinkage and selection operator regression analysis. Internal validity and prognosis error were evaluated after 1-year follow-up. Receiver operating characteristic curves for discrimination (area under the curve) and cutoff values were determined.
Results: The risk stratification index identified persons with increased risk of chronic LBP and accurately estimated expected pain intensity and disability on the Pain Grade Questionnaire (0-100 points) up to 1 year later with an average prognosis error of 15 points. In addition, 3-risk classes were discerned with an accuracy of area under the curve = 0.74 (95% confidence interval 0.63-0.85). The RPI-S also distinguished persons with potentially modifiable prognostic indicators from 4 flag domains and stratified allocation to biopsychosocial treatments accordingly.
Conclusion: The screening tools, developed in compliance with the PROGRESS and TRIPOD statements, revealed good validation and prognostic strength. These tools improve on existing screening tools because of their utility for secondary preventions, incorporation of exercise effect modifiers, exact pain estimations, and personalized allocation to multimodal treatments.
urn:nbn:de:kobv:517-opus4-403424
online registration
Pain reports 9 (2017). - DOI: 10.1097/PR9.0000000000000623
<a href="http://publishup.uni-potsdam.de/opus4-ubp/frontdoor/index/index/docId/40341">Bibliographieeintrag der Originalveröffentlichung/Quelle</a>
CC-BY - Namensnennung 4.0 International
Pia-Maria Wippert
Anne-Katrin Puschmann
David Drießlein
Adamantios Arampatzis
Winfried Banzer
Heidrun Beck
Marcus Schiltenwolf
Hendrik Schmidt
Christian Schneider
Frank Mayer
Zweitveröffentlichungen der Universität Potsdam : Humanwissenschaftliche Reihe
351
eng
uncontrolled
Back pain prognosis
eng
uncontrolled
Back pain diagnosis
eng
uncontrolled
Pain screening
eng
uncontrolled
PROGRESS/TRIPOD
eng
uncontrolled
Prediction of disability/intensity
eng
uncontrolled
Yellow flags
eng
uncontrolled
Exercise
Medizin und Gesundheit
open_access
Strukturbereich Kognitionswissenschaften
Referiert
Open Access
Universität Potsdam
https://publishup.uni-potsdam.de/files/40342/phr351_online.pdf
40341
2017
2017
eng
1
11
9
article
Wolters Kluwer Health
Riverwoods, IL
1
--
2017-09-28
--
Development of a risk stratification and prevention index for stratified care in chronic low back pain. Focus: yellow flags (MiSpEx network)
Introduction: Chronic low back pain (LBP) is a major cause of disability; early diagnosis and stratification of care remain challenges.
Objectives: This article describes the development of a screening tool for the 1-year prognosis of patients with high chronic LBP risk (risk stratification index) and for treatment allocation according to treatment-modifiable yellow flag indicators (risk prevention indices, RPI-S).
Methods: Screening tools were derived from a multicentre longitudinal study (n = 1071, age >18, intermittent LBP). The greatest prognostic predictors of 4 flag domains ("pain," "distress," "social-environment," "medical care-environment") were determined using least absolute shrinkage and selection operator regression analysis. Internal validity and prognosis error were evaluated after 1-year follow-up. Receiver operating characteristic curves for discrimination (area under the curve) and cutoff values were determined.
Results: The risk stratification index identified persons with increased risk of chronic LBP and accurately estimated expected pain intensity and disability on the Pain Grade Questionnaire (0-100 points) up to 1 year later with an average prognosis error of 15 points. In addition, 3-risk classes were discerned with an accuracy of area under the curve = 0.74 (95% confidence interval 0.63-0.85). The RPI-S also distinguished persons with potentially modifiable prognostic indicators from 4 flag domains and stratified allocation to biopsychosocial treatments accordingly.
Conclusion: The screening tools, developed in compliance with the PROGRESS and TRIPOD statements, revealed good validation and prognostic strength. These tools improve on existing screening tools because of their utility for secondary preventions, incorporation of exercise effect modifiers, exact pain estimations, and personalized allocation to multimodal treatments.
Pain reports
10.1097/PR9.0000000000000623
Universität Potsdam, Publikationsfonds
PA 2017_48
1955.75
online registration
e623
<a href="http://nbn-resolving.de/urn:nbn:de:kobv:517-opus4-403424">Zweitveröffentlichung in der Schriftenreihe Postprints der Universität Potsdam : Humanwissenschaftliche Reihe ; 351</a>
CC-BY - Namensnennung 4.0 International
Pia-Maria Wippert
Anne-Katrin Puschmann
David Drießlein
Adamantios Arampatzis
Winfried Banzer
Heidrun Beck
Marcus Schiltenwolf
Hendrik Schmidt
Christian Schneider
Frank Mayer
eng
uncontrolled
Back pain prognosis
eng
uncontrolled
Back pain diagnosis
eng
uncontrolled
Pain screening
eng
uncontrolled
PROGRESS/TRIPOD
eng
uncontrolled
Prediction of disability/intensity
eng
uncontrolled
Yellow flags
eng
uncontrolled
Exercise
Medizin und Gesundheit
Strukturbereich Kognitionswissenschaften
Referiert
Publikationsfonds der Universität Potsdam
Open Access
Universität Potsdam