Abstract
Background: It is universally acknowledged that psychological distress in chronic low back pain (LBP) is commonplace and the early identification of such distress is increasingly being advocated as an important aspect of LBP assessment. The Distress and Risk Assessment Method (DRAM) is a screening tool, using the Modified Zung (MZ) and Modified Somatic Perception Questionnaires (MSPQ), developed to provide a simple classification of patients with LBP. Patients are classified as normal, at risk of developing distress, and those who are distressed (Distressed Depressive {DD} and Distressed-Somatic {DS}). The DRAM was used to screen LBP patients for entrance to an RCT examining different physiotherapy regimes for recurrent LBP.
Methods: Patients referred for physiotherapy, at three hospitals within South Birmingham, with a diagnosis of recurrent LBP were screened using the DRAM and Roland Morris Disability Questionnaire (RMDQ). Distressed patients were excluded from the trial as psychological distress has been shown to be associated with an increased risk of poor treatment outcome.
Results: 214 patients were screened for entrance to the trial with 69 (31%) excluded on the basis of their DRAM scores (DD=39, DS=30). Excluded (distressed) patients (n=69) had a mean MZ score of 33.30 (SD: 9.28, range= 7 to 56), with patients entered into the trial (non-distressed, n=95) having a mean of 18.12 (SD: 7.83, range=3 to 36). The mean MSPQ score for the distressed patients was 12.70 (SD: 5.69, range=0 to 26), and for the non-distressed patients was 4.37 (SD: 3.67, range= 0 to 22). RMDQ scores (functional disability) were higher for the distressed group (mean 14.09 [SD: 4.80], range=3 to 23) than the non-distressed group (mean 10.52 [SD: 4.22], range= 5 to 21).
Conclusions: The results indicate that approximately one third of patients referred for physiotherapy at the units studied exhibited a level of distress that increased their relative risk of poor outcome by 3 to 4 times. The impact of these results has been to slow the recruitment to the ongoing RCT. The clinical implications are that screening this group of patients may indicate when liaison with clinical psychologists is appropriate and possibly identify patients who are too distressed to respond to physiotherapy.
The abstracts were prepared by Dr P Dolan. Correspondence should be addressed to him at the British Orthopaedic Association, Royal College of Surgeons, 35-43 Lincoln’s Inn Fields, London WC2A 3PN.
