A multisite longitudinal evaluation of patient characteristics associated with a poor response to non-surgical multidisciplinary management of low back pain in an advanced practice physiotherapist-led tertiary service

Shaun O'Leary; Maree Raymer; Peter Window; Patrick Swete Kelly; Darryl Lee; Linda Garsden; Rebecca Tweedy; Ben Phillips; Will O'Sullivan; Anneke Wake; Alison Smith; Sheryl Pahor; Luen Pearce; Rod McLean; David Thompson; Erica Williams; Damien Nolan; Jody Anning; Ian Seels; Daniel Wickins; Darryn Marks; Brendan Diplock; Vicki Parravicini; Linda Parnwell; Bill Vicenzino; Tracy Comans; Michelle Cottrell; Asaduzzaman Khan; Steven McPhail

doi:10.1186/s12891-020-03839-5

A multisite longitudinal evaluation of patient characteristics associated with a poor response to non-surgical multidisciplinary management of low back pain in an advanced practice physiotherapist-led tertiary service

Shaun O'Leary, Maree Raymer, Peter Window, Patrick Swete Kelly, Darryl Lee, Linda Garsden, Rebecca Tweedy, Ben Phillips, Will O'Sullivan, Anneke Wake, Alison Smith, Sheryl Pahor, Luen Pearce, Rod McLean, David Thompson, Erica Williams, Damien Nolan, Jody Anning, Ian Seels, Daniel WickinsDarryn Marks, Brendan Diplock, Vicki Parravicini, Linda Parnwell, Bill Vicenzino, Tracy Comans, Michelle Cottrell, Asaduzzaman Khan, Steven McPhail

Faculty of Health Sciences & Medicine

Research output: Contribution to journal › Article › Research › peer-review

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Abstract

BACKGROUND: Non-surgical multidisciplinary management is often the first pathway of care for patients with chronic low back pain (LBP). This study explores if patient characteristics recorded at the initial service examination have an association with a poor response to this pathway of care in an advanced practice physiotherapist-led tertiary service.

METHODS: Two hundred and forty nine patients undergoing non-surgical multidisciplinary management for their LBP across 8 tertiary public hospitals in Queensland, Australia participated in this prospective longitudinal study. Generalised linear models (logistic family) examined the relationship between patient characteristics and a poor response at 6 months follow-up using a Global Rating of Change measure.

RESULTS: Overall 79 of the 178 (44%) patients completing the Global Rating of Change measure (28.5% loss to follow-up) reported a poor outcome. Patient characteristics retained in the final model associated with a poor response included lower Formal Education Level (ie did not complete school) (Odds Ratio (OR (95% confidence interval)) (2.67 (1.17-6.09), p = 0.02) and higher self-reported back disability (measured with the Oswestry Disability Index) (OR 1.33 (1.01-1.77) per 10/100 point score increase, p = 0.046).

CONCLUSIONS: A low level of formal education and high level of self-reported back disability may be associated with a poor response to non-surgical multidisciplinary management of LBP in tertiary care. Patients with these characteristics may need greater assistance with regard to their comprehension of health information, and judicious monitoring of their response to facilitate timely alternative care if no benefits are attained.

Original language	English
Article number	807
Journal	BMC Musculoskeletal Disorders
Volume	21
Issue number	1
DOIs	https://doi.org/10.1186/s12891-020-03839-5
Publication status	Published - 3 Dec 2020

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O'Leary, S., Raymer, M., Window, P., Swete Kelly, P., Lee, D., Garsden, L., Tweedy, R., Phillips, B., O'Sullivan, W., Wake, A., Smith, A., Pahor, S., Pearce, L., McLean, R., Thompson, D., Williams, E., Nolan, D., Anning, J., Seels, I., ... McPhail, S. (2020). A multisite longitudinal evaluation of patient characteristics associated with a poor response to non-surgical multidisciplinary management of low back pain in an advanced practice physiotherapist-led tertiary service. BMC Musculoskeletal Disorders, 21(1), Article 807. https://doi.org/10.1186/s12891-020-03839-5

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title = "A multisite longitudinal evaluation of patient characteristics associated with a poor response to non-surgical multidisciplinary management of low back pain in an advanced practice physiotherapist-led tertiary service",

abstract = "BACKGROUND: Non-surgical multidisciplinary management is often the first pathway of care for patients with chronic low back pain (LBP). This study explores if patient characteristics recorded at the initial service examination have an association with a poor response to this pathway of care in an advanced practice physiotherapist-led tertiary service.METHODS: Two hundred and forty nine patients undergoing non-surgical multidisciplinary management for their LBP across 8 tertiary public hospitals in Queensland, Australia participated in this prospective longitudinal study. Generalised linear models (logistic family) examined the relationship between patient characteristics and a poor response at 6 months follow-up using a Global Rating of Change measure.RESULTS: Overall 79 of the 178 (44%) patients completing the Global Rating of Change measure (28.5% loss to follow-up) reported a poor outcome. Patient characteristics retained in the final model associated with a poor response included lower Formal Education Level (ie did not complete school) (Odds Ratio (OR (95% confidence interval)) (2.67 (1.17-6.09), p = 0.02) and higher self-reported back disability (measured with the Oswestry Disability Index) (OR 1.33 (1.01-1.77) per 10/100 point score increase, p = 0.046).CONCLUSIONS: A low level of formal education and high level of self-reported back disability may be associated with a poor response to non-surgical multidisciplinary management of LBP in tertiary care. Patients with these characteristics may need greater assistance with regard to their comprehension of health information, and judicious monitoring of their response to facilitate timely alternative care if no benefits are attained.",

author = "Shaun O'Leary and Maree Raymer and Peter Window and {Swete Kelly}, Patrick and Darryl Lee and Linda Garsden and Rebecca Tweedy and Ben Phillips and Will O'Sullivan and Anneke Wake and Alison Smith and Sheryl Pahor and Luen Pearce and Rod McLean and David Thompson and Erica Williams and Damien Nolan and Jody Anning and Ian Seels and Daniel Wickins and Darryn Marks and Brendan Diplock and Vicki Parravicini and Linda Parnwell and Bill Vicenzino and Tracy Comans and Michelle Cottrell and Asaduzzaman Khan and Steven McPhail",

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O'Leary, S, Raymer, M, Window, P, Swete Kelly, P, Lee, D, Garsden, L, Tweedy, R, Phillips, B, O'Sullivan, W, Wake, A, Smith, A, Pahor, S, Pearce, L, McLean, R, Thompson, D, Williams, E, Nolan, D, Anning, J, Seels, I, Wickins, D, Marks, D, Diplock, B, Parravicini, V, Parnwell, L, Vicenzino, B, Comans, T, Cottrell, M, Khan, A & McPhail, S 2020, 'A multisite longitudinal evaluation of patient characteristics associated with a poor response to non-surgical multidisciplinary management of low back pain in an advanced practice physiotherapist-led tertiary service', BMC Musculoskeletal Disorders, vol. 21, no. 1, 807. https://doi.org/10.1186/s12891-020-03839-5

A multisite longitudinal evaluation of patient characteristics associated with a poor response to non-surgical multidisciplinary management of low back pain in an advanced practice physiotherapist-led tertiary service. / O'Leary, Shaun; Raymer, Maree; Window, Peter et al.
In: BMC Musculoskeletal Disorders, Vol. 21, No. 1, 807, 03.12.2020.

Research output: Contribution to journal › Article › Research › peer-review

TY - JOUR

T1 - A multisite longitudinal evaluation of patient characteristics associated with a poor response to non-surgical multidisciplinary management of low back pain in an advanced practice physiotherapist-led tertiary service

AU - O'Leary, Shaun

AU - Raymer, Maree

AU - Window, Peter

AU - Swete Kelly, Patrick

AU - Lee, Darryl

AU - Garsden, Linda

AU - Tweedy, Rebecca

AU - Phillips, Ben

AU - O'Sullivan, Will

AU - Wake, Anneke

AU - Smith, Alison

AU - Pahor, Sheryl

AU - Pearce, Luen

AU - McLean, Rod

AU - Thompson, David

AU - Williams, Erica

AU - Nolan, Damien

AU - Anning, Jody

AU - Seels, Ian

AU - Wickins, Daniel

AU - Marks, Darryn

AU - Diplock, Brendan

AU - Parravicini, Vicki

AU - Parnwell, Linda

AU - Vicenzino, Bill

AU - Comans, Tracy

AU - Cottrell, Michelle

AU - Khan, Asaduzzaman

AU - McPhail, Steven

PY - 2020/12/3

Y1 - 2020/12/3

N2 - BACKGROUND: Non-surgical multidisciplinary management is often the first pathway of care for patients with chronic low back pain (LBP). This study explores if patient characteristics recorded at the initial service examination have an association with a poor response to this pathway of care in an advanced practice physiotherapist-led tertiary service.METHODS: Two hundred and forty nine patients undergoing non-surgical multidisciplinary management for their LBP across 8 tertiary public hospitals in Queensland, Australia participated in this prospective longitudinal study. Generalised linear models (logistic family) examined the relationship between patient characteristics and a poor response at 6 months follow-up using a Global Rating of Change measure.RESULTS: Overall 79 of the 178 (44%) patients completing the Global Rating of Change measure (28.5% loss to follow-up) reported a poor outcome. Patient characteristics retained in the final model associated with a poor response included lower Formal Education Level (ie did not complete school) (Odds Ratio (OR (95% confidence interval)) (2.67 (1.17-6.09), p = 0.02) and higher self-reported back disability (measured with the Oswestry Disability Index) (OR 1.33 (1.01-1.77) per 10/100 point score increase, p = 0.046).CONCLUSIONS: A low level of formal education and high level of self-reported back disability may be associated with a poor response to non-surgical multidisciplinary management of LBP in tertiary care. Patients with these characteristics may need greater assistance with regard to their comprehension of health information, and judicious monitoring of their response to facilitate timely alternative care if no benefits are attained.

AB - BACKGROUND: Non-surgical multidisciplinary management is often the first pathway of care for patients with chronic low back pain (LBP). This study explores if patient characteristics recorded at the initial service examination have an association with a poor response to this pathway of care in an advanced practice physiotherapist-led tertiary service.METHODS: Two hundred and forty nine patients undergoing non-surgical multidisciplinary management for their LBP across 8 tertiary public hospitals in Queensland, Australia participated in this prospective longitudinal study. Generalised linear models (logistic family) examined the relationship between patient characteristics and a poor response at 6 months follow-up using a Global Rating of Change measure.RESULTS: Overall 79 of the 178 (44%) patients completing the Global Rating of Change measure (28.5% loss to follow-up) reported a poor outcome. Patient characteristics retained in the final model associated with a poor response included lower Formal Education Level (ie did not complete school) (Odds Ratio (OR (95% confidence interval)) (2.67 (1.17-6.09), p = 0.02) and higher self-reported back disability (measured with the Oswestry Disability Index) (OR 1.33 (1.01-1.77) per 10/100 point score increase, p = 0.046).CONCLUSIONS: A low level of formal education and high level of self-reported back disability may be associated with a poor response to non-surgical multidisciplinary management of LBP in tertiary care. Patients with these characteristics may need greater assistance with regard to their comprehension of health information, and judicious monitoring of their response to facilitate timely alternative care if no benefits are attained.

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DO - 10.1186/s12891-020-03839-5

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C2 - 33272228

SN - 1471-2474

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JO - BMC Musculoskeletal Disorders

JF - BMC Musculoskeletal Disorders

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O'Leary S, Raymer M, Window P, Swete Kelly P, Lee D, Garsden L et al. A multisite longitudinal evaluation of patient characteristics associated with a poor response to non-surgical multidisciplinary management of low back pain in an advanced practice physiotherapist-led tertiary service. BMC Musculoskeletal Disorders. 2020 Dec 3;21(1):807. doi: 10.1186/s12891-020-03839-5