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Study Design. Validity and responsiveness study using a randomized clinical trial and prospective cohort study of patients with low back pain (LBP). Objective. To provide evidence for construct validity and responsiveness to change of a single-item presenteeism question (SIPQ) in patients with LBP. Summary of Background Data. The SIPQ is a simple, easy to administer tool that has been used to measure the impact of back pain on reduced productivity at work (presenteeism) as a standalone measure. Evidence supporting the validity and responsiveness of the SIPQ among patients with back pain is however lacking. Methods. The SIPQ was administered to patients consulting for back pain in a randomized controlled trial (N = 851) and a cohort intervention study (N = 922). Construct validity was assessed using convergent, divergent, and known-group validity. The validity investigation included assessing associations between the SIPQ and pain, disability, psychological, health status, and quality of life measures. Responsiveness was assessed using external indicators of change as comparators, evaluating correlation of clinical change scores and effect size statistics. Results. Moderate to strong correlations were found between presenteeism and pain (r: 0.44-0.77), disability (r: 0.53-0.70), and 12-Item Short Form Health Survey physical dimensions (r: -0.66 to -0.55). Presenteeism was strongly associated with disease-specific pain and disability scales. The SIPQ was responsive to changes in productivity--presenteeism change scores indicated strong correlation with change scores, and high responsiveness in distribution- and anchor-based testing. Conclusion. The SIPQ is a potentially valid and responsive tool for assessing the impact of back pain on presenteeism. This SIPQ could, with relative ease, facilitate further research on the estimation of presenteeism within economic evaluation studies of musculoskeletal conditions, thus providing policymakers with estimates of economic impact of musculoskeletal disease. Further evidence is, however, merited to assess its relationship with standardized presenteeism questionnaires. [ABSTRACT FROM AUTHOR]

Pain drawings can be presented as either a blank or a pre-shaded manikin. This study sought to determine the effect of these two presentations on prevalence estimates of neck and upper limb pain (NULP), and their relationship to patterns of pain report.A postal questionnaire was sent to a stratified random sample of 10,000 adults. It contained a blank body manikin and a pre-shaded neck and upper limb manikin screening question. Respondents answering positively to the pre-shaded manikin were asked about pain intensity, affect, disability and duration. Other measures included general health status (SF-12v2) and demographic questions.Adjusted response rate was 53.5%. Age-standardized 1-month period prevalence was 44.0% (crude prevalence 50.5%) for the screening question and 37.3% (crude prevalence 42.1%) for the blank manikin. There was 88% agreement between the pre-shaded manikin and the shading of corresponding areas on the blank manikin (kappa=0.76, 95% CI=0.74, 0.78). Of the 603 disagreements, 509 comprised no shading on the blank manikin but positive response to the pre-shaded manikin; they reported lower pain intensity, fewer days with pain, shorter time since initial onset and less disability than the 2030 reporting NULP on both manikins (P<0.001 in each case).The form of manikin presentation in a postal questionnaire can shift the reported prevalence of pain; a difference of 6.7% in our study. Furthermore, respondents only answering positively to a pre-shaded manikin form a group experiencing less severe NULP and less associated disability. [Copyright &y& Elsevier]

Many apparently distinctive clinical syndromes of pain and dysfunction show considerable overlap in both population and clinical settings. If the explanation is that they all share a common underlying mechanism, then we hypothesize that any one syndrome will be unlikely to retain its distinctiveness over time. Consultation data from general practice records for 10,073 women, collected between 1968 and 1978, was linked with information on pain complaints obtained from a subsequent postal survey carried out in 1994. Illness episodes were identified from the general practice records and grouped into diagnostic subcategories. Associations between these and future pain complaints were explored, adjusting for age, smoking, body mass index and social class in a series of nested case–control analyses. Overall, the strongest independent associations of current pain were with episodes of musculoskeletal illness and mental disorders recorded 15–25 years earlier; these associations were more marked for widespread pain (odds ratios 1.8 and 1.7, respectively) than for non-widespread pain (ORs 1.3 and 1.2, respectively). In analyses of specific illness subcategories, the strongest links for head and neck pain were with earlier migraine. Back pain was most strongly associated with earlier back complaints, and abdominal pain with earlier intestinal-related problems. By contrast, chest pain was most strongly linked with earlier psychological illness. Earlier soft tissue illness episodes showed no distinctive patterns of associations over time with subsequent regional pain complaints. This analysis provides some support for shared mechanisms of chronicity across regional pain complaints, particularly in relation to the earlier occurrence of mental illness and the development of widespread pain. However, there is strong evidence that regional pain complaints also track distinctively over time. This argues against chronic functional and pain syndromes all being the same problem with a common mechanism of persistence, and in favor of unique regional influences on chronicity as well. [Copyright &y& Elsevier]

Study Design: Reanalysis of data from 3 randomized controlled trials., Objective: Development and validation of a prediction rule that estimates the probability of complaints persisting for at least 6 months in patients presenting with nonspecific neck pain in primary care., Summary of Background Data: A substantial proportion of the neck pain patients will develop chronic neck pain. An important question is whether we can identify patients at risk of persistent complaints at the first consultation with the physician, based on their personal characteristics? A prediction model that quantifies prognosis in patients with nonspecific neck pain is not available., Methods: The study population consisted of a sample (n = 468) from the adult primary care population (18-70 years) in The Netherlands presenting with nonspecific neck pain. The primary outcome measure was global perceived recovery measured at 6 months of follow-up. Seventeen baseline characteristics of the patients were included in the analysis. Significant predictors were identified by multivariable backward stepwise logistic regression analysis. A score chart was constructed by using the regression coefficient estimates. The score chart was externally validated in a cohort of patients with nonspecific neck pain (n = 315), who participated in a randomized controlled trial in the United Kingdom (PANTHER-trial)., Results: The multivariable analysis resulted in a set of 9 predictors. The score chart has a discriminative ability of 0.66. External validation of the score chart showed a discriminative ability of 0.65, an adequate calibration, a good fit, and a low explained variation., Conclusion: We developed a score chart, estimating the probability of persistent complaints at 6 months follow-up for patients with nonspecific neck pain. This chart performed well in the study population and external validation population. The prediction which patients are more likely to develop persistent complaints is significantly improved by the score chart.

Objectives: This study evaluated predictors of poor outcome in patients with neck pain treated by physical therapy, and sought to compare the findings of empirical data with physical therapy practitioners' subjective perceptions about predictors of outcome., Methods: This study was a secondary analysis of data from a randomized controlled trial assessing physical therapy treatments for neck pain (n=346). A baseline questionnaire provided data on a number of potential risk factors of poor outcome at follow-up. Follow-up was conducted at 6 weeks and 6 months by postal questionnaire with outcome defined separately by perceived (global) change and minimal clinically important differences in the Northwick Park Neck Pain Questionnaire (MCID-NPQ). Therapists' perceptions of predictors for treatment outcome were captured using a separate questionnaire, and the ratings compared with ranks derived from the 6-month trial data., Results: Baseline characteristics accounted for a much greater proportion of explained variance for global change compared with MCID-NPQ at 6 months. Independent biopsychosocial characteristics included manual social class, catastrophizing, anxiety and depression, low treatment expectations, severity of baseline neck pain/disability, presence of comorbid back pain, and older age. Physical therapist ranks correlated highly with those derived from the trial data., Conclusions: Significant predictors of outcome were identified, particularly at 6 months, including psychosocial, functional, and demographic indicators. Our findings suggest that physical therapists are collectively aware of the relative importance of physical and psychosocial factors in predicting clinical outcome. However, a significant amount of variability in outcomes in our prognostic models remained largely unexplained, indicating that we need to explore further underlying factors to inform clinical decision-making.

Study Design: Study of interrater reliability., Objective: To assess the interrater reliability of data from pain drawings scored by multiple raters and the consistency of the subsequent classification of cases of widespread pain., Summary of Background Data: In large health surveys, pain drawings used to capture self-reported pain, and to classify cases of widespread pain, are often scored by several raters. The reliability of multiple rater scoring of pain drawings has not been investigated., Methods: As part of a postal survey sent to adults 50 years and older, subjects were asked to shade their pain on a blank body manikin. The first 50 pain drawings in which respondents had shaded pain were selected for this study. Eight nonclinical staff were trained to score pain drawings using transparent templates divided into 50 body areas. Interrater reliability was assessed by comparing the scoring of "pain" or "no pain" for all 50 areas of each pain drawing., Results: Complete scoring agreement among all raters was observed for at least 78% of pain drawings across all body areas (kappa > 0.60). The raters had complete agreement in 42 of 50 areas in 90% or more of pain drawings. From the raters' scoring of pain areas, there was complete agreement on the presence or absence of widespread pain for 49 of 50 pain drawings (98% agreement, Kappa = 0.98)., Conclusions: This study shows that multiple raters, with training and guidelines, can reliably score pain drawings, and high consistency in the subsequent classification of cases of widespread pain can be obtained from such data.