Identifying patients at risk of becoming disabled because of low-back pain. The Vermont Rehabilitation Engineering Center predictive model.

A predictive risk model of low-back pain (LBP) disability was developed by a panel of six experts in the fields of chronic pain and disability. It comprised 28 factors organized into eight categories: job, psychosocial, injury, diagnostic, demographic, medical history, health behaviors, and anthropometric characteristics and was administered as a 15-minute written questionnaire. The model was tested prospectively on 250 patients (age range, 18-65 years) attending two secondary-care low-back clinics. Disability, as predicted by the model, was compared with 1) actual disability assessed 3 and 6 months later; 2) predictions of disability made by the attending physicians; and 3) predictions obtained from an empirically derived model. These results showed that 1) the expert-generated risk model had a predictive accuracy of 89% and did better in predicting disability than the physicians across all samples and 2) the empirically weighted model did best of all (91% predictive accuracy), suggesting that the expert model used appropriate factors but that the weights assigned to these factors by the panel of experts could be improved.

The North American spine society lumbar spine outcome assessment Instrument: reliability and validity tests.

STUDY DESIGN: A cross-sectional study of a convenience sample of lumbar spine patients, with a subsample followed for retest reliability. OBJECTIVES: To assess the instrument's reliability, validity, and acceptability to patients. SUMMARY OF BACKGROUND DATA: Patients with eight diagnoses, four before surgery and four after surgery, were recruited from six orthopedic practices to test the questionnaire. METHODS: One hundred sixty-seven patients were approached through the physician's office, yielding 136 usable questionnaires (84%) and 24-hour retests on 64 patients. RESULTS: The questionnaire took about 20 minutes to administer and was acceptable to patients. The lumbar spine pain and disability and neurogenic symptoms subscales discriminated among patient groups as hypothesized and showed significantly better scores for patients independently judged successful by their physicians after surgery. Test-retest reliability and internal reliability were high (range, 0.85-0.97). Sample sizes of 20-37 would be needed to detect a 20% difference between two groups (alpha, 0.05; beta, 0.20). CONCLUSIONS: The questionnaire should be considered for monitoring of individual patient's progress in treatment and for clinical trials.

An overview of the incidences and costs of low back pain.

The basic premise of this article is that low back disorders are extremely prevalent in all societies, and probably have not increased substantially over the past two decades. What has increased is the rate of disability, the reasons for which are uncertain. Not only has this phenomenon heightened the awareness of low back pain, but it has led to an explosion in costs. Although a precise estimate is impossible, it is plausible that the direct medical and indirect costs of these conditions are in the range of more than $50 billion per annum, and could be as high as $100 billion at the extreme. Of these costs, 75% or more can be attributed to the 5% of people who become disabled temporarily or permanently from back pain--a phenomenon that seems more rooted in psychosocial rather than disease determinants. Within this overall equation, spinal surgery plays a relatively small role, although the contribution to disability probably has more than passing significance. The future challenge, if costs are to be controlled, appears to lie squarely with prevention and optimum management of disability, rather than perpetrating a myth that low back pain is a serious health disorder.

Working it out: recommendations from a multidisciplinary national consensus panel on medical problems in Workers' Compensation. Committee on Occupational Health, American Academy of Orthopedic Surgeons.

This article presents the recommendations of a national multidisciplinary consensus panel brought together to discuss the medical problems facing the troubled Workers' Compensation System. The process, organized by the American Academy of Orthopedic Surgeons, was needed because participants in the System seldom communicate with nor understand the other's positions. Altogether 119 individuals representing employers, insurers, allied health professionals, administrators, lawyers, legislators, unions, and physicians participated in a year-long iterative process agreeing on 38 high-priority problems, and developing solution papers for 14 of them. These papers were discussed at a workshop that generated 48 recommendations in 6 categories, including guideline development, temporary modified work, education, prevention, patient advocacy, and legislative and regulatory changes. A post-process evaluation by the participants strongly endorsed this process as an effective way to improve communication and urged similar state or regional panels.