Abstract
Purpose: This study aimed to determine the level of pre-assessment distress in patients referred to an outpatient physical therapy department from primary care. (This work was undertaken alongside a pilot randomised controlled trial, designed to test the feasibility of a tailored psychosocial intervention).
Background: Research has shown that psychosocial factors are more important than physical factors for patients with back pain, in predicting outcome from physical therapy.
Methods: 300 patients reporting low back pain +/− referred leg pain were consecutively sampled. They completed 3 self-report questionnaires prior to attending the hospital department:
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Acute Low Back Screening Questionnaire (ALBSQ), designed to assess psychosocial variables identified as risk factors for continued back pain symptoms;
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Tampa Scale of Kinesiophobia (TSK), measuring fear of movement
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Clinical Back Pain Questionnaire (CBPQ), measuring pain and function.
The patients’ specific responses were used to develop the tailored psychosocial intervention.
Results: The majority of the 91 respondents (51%) were distressed and at risk of poor outcome after their primary care consultation. (A score of 112 or greater on the ALBPSQ suggests patients have an 80% chance of not returning to their usual employment or pre-morbid functional level). These distressed patients were also shown to have significantly higher levels of fear-avoidance beliefs, pain and reduced function (p=0.000).
Conclusion: Following a consultation in primary care, the majority of patients with back pain score above the cut-off level for distress. To ensure optimal outcome, clinicians must develop strategies to recognise and reduce these high levels of distress.
Correspondence should be addressed to SBPR at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE, England.
