Does pain duration and other variables measured at baseline predict re-referral of low back pain patients managed on an evidence-based pathway? A cohort study

Jess, Mary-Anne ORCID: https://orcid.org/0000-0002-4863-2221, Ryan, Cormac ORCID: https://orcid.org/0000-0001-5864-4325, Wellburn, Shaun ORCID: https://orcid.org/0000-0003-2630-5876, Atkinson, Greg, Greenough, Charles ORCID: https://orcid.org/0000-0003-1797-0516, Peat, Glynis, Coxon, Andrew, Roper, Helena, Fatoye, Francis ORCID: https://orcid.org/0000-0002-3502-3953, Ferguson, Diarmaid, Dickson, Alastair ORCID: https://orcid.org/0000-0003-2189-3859, Ridley, Helen and Martin, Denis (2023) Does pain duration and other variables measured at baseline predict re-referral of low back pain patients managed on an evidence-based pathway? A cohort study. Physiotherapy (United Kingdom), 121. pp. 5-12. ISSN 0031-9406

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Abstract

Objective: To explore the association between baseline pain duration and the likelihood of re-referral of patients with low back pain (LBP) managed on the evidence-based North East of England Regional Back Pain and Radicular Pain Pathway (NERBPP). Study design: Longitudinal, observational cohort study. Methods: In all, 12,509 adults with LBP were identified as having been discharged from the pathway, between May 2015 and December 2019. To quantify any association between baseline pain duration and the likelihood of re-referral, two statistical modelling approaches, were used: logistic regression models for odds ratios and generalised linear models with a binomial link function in order to quantify risk differences. Results: Twenty-five percent of patients with LBP, who were discharged, re-referred for management over a 4.5-year period. A large difference in pain duration of 2 SD days was statistically associated with re-referral, with an odds ratio of 1.22 (95% CI: 1.03, 1.44) and a risk difference of 3.6% (95% CI: 0.6, 6.6). Nevertheless, the predictive value of an individual's pain duration was found to be weak for re-referral. Higher baseline disability [odds ratio of 1.40 (95% CI: 1.07, 1.83)] and a younger age at baseline [odds ratio of 0.73 (95% CI 0.61, 0.86)] were also associated with an increased risk of re-referral. Conclusions: Baseline pain duration, disability and younger age are statistically associated with re-referral onto the NERBPP. However, the value of these variables for predicting an individual's risk of re-referral is weak. Contribution of paper: • The NERBPP is an evidence-based clinical pathway for low back pain and a forerunner to the National Back Pain Pathway. • Baseline pain duration, disability and younger participants have an association with re-referral onto the NERBPP, however, the predictive values of these variables are weak. • 25% of patients with low back pain, who were discharged, re-referred for management over a four-and-a-half-year period, re-referral rates onto the NERBPP have not previously been published.