Abstract
Patients with mechanical back pain have been treated in a nurse-led spinal clinic. They attend two one-on-one sessions with a nurse, the second session usually between three and 12 months after the first. Between these visits, they also attended two sets of classes in the spinal assessment clinic to help them improve and manage their back pain. A questionnaire is completed at presentation and at review.
The questionnaires include three scores: The low back outcome Score, MSPQ and the Zung Depression Scale. Since 1995, approximately 2250 patients have been treated. The influence of smoking, gender, age, occupation and marital status on recovery has been studied.
Smoking: Patients who had given up smoking between the first and second questionnaires showed a significant improvement in their outcome score and MSPQ score. Out of 827 who said they smoked on presentation, 280 said they did not on review. From an average outcome score on presentation of 25, those who gave up improved more than those who did not (average score at review 37 vs. 31). A similar trend was seen in the MSPQ averages (from 9 to 7.4 vs. 9 to 8.7). Non-smokers had better results than smokers with an increased outcome score from 30 to 38, MSPQ from 8 to 7.1 and Zung from 20.6 to 19.6. Thus people who gave up smoking showed a larger improvement in their outcome and MSPQ scores than those who continued smoking and those who did not smoke at all.
Gender: Women showed greater improvement in each of the areas than men – 14.5% greater in the outcome score, a 21.2% greater increase in the MSPQ score, and 3.7% in the Zung score.
Age: Patients were divided into 10-year groups. The age group of 50–60 showed the lowest average response for each score, ( 28 to 34 on outcome (average difference = 8), 8.3 to 7.8 on MSPQ (average difference = −0.8), and 21.1 to 21 on Zung (average difference = −0.7). The 30–40 group showed the highest average change on each score (29 to 39 on outcome, 7.9 to 6.9 on MSPQ, 21.8 to 20.1 on Zung). The adjacent age groups showed similar trends but the numbers were not significant.
Occupation: Occupation was divided into eight categories from high-grade professionals to the unemployed. The least improvement was shown by the low-grade occupations (semi-skilled manual workers and the unemployed). The greatest improvements were shown by the middle grade groups. The highest grade occupation showed poor improvement but this was not significant.
Marital Status: For the outcome score, patients who were divorced/separated showed the least improvement, while the married group showed the greatest. On the MSPQ and Zung score, divorced/separated showed the greatest and second greatest improvement (61 % greater than the average on Zung score). The single group showed the worst overall response, scoring the second lowest improvement for the outcome score, the lowest on the MSPQ score (difference −0.47) and their average response actually worsened for the Zung score (from 21 to 21.6).
Conclusion: This study demonstrates that demographic and socio-economic factors significantly influence the level of improvement which patients make in their recovery from mechanical back pain after a treatment program.
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.
