Abstract
BACKGROUND: Successful management of workers on sick leave due to low back pain by the general physician and physiotherapist depends on reliable prognostic information on the course of low back pain and work resumption.
METHODS: Retrospective cohort study in 194 patients who were compensated because of chronic low back pain and who were treated by a physiotherapy functional restoration program. Patient-reported and clinician based prognostic indicators were assessed at baseline before patients entered the functional restoration program. We investigated the predictive value of these indicators on work status at 6 months. Relationships were studied using logistic regression analysis in a 2-step bootstrap modelling approach and a nomogram was developed. Discrimination and calibration of the nomogram was evaluated internally and the explained variation of the nomogram calculated.
RESULTS: Seventy percent of workers were back to work at 6 months. We found that including duration of complaints, functional disability, disc herniation and fear avoidance beliefs resulted in the "best" prognostic model. All these factors delayed work resumption. This model was used to construct a nomogram. The explained variation of the nomogram was 23.7%. Discrimination was estimated by the area under the receiver operating characteristic curve and was 0.76 and for calibration we used the slope estimate that was 0.91. The positive predictive values of the nomogram at different cut-off levels of predicted probability were good.
CONCLUSIONS: Knowledge of the predictive value of these indicators by physicians and physiotherapists will help to identify subgroups of patients and will thus enhance clinical decision-making.
| Original language | English |
|---|---|
| Pages (from-to) | 383-97 |
| Number of pages | 15 |
| Journal | Journal of Occupational Rehabilitation |
| Volume | 17 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - Sep 2007 |
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Exploring the contribution of patient-reported and clinician based variables for the prediction of low back work status. / Heymans, Martijn W; Ford, Jon J; McMeeken, Joan M; Chan, Alexander; de Vet, Henrica C W; van Mechelen, Willem.
In: Journal of Occupational Rehabilitation, Vol. 17, No. 3, 09.2007, p. 383-97.Research output: Contribution to journal › Article › Academic › peer-review
TY - JOUR
T1 - Exploring the contribution of patient-reported and clinician based variables for the prediction of low back work status
AU - Heymans, Martijn W
AU - Ford, Jon J
AU - McMeeken, Joan M
AU - Chan, Alexander
AU - de Vet, Henrica C W
AU - van Mechelen, Willem
PY - 2007/9
Y1 - 2007/9
N2 - BACKGROUND: Successful management of workers on sick leave due to low back pain by the general physician and physiotherapist depends on reliable prognostic information on the course of low back pain and work resumption.METHODS: Retrospective cohort study in 194 patients who were compensated because of chronic low back pain and who were treated by a physiotherapy functional restoration program. Patient-reported and clinician based prognostic indicators were assessed at baseline before patients entered the functional restoration program. We investigated the predictive value of these indicators on work status at 6 months. Relationships were studied using logistic regression analysis in a 2-step bootstrap modelling approach and a nomogram was developed. Discrimination and calibration of the nomogram was evaluated internally and the explained variation of the nomogram calculated.RESULTS: Seventy percent of workers were back to work at 6 months. We found that including duration of complaints, functional disability, disc herniation and fear avoidance beliefs resulted in the "best" prognostic model. All these factors delayed work resumption. This model was used to construct a nomogram. The explained variation of the nomogram was 23.7%. Discrimination was estimated by the area under the receiver operating characteristic curve and was 0.76 and for calibration we used the slope estimate that was 0.91. The positive predictive values of the nomogram at different cut-off levels of predicted probability were good.CONCLUSIONS: Knowledge of the predictive value of these indicators by physicians and physiotherapists will help to identify subgroups of patients and will thus enhance clinical decision-making.
AB - BACKGROUND: Successful management of workers on sick leave due to low back pain by the general physician and physiotherapist depends on reliable prognostic information on the course of low back pain and work resumption.METHODS: Retrospective cohort study in 194 patients who were compensated because of chronic low back pain and who were treated by a physiotherapy functional restoration program. Patient-reported and clinician based prognostic indicators were assessed at baseline before patients entered the functional restoration program. We investigated the predictive value of these indicators on work status at 6 months. Relationships were studied using logistic regression analysis in a 2-step bootstrap modelling approach and a nomogram was developed. Discrimination and calibration of the nomogram was evaluated internally and the explained variation of the nomogram calculated.RESULTS: Seventy percent of workers were back to work at 6 months. We found that including duration of complaints, functional disability, disc herniation and fear avoidance beliefs resulted in the "best" prognostic model. All these factors delayed work resumption. This model was used to construct a nomogram. The explained variation of the nomogram was 23.7%. Discrimination was estimated by the area under the receiver operating characteristic curve and was 0.76 and for calibration we used the slope estimate that was 0.91. The positive predictive values of the nomogram at different cut-off levels of predicted probability were good.CONCLUSIONS: Knowledge of the predictive value of these indicators by physicians and physiotherapists will help to identify subgroups of patients and will thus enhance clinical decision-making.
KW - Adolescent
KW - Adult
KW - Aged
KW - Cohort Studies
KW - Female
KW - Health Surveys
KW - Humans
KW - Low Back Pain/rehabilitation
KW - Male
KW - Middle Aged
KW - Models, Biological
KW - Netherlands
KW - Nomograms
KW - Patient Participation
KW - Physical Therapy Modalities
KW - Predictive Value of Tests
KW - Recovery of Function
KW - Retrospective Studies
KW - Severity of Illness Index
KW - Sick Leave
U2 - 10.1007/s10926-007-9084-1
DO - 10.1007/s10926-007-9084-1
M3 - Article
VL - 17
SP - 383
EP - 397
JO - Journal of Occupational Rehabilitation
JF - Journal of Occupational Rehabilitation
SN - 1053-0487
IS - 3
ER -