Level of Distress in a Recurrent Low Back Pain Population Referred for Physical Therapy

STUDY DESIGN: Recruitment phase of a randomized clinical trial. OBJECTIVES: To review the published literature on the use of the distress risk assessment method in different back pain populations and healthcare settings and compare results with those obtained from the current trial. SUMMARY OF BACKGROUND: Psychological distress in low back pain is commonplace, and distress increases the relative risk of poor outcome with physical treatment alone. The Distress and Risk Assessment Method is a tool for use in the clinical setting to assist in the identification of distress and clinical decision-making. METHODS: The Distress Risk Assessment Method and Roland Morris Disability Questionnaire were used to assess eligibility of patients with recurrent low back pain for recruitment into a randomized clinical trial examining different physical therapy approaches. RESULTS: In total, 221 patients were assessed, resulting in 212 correctly complete questionnaires. Of those 212, 71 (33%) showed evidence of marked distress (41 depressed and 30 somatic). Functional disability, measured using the Roland Morris Disability Questionnaire, was higher for the distressed group (mean 14.1, SD 4.8, range 3-23) than the nondistressed group (mean 8.0, SD 5.1, range 0-21). Distress and anxiety measured using the distress risk assessment method were correlated to self-reported back-related functional disability. CONCLUSIONS: Distress associated with low back pain is common with one third of patients referred for physical therapy at the units studied exhibiting a level of distress that increased their relative risk of poor outcome by 3 to 4 times. Clinically, screening this group of patients may help indicate when liaison with other professionals is appropriate and possibly identify those patients who may be too distressed to respond to physical therapy intervention alone.