The influence of psychosocial variables on treatment outcomes, expectations and costs in acute low back pain

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Title The influence of psychosocial variables on treatment outcomes, expectations and costs in acute low back pain
Publication Type dissertation
School or College College of Health
Department Physical Therapy
Author Magel, John Shelton
Date 2015-05
Description Low back pain (LBP) is a common and costly problem. Among the top primary care research priorities are identifying prognostic subgroups of patients with LBP and identifying specific management strategies based on relevant subgroups. The Start Back Screening Tool (SBST) is a primary care decision tool that stratifies patients into prognostic subgroups based on the patient's risk for prolonged disability. Other subgrouping strategies screen for patients who fit a prediction rule (CPR) that may identify them as likely to respond to spinal manipulation (SM). It is unclear whether patients who are stratified by the SBST (high- and medium-risk) and who meet a CPR respond differentially to SM with exercise based on their risk stratification. In a secondary analysis of a randomized controlled trial, we found no 2-way interactions between risk stratification and treatment group at 4-week, 3-month or 1-year time points for disability or pain, indicating that the effects of treatment were no different between the medium- and high-risk groups. When we examined the effects of treatment separately within each risk subgroup, SM with exercise was superior to usual care at 3 months for disability and pain in those categorized as high-risk (mean difference = 3.95, 95% CI: 0.02, 7.87). After controlling for covariates, the SBST accounted for 2.4% (β = 4.25, p = 0.035) of the variance in the 4-week disability. In the same group of patients, we explored the relationship between the SBST and treatment expectations. Expectations of benefit from ten commonly used interventions for LBP were represented by four principal components: Exercise, Passive, Rest/Medication and Surgery). There were no associations between the components and the SBST (high versus medium- and low-risk). Finally, we retrospectively examined the influence of a mental health (MH) comorbidity on LBP-related healthcare costs in new consulters to primary care for LBP. Interaction terms between mental health comorbidity and patient factors were explored as contributors to predicting total costs. Individuals with a comorbid MH condition had higher LBP-related costs than those without. Males with a MH comorbidity experienced greater LBP-related healthcare costs than females (mean difference = $1077.26 USD, 95% CI = 428.10 - 1776.43).
Type Text
Publisher University of Utah
Subject MESH Low Back Pain; Mass Screening; Disability Evaluation; Decision Support Techniques; Mental Health; Comorbidity; Psychosocial Support Systems; Manipulation, Spinal; Pain Measurement; Psychometrics; Treatment Outcome; Motivation; Primary Health Care; Patient Acceptance of Health Care; Health Care Costs
Dissertation Institution University of Utah
Dissertation Name Doctor of Philosophy
Language eng
Relation is Version of Digital version of The Influence of Psychosocial Variables on Treatment Outcomes, Expectations and Costs in Acute Low Back Pain
Rights Management Copyright © John Shelton Magel 2015
Format application/pdf
Format Medium application/pdf
Format Extent 518,042 bytes
Source Original in Marriott Library Special Collections
ARK ark:/87278/s6vm8sdd
Setname ir_etd
ID 1419009
Reference URL https://collections.lib.utah.edu/ark:/87278/s6vm8sdd
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