Simple questionnaire helps predict prognosis in back pain patients

By Lucy Piper, Senior medwireNews Reporter

The Örebro Musculoskeletal Pain Questionnaire (ÖMPQ) and a prognostic assessment may help manual therapists identify patients with low-back pain (LBP) who are at risk for persistent problems following manual therapy, research indicates.

"Careful selection of patients based on early identification of risk factors for poor prognosis will enhance the possibility to address relevant factors and thereby improve treatment outcome in manual therapy practice," say H Dagfinrud (Diakonhjemmet Hospital, Oslo, Norway) and colleagues.

Their study found, however, that these methods were less able to predict long-term prognosis in patients with neck pain.

For the study, 157 patients, 81 with neck and 76 with LBP, completed the ÖMPQ and the low-back- or neck-specific Oswestry Disability index/Neck Disability Index as a reference before and 8 weeks after manual therapy.

The manual therapists also filled in their assessment of a patient's prognosis by rating the likelihood of the patient's function improving significantly in 8 weeks on a scale of 0 to 10, where 10 denotes functional improvement is certain.

The results, published in Manual Therapy, showed that for patients with LBP, the clinician's assessment predicted functional improvement with 56% specificity and 69% sensitivity, while the ÖMPQ predicted it with 78% specificity and 21% sensitivity.

Neither of the two methods showed high precision, the researchers acknowledge, but both contributed significantly to the prediction of functional outcome in regression models.

The predictive ability of the two models was almost equal, although, according to likelihood ratios, the clinician's assessment gave the best odds for predicting outcome in the patients with LBP.

"Thus, it seems that both GPs [general practitioners] and manual therapists have the ability to predict their patients prognosis, and this clinical knowledge should explicitly be utilized as an initial screening," Dagfinrud and team recommend.

"The more comprehensive ÖMPQ can thereafter be tailored to the most relevant patients, in order to provide more detailed information, needed to guide and support clinical decisions."

For patients with neck pain, however, the specificity for predicting improvement was 56% for the clinician's assessment tool and 86% for the ÖMPQ, while the sensitivity was 55% and 18%, respectively. Neither of the tools significantly contributed to the prediction of functional outcome in these patients.

"Such screening for neck patients seems to be more difficult," the team concludes.

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