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Adding Psychosocial Factors Does Not Improve Predictive Models for People With Spinal Pain Enough to Warrant
Luc Ailliet1, Sidney M Rubinstein2, Trynke Hoekstra3
1L. Ailliet, PT, MSc, DC, EMGO+ Institute for Health and Care Research, VU University Medical Center, and Department of Epidemiology and Biostatistics, VU University Medical Center, De Boelelaan 1089a, F Vleugel, Amsterdam 1081 HV, the Netherlands. luc.ailliet@skynet.be.
Background:
Chiropractors throughout the world by and large focus on patients with musculoskeletal complaints who are generally in good health. Currently, it is widely accepted that neck pain and low back pain are best understood as biopsychosocial phenomena.
Objective:
The purpose of this study was to determine whether certain psychosocial factors provide added value for predicting recovery.
Design:
This was a prospective, multicenter, chiropractic, practice-based cohort study in Belgium and the Netherlands.
Methods:
A total of 917 participants, 326 with neck pain and 591 with low back pain, completed self-administered questionnaires at baseline and at 3, 6, and 12 months. They provided information on several demographic, biomedical, and psychosocial variables. Lasting perceived recovery was used as the outcome measure, that is, recovery at all follow-up assessments from 3 months on. Twenty-seven potential predictors of outcome were used to build the predictive model. Stepwise, backward generalized estimating equation regression models were used to take into account the clustering of participants within practices. For assessment of the added value of psychosocial variables, 2 model fit indexes were compared.
Results:
After the addition of psychosocial variables, predictors in the final model for neck pain included occupational status, body mass index, duration of complaints, previous treatment, and participant expectations (the model fit was marginally improved from 0.684 to 0.695 for the area under the curve and from 65.0% to 66.1% for the percentage correctly predicted). In the final model for low back pain, the selected predictors included country of treatment, age, duration of complaints, previous imaging, and somatization (the area under the curve changed from 0.669 to 0.715, and the percentage correctly predicted changed from 68.6% to 69.5%). Only a minority of participants had high scores on psychological variables.
Limitations:
The reliability and validity of lasting recovery as an outcome measure have not been tested. The cohort needs to be seen as a convenience sample. Selection bias, therefore, not be ruled out. There are no indications, however, that patients with complex psychosocial profiles were excluded from this study.
Conclusions:
Psychosocial variables provided little added value for predicting outcome in people who had neck pain or low back pain and sought chiropractic care. Therefore, chiropractors should not screen extensively for them at baseline. With regard to the identification of the small subgroup of people with high scores on psychosocial variables and a high risk for chronic pain, further investigation is needed.
