CAN WE SCREEN FOR PROBLEMATIC BACK PAIN - A SCREENING QUESTIONNAIRE FOR PREDICTING OUTCOME IN ACUTE AND SUBACUTE BACK PAIN

Objectives: Because musculoskeletal pain is the second most frequent r eason for seeking health care, the aims of this study were to determin e the value of psychosocial variables in evaluating risk for developin g chronic back pain problems and to develop a screening methodology to identify patients likely to have a poor prognosis. Study Design: A pr ospective study was conducted on consecutive patients with acute or su bacute back pain, in which patients completed a screening questionnair e and were then followed up for 6 months to determine outcome. The pri mary outcome variable was accumulated sick leave. Methods: One hundred forty-two consecutive patients were asked to complete a questionnaire designed for this study. This questionnaire contained 24 items concer ning psychosocial aspects of the problem. Six months later, patients w ere contacted to complete outcome questions about accumulated sick lea ve. Results: A total of 97% of the patients completed both questionnai res. Although patients, on average, improved greatly, 18% had 1-30 day s and 20% had fewer than 30 days of sick leave during the follow-up pe riod. Five variables were found to be the strongest predictors of sick leave outcome (fear-avoidance work beliefs, perceived improvement, pr oblems with work function, stress, and previous sick leave), correctly classifying 73% of the patients as opposed to a chance rate of 33%. A total score was evaluated as a means of judging risk and found to be strongly related to outcome. Conclusion: Potent psychosocial risk fact ors associated with future sick absenteeism were identified. Because t he total score was related to outcome, the instrument may have use in screening patients with acute or subacute spinal pain in clinical situ ations.