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Differences among primary care patients with different mechanical patterns of low back pain: a cross-sectional investigation.

Differences among primary care patients with different mechanical patterns of low back pain: a cross-sectional investigation.
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Della Mora LS, Perruccio AV, Badley EM, Rampersaud YR,


Della Mora LS, Perruccio AV, Badley EM, Rampersaud YR, (click to view)

Della Mora LS, Perruccio AV, Badley EM, Rampersaud YR,

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BMJ open 2016 12 076(12) e013060 doi 10.1136/bmjopen-2016-013060
Abstract
OBJECTIVES
To characterise and compare a persistent low back pain (LBP) population based on 4 clinical pain patterns.

DESIGN
Cross-sectional analysis of patient-reported data.

SETTING
Patients from 220 primary care practitioners in 3 cities in Ontario, Canada.

PARTICIPANTS
1020 individuals seeking LBP care.

INCLUSION CRITERIA
LBP symptoms lasting 1½-12 months, or unmanageable recurrent symptoms; ages 18+years.

EXCLUSION CRITERIA
pregnant/1-year postpartum; involved in active litigation or motor vehicle injury; emergent spinal presentations; pain disorder diagnosis; work injury claim; or constant symptoms persisting >12 months postonset.

MAIN OUTCOME MEASURE
Hall pain pattern subgroups: back dominant pain aggravated by flexion (P1) or extension (P2), or leg dominant constant (P3) or intermittent (P4) pain (multinomial logistic outcome; referent: P1).

RESULTS
Groups P1 and P2 had the highest proportion of women. P2 and P4 had higher mean ages and comorbidity counts. P3 and P4 had higher proportions of overweight/obese individuals and lower general health scores. Adjusted models: being male and overweight/obese was associated with increased odds of being in P3 (OR 1.64 (95% CI 1.10 to 2.46), and OR 1.74 (1.13 to 2.68), respectively) and P4 (OR 1.87 (1.11 to 3.15) and OR 1.91 (1.06 to 3.42), respectively), and increasing age with increased odds of being in P2 (OR 1.02 (1.01 to 1.03)) and P4 (OR 1.06 (1.04 to 1.08)). Increasing comorbidity count was associated with increased odds of being in P2 (OR 1.14 (1.0 to 1.3)), and better general health scores with decreased odds of being in P3 (OR 0.40 (0.18 to 0.93)).

CONCLUSIONS
This is the first study to examine the ‘Hall system’ in a non-rehab primary care population. Subgroups classified according to this system appear to have distinct profiles. Further research is needed to better characterise and determine the prognostic implication of these clinically derived subgroups.

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