Does pain duration and other variables measured at baseline predict re-referral of low back pain patients managed on an evidence-based pathway? A cohort study

Mary-Anne Jess; Cormac Ryan; Shaun Wellburn; Greg Atkinson; Charles Greenough; Glynis Peat; Andrew Coxon; Helena Roper; Francis Fatoye; Diarmaid Ferguson; Alastair Dickson; Helen Ridley; Denis Martin

doi:10.1016/j.physio.2023.07.006

Does pain duration and other variables measured at baseline predict re-referral of low back pain patients managed on an evidence-based pathway? A cohort study

Physiotherapy. 2023 Jul 29:121:5-12. doi: 10.1016/j.physio.2023.07.006. Online ahead of print.

Authors

Affiliations

¹ School of Health and Life Sciences, Teesside University, Middlesbrough, UK. Electronic address: Maryanne.jess@yahoo.com.
² School of Health and Life Sciences, Teesside University, Middlesbrough, UK.
³ School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK.
⁴ South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK.
⁵ Department of Health Professions, Faculty of Health and Education, Manchester Metropolitan University, UK.
⁶ Northumbria Healthcare NHS Trust, North Tyneside General Hospital, North Shields, UK; Primary Care Rheumatology & Musculoskeletal Medicine Society, York, UK.
⁷ Primary Care Rheumatology & Musculoskeletal Medicine Society, York, UK; The North of England Low Back Pain Pathway, NIHR Applied Research Collaboration (ARC) North East and North Cumbria, St Nicolas' Hospital, Newcastle Upon Tyne, UK; AD Outcomes Ltd, York, UK.
⁸ Getting It Right First Time (GIRFT): Clinically led improvement programme delivered in partnership with the Royal National Orthopaedic Hospitals NHS Trust, NHS England and NHS Improvement, UK.
⁹ School of Health and Life Sciences, Teesside University, Middlesbrough, UK; NIHR Applied Research Collaboration for the North East and North Cumbria, UK.

PMID: 37591028
DOI: 10.1016/j.physio.2023.07.006

Abstract

Objective: To explore the association between baseline pain duration and the likelihood of re-referral of patients with low back pain (LBP) managed on the evidence-based North East of England Regional Back Pain and Radicular Pain Pathway (NERBPP).

Study design: Longitudinal, observational cohort study.

Methods: In all, 12,509 adults with LBP were identified as having been discharged from the pathway, between May 2015 and December 2019. To quantify any association between baseline pain duration and the likelihood of re-referral, two statistical modelling approaches, were used: logistic regression models for odds ratios and generalised linear models with a binomial link function in order to quantify risk differences.

Results: Twenty-five percent of patients with LBP, who were discharged, re-referred for management over a 4.5-year period. A large difference in pain duration of 2 SD days was statistically associated with re-referral, with an odds ratio of 1.22 (95% CI: 1.03, 1.44) and a risk difference of 3.6% (95% CI: 0.6, 6.6). Nevertheless, the predictive value of an individual's pain duration was found to be weak for re-referral. Higher baseline disability [odds ratio of 1.40 (95% CI: 1.07, 1.83)] and a younger age at baseline [odds ratio of 0.73 (95% CI 0.61, 0.86)] were also associated with an increased risk of re-referral.

Conclusions: Baseline pain duration, disability and younger age are statistically associated with re-referral onto the NERBPP. However, the value of these variables for predicting an individual's risk of re-referral is weak. CONTRIBUTION OF PAPER.

Keywords: Disability; Duration; Low back pain; NICE guidelines; Re-referrals.