Appendix C: Risk_Factors_of_Chronicity
 
   

Appendix C:
Risk Factors of Chronicity

 
   

A. Risk factors (Documentation):

1.   Abnormal illness behavior (Waddell's, SF-36)

2.   Job dissatisfaction

3.   Past Hx of >4 episodes

4.   Symptoms > 1 wk w/o health provision

5.   Severe pain intensity (Triple VAS) (>69%)

6.   New condition / injury related to pre-existing
      structural pathology or skeletal anomaly

7.   Weak back extensor musculature
      (Static back endurance test)

8.   Smokes 1 pack or greater / day

9.   Poor self-rated health (SF/HSQ-36 or -12)

10.   Heavy Job Classification


B. Yellow Flags

Symptoms

Yellow Flag

Reference

Number of pain sites Linton, 1998;   Linton, 1997
Duration of symptoms Cherkin, 1996;   Von Korff, 1993;   Linton 1998;   Linton 1997
Duration of symptoms before the 1st visit Van den Hoogen, 1997
Past history of numerous episodes Frank, 1996;   Cherkin, 1996;   Hazard, 1996;   Burton, 1995
Past hospitalization or surgery for similar complaint Van den Hoogen, 1997;   Hazard, 1996;   Lancourt, 1992
Severe pain intensity Frank, 1996;   Cherkin, 1996;   Von Korff, 1993;   Linton, 1998;   Hazard, 1996
Frequency of painful episodes over the last 3 months Linton, 1998;   Linton, 1997
Sciatica Frank, 1996;   Cherkin, 1996;   Burton, 1995;   Salim, 1998;   Lancourt, 1992


Psycho-social

Anxiety Cherkin, 1996
Locus of control Burton, 1995
Depression Cherkin, 1996;   Linton, 1998;   Linton, 1997;   Klennerman, 1995
Catastrophizing Burton, 1995
Self-rated health as poor Cherkin, 1996;   Waddell, 1996
Heavy smoker Waddell, 1996;   Cats-Baril, 1991;   Hazard, 1996
Belief that you shouldn’t work with your current pain Linton, 1998;   Linton, 1997
Job dissatisfaction Cherkin, 1996;   Cats-Baril, 1991
Anticipation of trouble sitting or standing at work 6 weeks into the future Hazard, 1996
Anticipation of disability 6 months into the future Hazard, 1996


Function

Does physical activity make your pain worse? Linton, 1998;   Linton, 1997
Tolerance for light work Linton, 1998;   Linton, 1997
Is sleep affected by your pain? Linton, 1998;   Linton, 1997


Disability

Heavy job demand Waddell, 1996
Past disability for the same/similar complaint in prior 12 months Hazard, 1996
Disabled at present Hazard, 1996



Alaranta H, Rytokoski U, Rissanen A, et al. Intensive physical and psychosocial training program for patients with chronic low back pain. Spine 1994;   19:   1339-1349

Bigos S, Bowyer O, Braen G, et al. Acute low back problems in adults. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, 1994

Bolton JE. Evaluation of treatment of back pain patients: clinical outcome measures. European J of Chiro 1994;   42:   29-40

Burke SA, Harms-Constas CK, Aden PS. Return to work/work retention outcomes of a functional restoration program. Spine 1994;   17;   1880-1886

Burton CV, Cassidy JD. Economics, epidemiology, and Risk Factors. In: Managing Low Back Pain, 3rd ed. Kirkaldy-Willis WH, Burton CV eds., Churchill-Livingstone, New York; p2

Burton AK, Tillotson K, Main C, Hollis M. Psychosocial predictors of outcome in acute and sub-acute low back trouble. Spine 1995;   20:   722-728

Butler RJ, Johnson WG, Baldwin ML. Managing work disability: why first return to work is not a measure of success. Industrial and Labor Relations Review 1995;   48 (3):   452-469

Cats-Baril WL, Frymoyer JW. Demographic factors associated with the prevalence of disability in the general population: Analysis of the NHANES I database. Spine 1991;   16:   671-674

Cheadle A, Franklin G, Wolfhagen C, Savarino J, et al. Factors influencing the duration of work-related disability. Am J of Pub Health 1994;   84 (2);   190-196

Cherkin DC, Deyo RA, Street JH, Barlow W. Predicting poor outcomes for back pain seen in primary care using patients’ own criteria. Spine 1996;   21:   2900-2907

Cherkin DC, MacCornack. Patient evaluations of low back pain care from family physicians and chiropractors. West J Med 1989;   51:   355

Croft PR, Macfarlane GJ, Papageorgiou AC, Thomas E, Silman AJ. Outcome of low back pain in general practice: a prospective study. BMJ 1998;   316:   1356-1359

Cutler RB, Fishbain DA, Rosomoff HL, Abdel-Moty E, et al. Does nonsurgical pain center treatment of chronic pain return patients to work? A review and meta-analysis of the literature. Spine 1994;   19:   643-652

Deyo RA. Low back pain - A primary care challenge. Spine 1996;21:2826-2832

Flor H. Fydrick T, Turk DC. Efficacy of multidisciplinary pain treatment centers: A meta-analytic review. Pain 1992;   49L   221-230

Fordyce WE, Brockway JA, Bergman JA, Spengler D. Acute back pain: a control-group comparison of behvorial vs traditional management methods. J Behav Med 1986;   9:   127-140

Frank JW, Kerr MS, Brooker AS, DeMaio SE, Maetzel A, et al. Disability resulting from occupational low back pain. Part 2: What do we know about secondary prevention? Spine 1996;   21:   2918-2929

Frost H, Lamb SE, Klaber Moffett JA, Fairbank JCT, Moser JS. A fitnes programme for patients with chronic low back pain: 2-year follow-up of a randomized controlled trial. Pain 1998;   75:   273-279

Goosens MEJB, Evers SMAA. Economic evaluation of back pain interventions. J Occup Rehab 1997;   9:   15-32

Hazard RG, Haugh LD, Reid S, Preble JB, MacDonald L. Early prediction of chronic disability after occupational low back injury. Spine 1996;21: 945-951

Hazard RG, Fenwick JW, Kalisch SM, et al. Functional restoration with behavioral support. Spine 1989;   14:   157-161

Indahl A, Velund L, Reikeraas O. Good prognosis for low back pain when left untampered: A randomized clinical trial. Spine 1995;   20:   473-477

Kendall NAS, Linton SJ, Main CJ. Guide to assessing psychosocial yellow flags in acute low back pain: Risk factors for long-term disabilty and work loss. Accident Rehabilitation & Compensation Insurance Corporation of New Zealand and the National Health Committee 1997. Wellington, NZ

Klenerman L, Slade P, Stanley I, et al. The prediction of chronicity in patients with an acute attack of low back pain in a general practice setting. Spine 1995;   20:   478-484

Lancourt J, Ketteljut M. Predicting return to work for lower back pain patients receiving worker's compensation. Spine 1992;17:629-640

Lindstrom A, Ohlund C, Eek C, et al. Activation of subacute low back patients. Physical Therapy 1992;   4:   279-293

Linton SJ, Hellsing AL, Hallden K. A population based study of spinal pain among 35-45 year olds: prevalance, sick leave, and health care utilization. Spine 1998 in press

Linton SJ, Hallden BH. Can we screen for problematic back pain? A screening questionnaire for predicting outcome in acute and subacute back pain. Clin J Pain 1998:   14;   1-7

Linton SJ, Hallden K. Risk factors and the natural course of acute and recurrent musculoskeletal pain: Developing a screening instrument. Proceedings of the 8th World Congress on Pain, Progress in Pain Research and Management, Vol 8, ed. Jensen TS, Turner JA, Wiesenfeld-Hallin Z, IASP Press, Seattle, 1997

Linton SL, Hellsing AL, Andersson D. A controlled study of the effects of an early active intervention on acute musculoskeletal pain problems. Pain 1993;   54:   353-359

Malmivaara A, Hakkinen U, Aro T, et al. The treatment of acute low back pain - bed rest, exercises, or ordinary activity? N Engl J Med 1995;   332:   351-355

Mayer TG, Gatchel RJ, Mayer H, Kishino ND, Keeley J, Mooney V. A prospective two-year study of functional restoration in industrial low back injury. JAMA, 1987;   258:   1763-1767

O’Sullivan P, Twomey L, Allison G 1997. Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylolysis or spondylolysthesis. Spine 24:   2959-2967

Reid S, Haugh LD, Hazard RG, Tripathi M. Occupational low back pain: recovery curves and factors associated with disability. J Occup Rehab 1997;   7:   1-14

Sachs BL, David JF, Olimpio D, et al. Spinal rehabilitation by work tolerance based on objective physical capacity assessment of dysfunction. Spine 1990;   15:   1325-1332

Selim AJ, Xinhua SR, Graeme F, Deyo RA, Rogers W, et al.. The importance of radiating leg pain in assessing health outcomes among patients with low back pain. Spine 1998:   23:   470-474

Shekelle PG, Adams AH, Chassin MR, et al. Spinal manipulation for low-back pain. Ann Intern Med 1992;   117:   590-598

Spitzer WO, et al. Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders. Spine 1995;   20 (8S);   1S-73S

Timm KE. A randomized-control study of active and passive treatments for chronic low back pain following L5 laminectomy. JOSPT 1994;   20:   276-286

Triano J, McGregor M, et al. Manipulative therapy vs education programs in chronic low back pain. Spine 1995;   20:   948-954

Troup JDG, Martin JW, Lloyd DCEF. Back pain in industry: a prospective survey. Spine 1981;   6:   61-69

van den Hoogen HJM, Koes BW, Deville W, van Eijk JTM, Bouter LM. The prognosis of low back pain in general practice. Spine 1997;   22:   1515-1521

van Tulder MW, Koes BW, Bouter LM. A cost of illness study of back pain in The Netherlands. Pain 1995;   62:   233-240

Von Korff M, Deyo RA, Cherkin D, Barlow W. Back pain in primary care: Outcomes at 1 year. Spine 1993;   18:   855-862

Von Korff M, Saunders K. The course of back pain in primary care. Spine 1996;   21:   2833-2839

Waddell G Feder G, McIntosh A, Lewis M, Hutchinson A (1996) Low Back Pain Evidence Review. London: Royal College of General Practitioners

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