Article

Managing patients with lumbar spine syndromes who are seeking
outpatient physical therapy represents a complex problem where psychosocial
constructs such as fear-avoidance beliefs regarding physical activities or work
activities, somatization, and depressive symptoms may affect functional status
(FS) outcomes. The purpose of this study was to determine whether
intake or changes in fear-avoidance beliefs regarding physical or work
activities, somatization, and depressive symptoms assessed simultaneously affect
FS outcomes prediction. DESIGN: This study was a secondary analysis of
prospectively collected, longitudinal, observational cohort data. METHODS: Data
analyzed were from adult patients (n=323) with lumbar syndromes classified as
elevated versus not elevated on single-item screening instruments for
fear-avoidance beliefs regarding physical or work activities, somatization, and
depressive symptoms at intake and discharge. Prediction of minimal clinically
important difference in FS was assessed separately for intake and change from
intake to discharge classifications using logistic regression models controlling
for important variables. RESULTS: Intake and change models were strong (McFadden
rho-squared values=.31 and .49, respectively). Patients classified as not
elevated in fear-avoidance beliefs regarding physical activities but elevated in
fear-avoidance beliefs regarding work activities, somatization, and depressive
symptoms at intake were 5 out of 100 times less likely to report clinically
important outcomes compared with being elevated in each measure. Patients not
elevated in fear-avoidance beliefs regarding work activities and somatization at
intake and discharge were 8 to 14 times more likely to report clinically
important outcomes compared with being elevated in each measure. LIMITATIONS:
Sample size was limited. Data analyses were retrospective with no control of
missing data. CONCLUSIONS: Combinations of multiple psychosocial constructs were
important predictors of FS outcomes and may assist patient management by: (1)
identifying patients with elevated psychosocial constructs at intake and (2)
tracking change in psychosocial variables for improved outcomes prediction. This
model may prove helpful for future clinical and research applications to
determine optimal psychosocial screening methods.

Langue : ANGLAIS