Predicting chronic low-back pain based on pain trajectories in patients in an occupational setting: an exploratory analysis.

OBJECTIVE: This study aimed to (i) identify subpopulations of patients in an occupational setting who will still have or develop chronic low-back pain (LBP) and (ii) evaluate a previously developed prediction model based on the determined subpopulations. METHOD: In this prospective cohort, study data were analyzed from three merged randomized controlled trials, conducted in an occupational setting (N=622). Latent class growth analysis (LCGA) was used to distinguish patients with a different course of pain intensity measured over 12 months. The determined subpopulations were used to derive a definition for chronic LBP and evaluate an existing model to predict chronic LBP. RESULTS: The LCGA model identified three subpopulations of LBP patients. These were used to define recovering (353) and chronic (269) patients. None of the interventions showed a relevant treatment effect over another but the rate of decline in symptoms during the first months of the intervention seems to predict recovery. The prediction model, based on this dichotomous outcome, with the variables pain intensity, kinesiophobia and a clinically relevant change in pain intensity and functional status in the first three months, showed a bootstrap-corrected performance with an area under the operating characteristic curve (AUC) of 0.75 and explained variance of 0.26. CONCLUSION: In an occupational setting, different subpopulations of chronic LBP patients could be identified using LCGA. The prediction model based on these subpopulations showed a promising predictive performance

Geriatrisch spreekuur door een specialist ouderengeneeskunde in de huisartspraktijk

Beschreven wordt een innovatief project waarin huisartsen, een specialist ouderengeneeskunde en een thuiszorgorganisatie samenwerken. Doel was kwetsbare ouderen op te sporen, adequaat te behandelen en te ondersteunen, zodat ze zolang mogelijk in hun vertrouwde omgeving kunnen blijven wonen. Opsporing van kwetsbare ouderen vond plaats met het Easycare instrument. De resultaten, verzameld tussen 1 oktober 2007 en 1 juli 2009, tonen dat vooral mensen met dementieverschijnselen zijn opgespoord en behandeld. Bij hen lag het accent op het verlenen van zorgplangestuurde zorg, het geven van adviezen met betrekking tot de psychogeriatrische zorgverlening en de inzet van thuiszorg op maat. Bij ouderen met somatische problematiek vonden vooral eenmalige consulten door de specialist ouderengeneeskunde plaats. De tevredenheid over de geboden zorg bij ouderen zelf en ook de betrokken professionals was groot. In de pilot werd voorts een tendens gevonden van minder verwijzingen naar de 2elijn en een reductie van het aantal acute opnames in het verpleeghuis

Clinical prediction models for patients with nontraumatic knee pain in primary care: A systematic review and internal validation study

Copyright © 2017 Journal of Orthopaedic & Sports Physical Therapy®. STUDY DESIGN: Systematic review and validation study. BACKGROUND: Many prognostic models of knee pain outcomes have been developed for use in primary care. Variability among published studies with regard to patient population, outcome measures, and relevant prognostic factors hampers the generalizability and implementation of these models. OBJECTIVES: To summarize existing prognostic models in patients with knee pain in a primary care setting and to develop and internally validate new summary prognostic models. METHODS: After a sensitive search strategy, 2 reviewers independently selected prognostic models for patients with nontraumatic knee pain and assessed the methodological quality of the included studies. All predictors of the included studies were evaluated, summarized, and classified. The predictors assessed in multiple studies of sufficient quality are presented in this review. Using data from the Musculoskeletal System Study (BAS) cohort of patients with a new episode of knee pain, recruited consecutively by Dutch general medical practitioners (n = 372), we used predictors with a strong level of evidence to develop new prognostic models for each outcome measure and internally validated these models. RESULTS: Sixteen studies were eligible for inclusion. We considered 11 studies to be of sufficient quality. None of these studies validated their models. Five predictors with strong evidence were related to function and 6 to recovery, and were used to compose 2 prognostic models for patients with knee pain at 1 year. Running these new models in another data set showed explained variances (R2) of 0.36 (function) and 0.33 (recovery). The area under the curve of the recovery model was 0.79. After internal validation, the adjusted R2 values of the models were 0.30 (function) and 0.20 (recovery), and the area under the curve was 0.73. CONCLUSION: We developed 2 valid prognostic models for function and recovery for patients with nontraumatic knee pain, based on predictors with strong evidence. A longer duration of complaints predicted poorer function but did not adequately predict chance of recovery

Influence of corresponding parameters on the pressure and derivative. (A) preferential flow path length <i>L_D</i>, (B) equivalent radius <i>r_pD</i>, (C) conductivity <i>C_dD</i>, (D) vertical elevation <i>z_pD</i>,, (E) flow rate constant <i>q_DND</i> and (F) storage effect <i>C_D</i>.

<p>Influence of corresponding parameters on the pressure and derivative. (A) preferential flow path length <i>L_D</i>, (B) equivalent radius <i>r_pD</i>, (C) conductivity <i>C_dD</i>, (D) vertical elevation <i>z_pD</i>,, (E) flow rate constant <i>q_DND</i> and (F) storage effect <i>C_D</i>.</p