Exploring the contribution of patient-reported and clinician based variables for the prediction of low back work status

Martijn W Heymans, Jon J Ford, Joan M McMeeken, Alexander Chan, Henrica C W de Vet, Willem van Mechelen

Research output: Contribution to journalArticleAcademicpeer-review

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 languageEnglish
Pages (from-to)383-97
Number of pages15
JournalJournal of Occupational Rehabilitation
Volume17
Issue number3
DOIs
Publication statusPublished - Sep 2007

Cite this

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title = "Exploring the contribution of patient-reported and clinician based variables for the prediction of low back work status",
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.",
keywords = "Adolescent, Adult, Aged, Cohort Studies, Female, Health Surveys, Humans, Low Back Pain/rehabilitation, Male, Middle Aged, Models, Biological, Netherlands, Nomograms, Patient Participation, Physical Therapy Modalities, Predictive Value of Tests, Recovery of Function, Retrospective Studies, Severity of Illness Index, Sick Leave",
author = "Heymans, {Martijn W} and Ford, {Jon J} and McMeeken, {Joan M} and Alexander Chan and {de Vet}, {Henrica C W} and {van Mechelen}, Willem",
year = "2007",
month = "9",
doi = "10.1007/s10926-007-9084-1",
language = "English",
volume = "17",
pages = "383--97",
journal = "Journal of Occupational Rehabilitation",
issn = "1053-0487",
publisher = "Springer New York",
number = "3",

}

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 journalArticleAcademicpeer-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 -