Universität zu Köln

Hirsch, Oliver, Strauch, Konstantin, Held, Heiko, Redaelli, Marcus, Chenot, Jean-Francois ORCID: 0000-0001-8877-2950, Leonhardt, Corinna, Keller, Stefan, Baum, Erika, Pfingsten, Michael, Hildebrandt, Jan, Basler, Heinz-Dieter, Kochen, Michael M., Donner-Banzhoff, Norbert and Becker, Annette (2014). Low Back Pain Patient Subgroups in Primary Care Pain Characteristics, Psychosocial Determinants, and Health Care Utilization. Clin. J. Pain, 30 (12). S. 1023 - 1033. PHILADELPHIA: LIPPINCOTT WILLIAMS & WILKINS. ISSN 1536-5409

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Abstract

Objectives: In industrialized countries, low back pain (LBP) is one of the leading causes for prolonged sick leave, early retirement, and high health care costs. Providing the same treatments to all patients is neither effective nor feasible, and may impede patients' recovery. Recent studies have outlined the need for subgroup-specific treatment allocation. Methods: This is a cross-sectional study that used baseline data from consecutively recruited patients participating in a guideline implementation trial regarding LBP in primary care. Classification variables were employment status, age, pain intensity, functional capacity (HFAQ), depression (CES-D), belief that activity causes pain (FABQ subscale), 2 scales of the SF-36 (general health, vitality), and days in pain per year. We performed k-means cluster analyses and split-half cross-validation. Subsequently, we investigated whether the resulting groups incurred different direct and indirect costs during a 6-month period before the index consultation. Results: A 4-cluster solution showed good statistical quality criteria, even after split-half cross-validation. Elderly patients adapted to pain (cluster 1) and younger patients with acute pain (cluster 4) accounted for 55% of all patients. Cluster validation showed the lowest direct and indirect costs in these groups. About 72% of total costs per patient referred to clusters 2 and 3 (patients with chronic severe pain with comorbid depression and younger patients with subacute pain and emotional distress). Discussion: Our study adds substantially to the knowledge of LBP-related case-mix in primary care. Information on differential health care needs may be inferred from our study, enabling decision makers to allocate resources more appropriately and to reduce costs.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Hirsch, Oliver UNSPECIFIED UNSPECIFIED UNSPECIFIED Strauch, Konstantin UNSPECIFIED UNSPECIFIED UNSPECIFIED Held, Heiko UNSPECIFIED UNSPECIFIED UNSPECIFIED Redaelli, Marcus UNSPECIFIED UNSPECIFIED UNSPECIFIED Chenot, Jean-Francois UNSPECIFIED orcid.org/0000-0001-8877-2950 UNSPECIFIED Leonhardt, Corinna UNSPECIFIED UNSPECIFIED UNSPECIFIED Keller, Stefan UNSPECIFIED UNSPECIFIED UNSPECIFIED Baum, Erika UNSPECIFIED UNSPECIFIED UNSPECIFIED Pfingsten, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Hildebrandt, Jan UNSPECIFIED UNSPECIFIED UNSPECIFIED Basler, Heinz-Dieter UNSPECIFIED UNSPECIFIED UNSPECIFIED Kochen, Michael M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Donner-Banzhoff, Norbert UNSPECIFIED UNSPECIFIED UNSPECIFIED Becker, Annette UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-422108
DOI:	10.1097/AJP.0000000000000080
Journal or Publication Title:	Clin. J. Pain
Volume:	30
Number:	12
Page Range:	S. 1023 - 1033
Date:	2014
Publisher:	LIPPINCOTT WILLIAMS & WILKINS
Place of Publication:	PHILADELPHIA
ISSN:	1536-5409
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language FEAR-AVOIDANCE BELIEFS; RANDOMIZED CONTROLLED-TRIAL; PSYCHOLOGICAL RISK-FACTORS; MULTIDISCIPLINARY TREATMENT; MUSCULOSKELETAL-PAIN; EUROPEAN GUIDELINES; QUESTIONNAIRE FABQ; CROSS-VALIDATION; CLINICAL-TRIAL; LONG-TERM Multiple languages Anesthesiology; Clinical Neurology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/42210