Integrated disability evaluation in low back pain: feasibility and multidomain profiling from the EL DORADO cohort

Disability evaluation in low back pain (LBP) has traditionally relied on patient-reported outcomes (PROs), which alone incompletely capture functioning. This study tested the feasibility of embedding a multidomain disability evaluation protocol into routine secondary care, integrating PROs with performance-based measures, kinematic analysis, quantitative sensory testing (QST), and electronic health record (EHR) data, without performing formal multidomain profiling or subgroup identification. In this proof-of-concept study, 542 patients referred for advanced LBP assessment at the Spine Center of Southern Denmark underwent multidomain evaluation, including PROs (ODI, EQ-5D-5L, NPRS, STarT Back), functional capacity tests, markerless kinematic motion capture, QST, and EHR extraction; a subgroup provided 60-week SMS follow-up. Feasibility outcomes, including workflow integration, data completeness, acceptability, and adverse events, were evaluated overall and after the first 100 participants to guide protocol refinement. The assessment battery was completed in a mean of 22 min with over 95% data completeness, high acceptability, acceptable patient burden, and only two minor adverse events. PROs indicated moderate disability (ODI 34/100) and poor health (EQ-5D VAS 55/100), while functional and kinematic measures revealed substantial impairments, and QST showed widespread pain sensitivity with minimal conditioned pain modulation. EHR linkage was achieved for all participants, with MRI data available in 88%, and SMS follow-up retention was 75% at 60 weeks. These findings demonstrate that integrating PROs, performance-based tests, QST, kinematic assessment, and EHR data into routine secondary care is feasible, safe, and acceptable. The resulting multidomain dataset provides an infrastructure for future research on prognosis, subgrouping, and disability evaluation in LBP.