title: The Effect of Compensation Involvement on the Reporting of Pain and Disability by Patients Referred for Rehabilitation of Chronic Low Back Pain Assessing the Needs of Patients in Pain: A Matter of Opinion? Can It Be Predicted Which Patients With Chronic Low Back Pain Should Be Offered Tertiary Rehabilitation in a Functional Restoration Program?: A Search for Demographic, Socioeconomic, and Physical Predictors Predictors of efficacy in treatment of chronic low back pain. A randomized clinical trial of three active therapies for chronic low back pain. The Centralization Phenomenon: Its Usefulness as a Predictor of Outcome in Conservative Treatment of Chronic Low Back Pain (A Pilot Study) A Preliminary Study of Multidimensional Pain Inventory Profile Differences in Predicting Treatment Outcome in a Heterogeneous Cohort of Patients with Chronic Pain Health locus of control beliefs and psychological distress as predictors for treatment outcome in low-back pain patients: results of a 3-month follow-up of a controlled intervention study Problems in defining cutoff points of continuous prognostic factors: example of tumor thickness in primary cutaneous melanoma. Predictive utility of the CSQ in low back pain: individual vs. composite measures Publication bias in clinical research The impact of psychologically different patient groups on outcome after a vocational rehabilitation program for long-term spinal pain patients Psychometric properties of the Multidimensional Pain Inventory, Dutch language version (MPI-DLV). [The practice of systematic reviews. V. Heterogeneity between studies and subgroup analysis].
abstract: Study Design . In this prospect i ve , observational , cohort study of 192 individuals with chronic low back pain , the group of individuals was divided based on compensation involvement , and their presentation pain and disability , treatment recommendations , and compliance were compared . For 85 of these individuals who completed a spine rehabilitation program  , their pain and disability at 3 and 12 months were compared . Objectives . To test the theory that individuals with compensation involvement  presented with greater pain and disability and would report less change of pain and disability after rehabilitation efforts . Background . Previous studies have produced conflicting results concerning this issue . Methods . Individuals were recruited as consecutive patients referred for consultation at a spine rehabilitation center . Pain , depression , and disability were assessed using self‐report question naires at evaluation and at 3 and 12 months . Rehabilitation services consisted of aggressive , quota‐based exercises aim ed at correcting impairments in flexibility , strength , endurance , and lifting capacity , identified through quantification of back function . Multifactoral analysis of variance models were used to control for baseline differences between compensation and noncompensation patients during analysis of target variables . Results . The compensation group included 96 patients ; these patients reported more pain , depression , and disability than the 96 patients without compensation involvement . These differences persisted when baseline differences were controlled for with multifactoral analysis of variance models . Treatment recommendations and compliance were not affected by compensation . For patients completing the spine rehabilitation program , length of treatment , flexibility , strength , lifting ability , and lower extremity work performance before and after treatment and patient satisfaction ratings were similar for the compensation and non‐compensation groups . At 3 and 12 months , improvements in depression and disability were noted for both groups , but were statistically and clinical ly less substantial for the compensation group . At the 12 month follow‐up visit , pain scores improved for the noncompensation group , but not for the compensation group . Conclusions . In chronic low back pain  , compensation involvement may have an adverse effect on self‐reported pain , depression , and disability before and after rehabilitation interventions Study Design . A prospect i ve cohort study including patients with nonspecific spinal pain was performed . Objectives . To investigate whether the use of expert judgment in routine practice can provide a basis for reliable decision making concerning the need for intervention in patients with spinal pain and their ability to benefit from treatment . Summary of Background Data . A wide range of instruments and techniques are used to assess and treat patients with spinal pain . Many instruments are used without being clinimetrically tested . Methods . A question naire concerning the patients ’ need of treatment and their potential to assimilate it was sent to experts in the health care arena : physicians , physical therapists , social insurance officers . The experts included were those connected with patients participating in a larger outcome study . Two cohorts of patients ( sample 1 , n = 217 ; sample 2 , n = 257 ) were followed for 6 and 12 months , during which time the patients ’ health and work status were mapped . Results . No acceptable agreement was found between any of the experts ’ ratings of patients ’ needs and potential for rehabilitation . Logistic regression showed that the experts ’ judgments were based almost solely on the age of the patient . The prediction analyses showed that the most consistent predictor of the patients ’ status at the 6-month follow-up assessment was the patients ’ own belief in the existence of effective treatments and their perceived ability for learning to cope with the condition . Conclusions . Expert judgment as exercised in routine practice can not be used as basis for reliable decision making concerning the need of the patient with spinal pain for intervention and the patient ’s ability to benefit from treatment Study Design . A prospect i ve clinical trial was conducted that involved six groups of patients with chronic low back pain selected from a large cohort ( N = 816 ) . Objectives . To correlate pretreatment baseline variables with outcome parameters after treatment in a functional restoration program or in control programs , to identify possible factors predictive of the need for functional restoration . Summary of Background Data . Since the functional restoration program was first described , research has focused on identifying patients who will or will not benefit from such a program . The value of previous studies is limited , however , because predictive factors from a control group were not " subtracted . " Methods . Eight hundred sixteen patients with chronic low back disability were included . All had a structured medical examination , including various physical tests before participation in either a functional restoration program ( n = 621 ) or shorter " control " outpatient programs ( n = 144 ) . A smaller group of the cohort ( n = 51 ) had no treatment and served as a pure control group . Six groups were selected from the cohort : Three underwent an identical functional restoration program and three underwent different outpatient control programs . Several baseline demographic , physical , and socioeconomic variables were correlated to 1‐year outcome parameters . Results . Age , days of sick leave , connection to the work force , and back pain intensity , were significantly correlated to success 1 year after entry into the study in all groups , no matter what kind of treatment was administered . Back muscle endurance , sports activity , activity of daily living scores , and vibrations were of importance in some outcome parameters for success after functional restoration . Smoking was positively correlated to disability pension . Days of sick leave and , in functional restoration , ability to work were the only factors that were correlative with statistics for people who withdrew . Conclusions . Different factors can be identified as predictive of outcome in a functional restoration program , but most of these factors were also shown to predict success for shorter control outpatient programs or of no treatment The investigation of predictors for therapy outcome in patients with chronic low back pain date back to the early 1970s . Numerous well controlled prospect i ve longitudinal studies have confirmed the predominant predictive power of several psychological factors , which are in addition to objective work related , medical and sociodemographic variables . Studies published in the review period have reported markedly improved method ological st and ards . Further progress is seen with the enhanced search for predictors of working situation in chronic low back pain patients . Finally , there is a shift toward the investigation of predictors for efficacy of primary care in acute and subchronic low back pain patients STUDY DESIGN A r and omized clinical trial . OBJECTIVES To examine the relative efficacy of three active therapies for chronic low back pain . SUMMARY OF BACKGROUND DATA There is much evidence documenting the efficacy of exercise in the conservative management of chronic low back pain , but many questions remain regarding its exact prescription and method of application . The most successful method must be identified to enable refinement of future rehabilitation programs to target the specific needs of the patient with chronic low back pain and the budget of the healthcare provider . METHODS One hundred forty-eight patients with chronic low back pain were r and omized to one of the following treatments , which they attended twice a week for 3 months : 1 ) modern active physiotherapy , 2 ) muscle reconditioning on training devices , or 3 ) low-impact aerobics . Pretherapy and posttherapy , objective measurements of lumbar mobility were performed , and question naires were administered inquiring about self-rated pain and disability , and psychosocial factors . Similar question naires were administered 6 months after therapy . The data were analyzed using the intention-to-treat principle . RESULTS Of the 148 patients , 16 ( 10.8 % ) dropped out of the therapy . One hundred thirty-seven question naires ( 93 % ) were available for analysis at all three time points . After therapy , significant reductions were observed in pain intensity , frequency , and disability ; Fear-Avoidance Beliefs about physical activity ( FABQactivity ) ; and " praying/hoping , " " catastrophizing , " and " pain behavior " coping strategies -- each with no group differences in the extent of the response . These effects were maintained over the subsequent 6 months , with the exception of disability and FABQactivity for the physiotherapy group . There were small but significant posttherapy increases in lumbar mobility , with aerobics and devices showing a greater response than physiotherapy . CONCLUSION The general lack of treatment specificity suggests that the main effects of the therapies were educed not through the reversal of physical weaknesses targeted by the corresponding exercise modality , but rather through some " central " effect , perhaps involving an adjustment of perception in relation to pain and disability . The direct costs associated with administering physiotherapy were three times as great , and devices four times as great , as those for aerobics . Administration of aerobics as an efficacious therapy for chronic low back pain has the potential to relieve some of the huge financial burden associated with the condition Study Design Two-hundred-forty-three patients with chronic low back pain were studied in a prospect i ve comparative survey to determine whether the “ central ization phenomenon ” was associated with outcome after an interdisciplinary work-hardning program . Objective The hypothesis was that patients who demonstrated central ization during initial mechanical assessment would have better outcomes than non central izers . Summary of Background Data Overall subjects had decreased pain intensity ratings ( mean 10 % ) , increased lifting ability ( 6–8 kg ) , and a 59.2 % return-to-work rate at a mean of 9.7 months follow-up . Methods . Patients were classified as either central izers or non central izer  , based on results of their initial assessment , changes in pain ratings , one-time maximal weights lifted , Oswestry scores , and returen-to-work status were compared between groups . Results The central izers reported significant decreases in their maximum pain ratings ( central izers , 16 % non central izers , 6 % ) and had higher return-to-work rate ( central izers , 68 % ; non central izers , 52 % ) than the non central izers . Conclusion . Centrelization can help identify subgroups within the population with chronic low back pain and could be a useful goal setting and case management toll in the rehabilitation of low back pain Objective The objective was to evaluate whether the Multidimensional Pain Inventory ( MPI ) is effective for predicting response to interdisciplinary treatment in a heterogeneous group of patients with chronic pain . Changes in patients ' profiles to a predominantly adaptive coping status after treatment also were assessed . Design A prospect i ve study was conducted of patients with an array of pain conditions . A st and ard evaluation battery , including measures of self-reported pain and disability , psychosocial functioning , helpfulness of the program , and medication use , was used for all patients before and after treatment . The MPI status of patients was evaluated and differential response to treatment was assessed . Methods Sixty-five consecutive patients with chronic pain were evaluated before and immediately after participation in an interdisciplinary pain treatment program . This heterogeneous pain-condition cohort was also differentiated on the basis of the MPI to evaluate potential differential response to treatment . Results Results revealed significant improvement among these patients with chronic pain when a comprehensive interdisciplinary pain-management program was administered . This improvement was seen across the variety of outcomes evaluated , including narcotic medication use . Most important , the MPI subgroup classification did not significantly predict the degree of positive treatment outcome ; all subgroups improved . Conclusions Although there were major differences in psychosocial functioning before treatment , the MPI was not found to significantly predict response to interdisciplinary treatment in a heterogeneous group of patients with chronic pain . Thus , a comprehensive interdisciplinary treatment program may achieve its full effectiveness across a wide array of pain/disability-related outcome variables , regardless of initial MPI profile categorization & NA ; Association of health locus of control beliefs ( HLC ) and psychological distress ( GHQ‐12 ) with short‐term outcome of low‐back pain ( LBP ) rehabilitation was studied in patients with chronic or recurrent LBP ( n = 459 ; aged 35–54 years ; 63 % men ) . These patients were r and omly assigned to 3 study groups , namely the inpatient , the outpatient and the control group . The results showed a significant decrease in disability due to LBP in the 2 treated groups ; in addition , the accomplishment and frequency of back exercises was significantly better in the treated groups . HLC beliefs were associated with a successful outcome ; those patients with stronger internal beliefs had gained more from the treatment , had learned their exercises better and had done the exercises more frequently during the follow‐up period . Symptoms of psychological distress were significantly associated with poorer accomplishment of back exercises Continuous prognostic factors are often categorized by defining optimized cutoff points . One component of criticism of this approach is the problem of multiple testing that leads to an overestimation of the true prognostic impact of the variable . The present study focuses on another crucial point by investigating the dependence of optimized cutoff points on the observed distribution of the continuous variable . The continuous variable investigated was the vertical tumor thickness according to Breslow , which is known to be the most important prognostic factor in primary melanoma . Based on the data of 5093 patients , stratified r and om sample s were drawn out of six artificially created distributions of tumor thickness . For each of these sample s , Cox models were calculated to explore optimized cutoff points for tumor thickness together with other prognostic variables . The optimized cutoff points for tumour thickness varied considerably with the underlying distribution . Even in sample s from the same distribution , the range of cutoff points was amazingly broad and , for some of the distributions , covered the whole region of possible values . The results of the present study demonstrate that optimized cutoff points are extremely data dependent and vary notably even if prerequisites are constant . Therefore , if the classification of a continuous prognostic factor is necessary , it should not be based on the results of one single study , but on consensus discussion s including the findings of several investigations & NA ; Research ers have typically used factor‐analytic composite measures of coping , instead of individual scales , to predict rehabilitation outcome . There are , however , both advantages and disadvantages to using individual or composite scores . This study extended the findings of Jensen et al. ( 1992 ) , by prospect ively comparing the individual and composite scores of the  Coping Strategies Question naire ( CSQ ) in the prediction of 4 types of adjustment to low back pain . Two‐hundred patients completed the  CSQ  , the Oswestry Index , the SCL‐90R , and 4 lifting tasks at admission and discharge from a multidisciplinary pain clinic .  Return to work was determined at 9‐month follow‐up . The CSQ scales were factor‐analyzed to devise composite indices , and the 3 result ant factors were compared to the individual scales in the prediction of pain and other outcomes . The results indicated that the relative predictive utility of the composite or individual scales depended on which outcome measure was used to define adjustment In a retrospective survey , 487 research projects approved by the Central Oxford Research Ethics Committee between 1984 and 1987 , were studied for evidence of publication bias . As of May , 1990 , 285 of the studies had been analysed by the investigators , and 52 % of these had been published . Studies with statistically significant results were more likely to be published than those finding no difference between the study groups ( adjusted odds ratio [ OR ] 2.32 ; 95 % confidence interval [ Cl ] 1.25 - 4.28 ) . Studies with significant results were also more likely to lead to a greater number of publications and presentations and to be published in journals with a high citation impact factor . An increased likelihood of publication was also associated with a high rating by the investigator of the importance of the study results , and with increasing sample size . The tendency towards publication bias was greater with observational and laboratory-based experimental studies ( OR = 3.79 ; 95 % Cl = 1.47 - 9.76 ) than with r and omised clinical trials ( OR = 0.84 ; 95 % Cl = 0.34 - 2.09 ) . We have confirmed the presence of publication bias in a cohort of clinical research studies . These findings suggest that conclusions based only on a review of published data should be interpreted cautiously , especially for observational studies . Improved strategies are needed to identify the results of unpublished as well as published studies & NA ; A better knowledge of differential treatment outcomes for subgroups of chronic spinal pain patients may , for instance , help clinicians in treatment planning or pain research ers in treatment outcome research . The purpose of this prospect i ve study was to evaluate the predictive validity of a subgroup classification based on the Swedish version of the ( West Haven Yale ) Multidimensional Pain Inventory , the MPI‐S. Patients referred to a vocational rehabilitation program  were classified into one of three groups , labeled ‘ adaptive copers ’ , ‘ dysfunctional ’ patients  , and ‘ interpersonally distressed ’ patients , and followed over an 18‐month follow‐up period . The outcome variables were absence from work ( defined as sick listing plus early retirement ) , general health status , and utilization of health care re sources . To our knowledge , the predictive validity of the MPI subgroups has not been evaluated regarding sick listing and early retirement after rehabilitation . As hypothesized , the results showed that the ‘ dysfunctional ’ patient group had significantly more registered absences from work and reported higher utilization of health care , over the follow‐up period compared to the ‘ adaptive copers ’ . Furthermore , as hypothesized , the ‘ interpersonally distressed ’ and ‘ dysfunctional ’ patient groups report a poorer general health status than the ‘ adaptive copers ’ over the whole follow‐up period . However , contrary to our hypothesis , the proportion of improved patients did not differ significantly between the subgroups . Altogether , the predictive validity of the MPI‐S subgroup classification was mainly confirmed . The clinical implication s of this study suggest that the matching of treatment to patient needs may enhance treatment outcome , reduce pain and suffering among chronic spinal pain patients and facilitate a better health economic allocation of treatment re sources The purpose of this study was to investigate the psychometric properties of a Dutch translation of the Multidimensional Pain Inventory , MPI-DLV . Data was available on 733 chronic pain patients . There were three issues of special interest . The first one related to the comparability between the MPI-DLV and the American and German MPI versions with regard to the psychometric aspects . The second dealt with the construct validity of the  MPI-DLV scale ' general activity ' . It was predicted that patients with high scores on this scale would be in better physical condition , as measured on a working-to-tolerance bicycle ergometer test . In relation to the third issue , attention was given to the factor-invariance between fibromyalgia patients and back pain patients . From the results obtained it was concluded that ( 1 ) the factorial structure of the three MPI parts is replicated and the reliability estimates and validity indicators are similar to those from the American and German versions ; ( 2 ) patients with high scores on the ' general activity ' scale are in better physical condition and ( 3 ) MPI-DLVs of fibromyalgia and back pain patients do have similar factorial structures . Evidence was also obtained that the  MPI-DLV  is sensitive to treatment changes . Applications of the MPI-DLV are discussed Meta- analysis comprises the analysis of the data of similar studies gathered in a systematic review . If the results of the studies differ ( strongly ) , this is called heterogeneity . Possible causes of heterogeneity are : a wrong choice of type of measure of treatment effect , differences of method ological quality between studies , or real differences between studies . Heterogeneity between studies can be assessed by thorough examination of the differences between study characteristics in combination with a visual inspection of the degree of overlap of the confidence intervals of the estimates of effect of the different studies . By applying the r and om effects model for pooling , ( non- systematic ) heterogeneity between studies can be addressed . In case of heterogeneity between studies , sources of heterogeneity should be explored by means of subgroup analysis according to strict , present criteria . Subgroup analysis should address subgroups of patients within studies
target: Consistent evidence was found for the predictive value of pain intensity ( more pain-- > worse outcome ) , several work-related parameters ( e.g. , high satisfaction-- > better outcome ) , and coping style ( less active coping-- > better outcome ) .
  Other sociodemographic and physical variables consistently lacked predictive value .
  No consistent evidence was found for other psychological variables .
  CONCLUSIONS It is impossible to define a generic set of predictors of outcome of multidisciplinary rehabilitation and back schools for patients with chronic low back pain because the review ed studies were descriptive or exploratory in nature , and most predictors were only studied once .
  Nevertheless , for several predictors , consistent evidence was found .
background: OBJECTIVE To determine predictors of outcome of multidisciplinary rehabilitation-or back school treatment  for patients with chronic low back pain .
  SUMMARY OF BACKGROUND DATA Numerous review s have been performed to gain insight into which patients benefit from which treatment .
  However , no review has systematic ally focused on predictors from multiple domains ( i.e. , sociodemographic , physical , and psychological ) , or on treatment outcome measured as activity limitation or participation restriction .