Brief pain re-assessment provided more accurate prognosis than baseline information for low-back or shoulder pain

G. Mansell, K. P. Jordan, G. M. Peat, K. M. Dunn, D. Lasserson, T. Kuijpers, I. Swinkels-meewisse, D. A. W. M. Van Der Windt

Research output: Contribution to journalArticle

Abstract

Background
Research investigating prognosis in musculoskeletal pain conditions has only been moderately successful in predicting which patients are unlikely to recover. Clinical decision making could potentially be improved by combining information taken at baseline and re-consultation.

Methods
Data from four prospective clinical cohorts of adults presenting to UK and Dutch primary care with low-back or shoulder pain was analysed, assessing long-term disability at 6 or 12 months and including baseline and 4–6 week assessments of pain. Baseline versus short-term assessments of pain, and previously validated multivariable prediction models versus repeat assessment, were compared to assess predictive performance of long-term disability outcome. A hypothetical clinical scenario was explored which made efficient use of both baseline and repeated assessment to identify patients likely to have a poor prognosis and decide on further treatment.

Results
Short-term repeat assessment of pain was better than short-term change or baseline score at predicting long-term disability improvement across all cohorts. Short-term repeat assessment of pain was only slightly more predictive of long-term recovery (c-statistics 0.78, 95% CI 0.74 to 0.83 and 0.75, 95% CI 0.69 to 0.82) than a multivariable baseline prognostic model in the two cohorts presenting such a model (c-statistics 0.71, 95% CI 0.67 to 0.76 and 0.72, 95% CI 0.66 to 0.78). Combining optimal prediction at baseline using a multivariable prognostic model with short-term repeat assessment of pain in those with uncertain prognosis in a hypothetical clinical scenario resulted in reduction in the number of patients with an uncertain probability of recovery, thereby reducing the instances where patients may be inappropriately referred or reassured.

Conclusions
Incorporating short-term repeat assessment of pain into prognostic models could potentially optimise the clinical usefulness of prognostic information.
Original languageEnglish
Article number139
JournalBMC Musculoskeletal Disorders
Volume18
Issue number1
DOIs
Publication statusPublished - 4 Apr 2017

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Shoulder Pain
Pain Measurement
Low Back Pain
Musculoskeletal Pain
Primary Health Care
Referral and Consultation

Bibliographical note

© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Cite this

Mansell, G., Jordan, K. P., Peat, G. M., Dunn, K. M., Lasserson, D., Kuijpers, T., ... Van Der Windt, D. A. W. M. (2017). Brief pain re-assessment provided more accurate prognosis than baseline information for low-back or shoulder pain. BMC Musculoskeletal Disorders, 18(1), [139]. https://doi.org/10.1186/s12891-017-1502-8
Mansell, G. ; Jordan, K. P. ; Peat, G. M. ; Dunn, K. M. ; Lasserson, D. ; Kuijpers, T. ; Swinkels-meewisse, I. ; Van Der Windt, D. A. W. M. / Brief pain re-assessment provided more accurate prognosis than baseline information for low-back or shoulder pain. In: BMC Musculoskeletal Disorders. 2017 ; Vol. 18, No. 1.
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abstract = "BackgroundResearch investigating prognosis in musculoskeletal pain conditions has only been moderately successful in predicting which patients are unlikely to recover. Clinical decision making could potentially be improved by combining information taken at baseline and re-consultation.MethodsData from four prospective clinical cohorts of adults presenting to UK and Dutch primary care with low-back or shoulder pain was analysed, assessing long-term disability at 6 or 12 months and including baseline and 4–6 week assessments of pain. Baseline versus short-term assessments of pain, and previously validated multivariable prediction models versus repeat assessment, were compared to assess predictive performance of long-term disability outcome. A hypothetical clinical scenario was explored which made efficient use of both baseline and repeated assessment to identify patients likely to have a poor prognosis and decide on further treatment.ResultsShort-term repeat assessment of pain was better than short-term change or baseline score at predicting long-term disability improvement across all cohorts. Short-term repeat assessment of pain was only slightly more predictive of long-term recovery (c-statistics 0.78, 95{\%} CI 0.74 to 0.83 and 0.75, 95{\%} CI 0.69 to 0.82) than a multivariable baseline prognostic model in the two cohorts presenting such a model (c-statistics 0.71, 95{\%} CI 0.67 to 0.76 and 0.72, 95{\%} CI 0.66 to 0.78). Combining optimal prediction at baseline using a multivariable prognostic model with short-term repeat assessment of pain in those with uncertain prognosis in a hypothetical clinical scenario resulted in reduction in the number of patients with an uncertain probability of recovery, thereby reducing the instances where patients may be inappropriately referred or reassured.ConclusionsIncorporating short-term repeat assessment of pain into prognostic models could potentially optimise the clinical usefulness of prognostic information.",
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Mansell, G, Jordan, KP, Peat, GM, Dunn, KM, Lasserson, D, Kuijpers, T, Swinkels-meewisse, I & Van Der Windt, DAWM 2017, 'Brief pain re-assessment provided more accurate prognosis than baseline information for low-back or shoulder pain', BMC Musculoskeletal Disorders, vol. 18, no. 1, 139. https://doi.org/10.1186/s12891-017-1502-8

Brief pain re-assessment provided more accurate prognosis than baseline information for low-back or shoulder pain. / Mansell, G.; Jordan, K. P.; Peat, G. M.; Dunn, K. M.; Lasserson, D.; Kuijpers, T.; Swinkels-meewisse, I.; Van Der Windt, D. A. W. M.

In: BMC Musculoskeletal Disorders, Vol. 18, No. 1, 139, 04.04.2017.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Brief pain re-assessment provided more accurate prognosis than baseline information for low-back or shoulder pain

AU - Mansell, G.

AU - Jordan, K. P.

AU - Peat, G. M.

AU - Dunn, K. M.

AU - Lasserson, D.

AU - Kuijpers, T.

AU - Swinkels-meewisse, I.

AU - Van Der Windt, D. A. W. M.

N1 - © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

PY - 2017/4/4

Y1 - 2017/4/4

N2 - BackgroundResearch investigating prognosis in musculoskeletal pain conditions has only been moderately successful in predicting which patients are unlikely to recover. Clinical decision making could potentially be improved by combining information taken at baseline and re-consultation.MethodsData from four prospective clinical cohorts of adults presenting to UK and Dutch primary care with low-back or shoulder pain was analysed, assessing long-term disability at 6 or 12 months and including baseline and 4–6 week assessments of pain. Baseline versus short-term assessments of pain, and previously validated multivariable prediction models versus repeat assessment, were compared to assess predictive performance of long-term disability outcome. A hypothetical clinical scenario was explored which made efficient use of both baseline and repeated assessment to identify patients likely to have a poor prognosis and decide on further treatment.ResultsShort-term repeat assessment of pain was better than short-term change or baseline score at predicting long-term disability improvement across all cohorts. Short-term repeat assessment of pain was only slightly more predictive of long-term recovery (c-statistics 0.78, 95% CI 0.74 to 0.83 and 0.75, 95% CI 0.69 to 0.82) than a multivariable baseline prognostic model in the two cohorts presenting such a model (c-statistics 0.71, 95% CI 0.67 to 0.76 and 0.72, 95% CI 0.66 to 0.78). Combining optimal prediction at baseline using a multivariable prognostic model with short-term repeat assessment of pain in those with uncertain prognosis in a hypothetical clinical scenario resulted in reduction in the number of patients with an uncertain probability of recovery, thereby reducing the instances where patients may be inappropriately referred or reassured.ConclusionsIncorporating short-term repeat assessment of pain into prognostic models could potentially optimise the clinical usefulness of prognostic information.

AB - BackgroundResearch investigating prognosis in musculoskeletal pain conditions has only been moderately successful in predicting which patients are unlikely to recover. Clinical decision making could potentially be improved by combining information taken at baseline and re-consultation.MethodsData from four prospective clinical cohorts of adults presenting to UK and Dutch primary care with low-back or shoulder pain was analysed, assessing long-term disability at 6 or 12 months and including baseline and 4–6 week assessments of pain. Baseline versus short-term assessments of pain, and previously validated multivariable prediction models versus repeat assessment, were compared to assess predictive performance of long-term disability outcome. A hypothetical clinical scenario was explored which made efficient use of both baseline and repeated assessment to identify patients likely to have a poor prognosis and decide on further treatment.ResultsShort-term repeat assessment of pain was better than short-term change or baseline score at predicting long-term disability improvement across all cohorts. Short-term repeat assessment of pain was only slightly more predictive of long-term recovery (c-statistics 0.78, 95% CI 0.74 to 0.83 and 0.75, 95% CI 0.69 to 0.82) than a multivariable baseline prognostic model in the two cohorts presenting such a model (c-statistics 0.71, 95% CI 0.67 to 0.76 and 0.72, 95% CI 0.66 to 0.78). Combining optimal prediction at baseline using a multivariable prognostic model with short-term repeat assessment of pain in those with uncertain prognosis in a hypothetical clinical scenario resulted in reduction in the number of patients with an uncertain probability of recovery, thereby reducing the instances where patients may be inappropriately referred or reassured.ConclusionsIncorporating short-term repeat assessment of pain into prognostic models could potentially optimise the clinical usefulness of prognostic information.

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U2 - 10.1186/s12891-017-1502-8

DO - 10.1186/s12891-017-1502-8

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Mansell G, Jordan KP, Peat GM, Dunn KM, Lasserson D, Kuijpers T et al. Brief pain re-assessment provided more accurate prognosis than baseline information for low-back or shoulder pain. BMC Musculoskeletal Disorders. 2017 Apr 4;18(1). 139. https://doi.org/10.1186/s12891-017-1502-8