2022, Article / Letter to editor (BMC Musculoskeletal Disorders, (2022))Background
While low back pain occurs in nearly everybody and is the leading cause of disability worldwide, we lack instruments to accurately predict persistence of acute low back pain. We aimed to develop and internally validate a machine learning model predicting non-recovery in acute low back pain and to compare this with current practice and ‘traditional’ prediction modeling.
Methods
Prognostic cohort-study in primary care physiotherapy. Patients (n = 247) with acute low back pain (≤ one month) consulting physiotherapists were included. Candidate predictors were assessed by questionnaire at baseline and (to capture early recovery) after one and two weeks. Primary outcome was non-recovery after three months, defined as at least mild pain (Numeric Rating Scale > 2/10). Machine learning models to predict non-recovery were developed and internally validated, and compared with two current practices in physiotherapy (STarT Back tool and physiotherapists’ expectation) and ‘traditional’ logistic regression analysis.
Results
Forty-seven percent of the participants did not recover at three months. The best performing machine learning model showed acceptable predictive performance (area under the curve: 0.66). Although this was no better than a’traditional’ logistic regression model, it outperformed current practice.
Conclusions
We developed two prognostic models containing partially different predictors, with acceptable performance for predicting (non-)recovery in patients with acute LBP, which was better than current practice. Our prognostic models have the potential of integration in a clinical decision support system to facilitate data-driven, personalized treatment of acute low back pain, but needs external validation first.
2021, Article / Letter to editor (Journal of Pain, (2021))It is widely accepted that psychosocial prognostic factors should be addressed by clinicians in their assessment and management of patient suffering from low back pain (LBP). On the other hand, an overview is missing how these factors are addressed in clinical LBP guidelines. Therefore, our objective was to summarize and compare recommendations regarding the assessment and management of psychosocial prognostic factors for LBP chronicity, as reported in clinical LBP guidelines. We performed a systematic search of clinical LBP guidelines (PROSPERO registration number 154730). This search consisted of a combination of previously published systematic review articles and a new systematic search in medical or guideline-related databases. From the included guidelines, we extracted recommendations regarding the assessment and management of LBP which addressed psychosocial prognostic factors (i.e., psychological factors ('yellow flags'), perceptions about the relationship between work and health, ('blue flags'), system or contextual obstacles ('black flags') and psychiatric symptoms ('orange flags')). In addition, we evaluated the level or quality of evidence of these recommendations. In total, we included 15 guidelines. Psychosocial prognostic factors were addressed in 13/15 guidelines regarding their assessment and in 14/15 guidelines regarding their management. Recommendations addressing psychosocial factors almost exclusively concerned 'yellow' or 'black flags', and varied widely across guidelines. The supporting evidence was generally of very low quality. We conclude that in general, clinical LBP guidelines do not provide clinicians with clear instructions about how to incorporate psychosocial factors in LBP care and should be optimized in this respect. More specifically, clinical guidelines vary widely in whether and how they address psychosocial factors, and recommendations regarding these factors generally require better evidence support. This emphasizes a need for a stronger evidence-base underlying the role of psychosocial risk factors within LBP care, and a need for uniformity in methodology and terminology across guidelines. Perspective This systematic review summarized clinical guidelines on low back pain (LBP) on how they addressed the identification and management of psychosocial factors. This review revealed a large amount of variety across guidelines in whether and how psychosocial factors were addressed. Moreover, recommendations generally lacked details and were based on low quality evidence.
2021, Article / Letter to editor (European Journal of Physiotherapy, (2021))Purpose: To translate and culturally adapt the Swedish version of the 'Blue flags' questionnaire into Dutch and to examine the validity and reliability aspects of the Dutch version. Methods: The 'Blue flags' questionnaire was translated and culturally adapted to the Dutch situation. A total of 58 participants filled in the first questionnaire at baseline and 51 participants filled in the second questionnaire sent two weeks later. The data of the participants who filled in the first questionnaire was used to determine internal consistency, structural validity and concurrent validity. The data of the participants who filled in both questionnaires was used to determine test-retest reliability. Results: The internal consistency was good with a Cronbach's alpha of 0.83. The structural validity was satisfactory with a Kaiser-Meyer-Olkin (KMO) test of 0.75 and a significance of p < .001 for the Bartlett's test. Four factors were extracted using principal component analysis (PCA) with varimax rotation with an explained total variance of 70.8%. Spearman's rho for concurrent validity was 0.68 (p < .001). The intraclass correlation coefficient (ICC) for test-retest was 0.80 (p < .001) for the total score. Conclusions: The Dutch version of the 'Blue flags' questionnaire showed good internal consistency, satisfactory structural validity, strong concurrent validity (with mixed item representation results) and strong reliability.