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How is recovery (from low back pain) measured? A systematic review

Discussion in 'Other Health News and Research' started by Simon, Oct 17, 2013.

  1. Simon


    Monmouth, UK
    Interesting as it seems relevant to the debate about what counts as recovery in ME/CFS

    How is recovery from low back pain measured? A systematic review of the literature (Kamper 2010)

    Abstract highlights
    Eighty-two included studies used 66 different measures of recovery. Fifty-nine of the measures did not appear in more than one study. [only 7 measures used more than once, never in quite the same way]

    [using symptoms/function reports to indirectly measure recovery]
    Seventeen measures used pain as a proxy for recovery, seven used disability or function and seventeen were based on a combination of two or more constructs.

    [asking patients directly about recovery]
    There were nine single-item recovery rating scales. Eleven studies used a global change scale that included an anchor of ‘completely recovered’.

    [objective measures of recovery]
    Three measures used return to work as the recovery criterion, two used time to insurance claim closure and six used physical performance.

    In conclusion, almost every study that measured recovery from LBP in the last 10 years did so differently.

    When recovery doesn't mean recovery (from intro)
    I'm going to focus on the normal meaning of restoration of health here...
  2. Simon


    Monmouth, UK
    Pain & disability/function measures or recovery - all assume close to full health
    This is akin to the PACE Trial approach of using fatigue and self-rated physical function to define recovery. However, unlike PACE (which set fatigue and function recovery thresholds so low that 1 in 9 patients met a recovery threshold before the trial started) these back pain studies set 'high' recovery thresholds

    Pain scales
    - SF-36: Level of Pain 0 (0-6 scale)
    - Numerical Rating scale 0 or 1 (0-10 scale)
    - Visual Analog Scale 10mm (0-100mm)

    Other pain measures:
    Have you had back pain in past year (or week in once case)? NO
    No backache, cure etc

    RMDQ disability scale <=2 (0-24 scale)
    SF36 pain interfering with work or life 0 (0-6) = no interference at all
    "Able to perform daily activities as well as before this episode

    Some studies required improvements in both pain and disability, but again the recovery threshold was 'high' ie little or no pain or disability.

    Patient reports of recovery - again usually only 'complete recovery' used
    This invovles a 'recovery' scale, typically 1-6. Some studies also used 'global improvement' scales, usually used to measure amount of improvement but some of these have as the max score of "Completely recovered".

    - 'global improvement' scales all used max 'completely recovered' as measure of recovery
    - Most recovery scales were 1-5 or 1-6 and used only the maximum score as recovery. But not all:
    - Recovery scale 6-point (≤2 is recovered)
    - Question: Yes to: “completely better”

    By contrast, the PACE trial used a Clinical Global Improvement' scale from 'very much worse' to 'very much better'. It did not include 'recovered' as an option. However, PACE used either 'much better' or 'very much better' as part of its recovery definition.

    Worth noting too the comment in the discussion of this review about using patient reports of recovery
    Objective measures including 'Return to equal or own work'
    Various objective measures were used, including physical performance measures, self-reported return to work (inc eg return to previous work status) and closure of insurance claims.
    Valentijn and Dolphin like this.

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