Predictive factors for a successful outcome 1 year after treatment

Predictive factors for a successful outcome 1 year after an intensive combined physical and psychological programme for chronic low back pain

van Hooff, M. L., Spruit, M., O’Dowd, J. K., van Lankveld, W., Fairbank, J. C., & van Limbeek, J. (2014). Predictive factors for successful clinical outcome 1 year after an intensive combined physical and psychological programme for chronic low back pain. European Spine Journal, 23(1), 102-112.

What is the research about?

This research sought to determine: for whom does the RealHealth intensive treatment programme work best? If you can predict in advance who is most likely to succeed, you can better select patients and advise them on which treatment is most suitable for them.

How was the study conducted?

A total of 524 patients with chronic low back pain participated in this study, all of whom took part in the intensive pain management programme. Before treatment, the researchers collected all kinds of information: demographic data, degree of limitations, pain and psychological factors. A year later, they looked at which patients had been treated “successfully”. Successful meant functioning at the level of healthy people (ODI score ≤22). Using statistical analyses, they looked for factors that predicted who would reach this level.

The results:

Two factors predicted a successful outcome:

• Still being employed at the start increased the chance of success by 3.6 times

• A lower disability score at the start (mild to moderate disability, rather than severe disability) slightly increased the chance of success, but to a lesser extent than being employed

These two simple factors made it possible to correctly predict whether 67% of patients would be successful.

Notably, pain intensity or psychological factors such as anxiety or depression prior to the start of treatment did NOT predict who would be successful.

What is special about this?

This study shows that the programme works best for people who are still working and are mildly to moderately limited by their back pain. For this group, there is a good chance that they will function like healthy people again after the programme. These two easily identifiable factors can help doctors offer patients the right treatment.

What does this mean in practical terms?

Are you still (partly) working (even if it is difficult) and do you have chronic back pain that hinders you on a daily basis but does not completely incapacitate you? Then you have a good chance of recovering to a normal level of functioning with this programme. Have you been completely unable to work for a long time and are you severely limited? Then this programme may be less suitable. This knowledge helps to better advise patients in advance and create realistic expectations.

^{Abbreviations used
ODI (Oswestry Disability Index): Questionnaire that measures how much impact your back pain has on daily activities;}