Background: Low back pain (LBP) is the leading cause of disability in Portugal and worldwide. The majority of the patients use primary health care services but the treatment outcomes are unknown. Findings of prognostic studies indicate that a marked reduction in mean pain and disability is expected in the first 6-8 weeks, for acute or persistent LBP. Beyond that time frame period, improvement slows and thereafter the probability to develop a persistent disabling back pain condition improves. Therefore, it seems important to measure the patients’ outcomes at this time-point to better assess the effectiveness of the care provided.
Objectives: This study aims to describe the short-term outcomes for LBP patients treated in a primary health care centre in Portugal and to identify the prognostic factors for non-recovery and poor health related quality of live (HRQoL).
Methods: 116 patients with LBP were consecutively recruited from 7 different primary care units in Portugal. Baseline assessment includes socio-demographic and clinical data, psychosocial factors, pain, disability, and HRQoL. Pain, disability and HRQoL were then assessed at 8-weeks follow-up. A Global Rating of Change Scale to assess patient perception of improvement with treatment was added in the follow-up reassessment. Recovery criteria were determined according to the Minimal Clinically Important Difference established for pain and disability (reduction of ≥30% from baseline). The EQ-5D,3L index was dichotomised into ‘poor’ HRQoL (<0.6) and ‘good’ HRQoL (≥ 0.6), based on a proposed cut-off for having sufficient capacity to be able to work for a population with LBP. The relationship between variables on baseline and non-recovery/‘poor’ HRQoL was modulated through logistic regression.
Results: Of the 116 participants enrolled, 110 completed the 8-weeks follow-up. (mean age of 48,06±11,41). Approximately half of the participants (53.4%) were acute presentations of LBP. The main treatment strategy was medication (83.5%), with only 8.3% of patients having been referred for physiotherapy. At 8 weeks follow-up, there were statistically significant improvements on pain, disability and HRQoL (p≤ 0.05). However, 38% of the patients reported they felt the same or worse, 76.4% had a poor HRQoL, and only half of the patients reached the established recovery criteria (49% in disability and 50% in pain). In the adjusted model, the probability of non-recovery (p≤0.05) was associated with the presence of maladaptive psychosocial factors (OR: 1.65, 95% CI 1.13-2.40, for pain; OR: 1.61, 95% CI 1.15-2.24, for disability), a chronic pain condition (OR: 1.71, 95% CI 1.33-1.88, for pain; OR: 1.76, 95%CI 1.43-1.89, for disability), and high levels of pain at baseline for pain (OR: 1.26, 95%CI 1.09-1.39). Poor HRQoL was associated to the female gender (OR: 1.88, 95%CI 1.61-1.96), chronic pain condition (OR: 1.68, 95%CI 1.03-1.89) and high levels of pain intensity at baseline (OR: 1.36, 95%CI 1.11-1.67).
Conclusion: These results suggest there is a room for improvement in the healthcare delivered to LBP patients in the Portuguese primary healthcare setting.
Disclosure of Interests: None declared
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