Dynamic Chiropractic

Dynamic Chiropractic Facebook Twitter
Dynamic Chiropractic
Advanced Search
Wellness Blog
Dynamic Chiropractic
Dynamic Chiropractic PracticeINSIGHTS
Current Graphic

How well can doctors predict which patients respond to treatment?

Evidence suggests that both primary care practitioners and doctors of chiropractic are not highly accurate when predicting the prognosis for patients with low back pain.1,2 Because accurate prognosis is key to apprising patients of their condition and in developing/implementing treatment plans, researchers in Denmark conducted a study to understand what components doctors of chiropractic deem important in determining prognosis, and how prognosis predictions compared with treatment response and to a prognostic instrument called the STaRT Back Screening Tool.3

The investigators found that the 40 doctors in the study somewhat accurately predicted prognosis for groups of patients with respect to the mean predictive scores for patients categorized with short/uncomplicated or long-lasting low back pain. However, they poorly predicted the prognosis for individual patients. The STaRT Back Screening tool did not help improve prognosis prediction either. Factors that tended to influence study doctor’s opinions toward predicting a long-lasting or complicated condition were higher Body Mass Index, more previous low back pain, neurological signs, radiating pain, more disability, long duration of the present episode, more disability, being female. Patients with more than 5 years of education after public school were more likely to receive a short/uncomplicated prognosis prediction. Keep in mind, however, these factors didn’t predict prognosis well with individual patients.

An important limitation to consider is that clinical improvement was measured by patient reported pain using a numerical rating scale of 0-10 and disability using the Roland Morris Disability Questionnaire. These measures are often used in research and are considered valid and reliable, but they aren’t particularly sensitive to some condition changes nor are they sensitive to patient perceptions of progress or other factors that can be important to patients, such as sleep quality and pain medication use. In part, this lack of predictive ability may be due to low back pain being a symptom of many conditions and because the many factors that potentially influence prognosis may do so unequally among patients. Therefore, it may be too simplistic to think that any set of factors can be broadly applied to influence the prognosis of large numbers of patients with varied conditions.

So where does this information leave us? Well, it appears that doctors might not be able to predict accurately how individual patients with low back pain are going to respond to care. It is perhaps important to first accept this and recognize that we need more tools to help improve our prognostic ability. The study did not evaluate how prognosis changed after doctors could evaluate how patients were responding to initial treatment plans. Perhaps prognosis improves shortly after a course of care begins. That may be the question another study will seek to answer. In the interim, it seems that clear and regular communication with patients and regular clinical evaluation is one way to update, and perhaps, improve the accuracy of individual prognosis while maintaining a patient centered focus.

Reference List
1. Newell D, Field J, Visnes N. Prognostic accuracy of clinicians for back, neck and shoulder patients in routine practice. Chiropr Man Therap. 2013;21:42.
2. Jellema P, van der Windt DA, van der Horst HE, Stalman WA, Bouter LM. Prediction of an unfavourable course of low back pain in general practice: comparison of four instruments. Br J Gen Pract. 2007;57:15-22.
3. Kongsted A, Andersen CH, Hansen MM, Hestbaek L. Prediction of outcome in patients with low back pain – A prospective cohort study comparing clinicians’ predictions with those of the Start Back Tool. Man Ther. 2015.

Leave a Reply