American Journal of Epidemiology Advance Access originally published online on February 22, 2006
American Journal of Epidemiology 2006 163(8):754-761; doi:10.1093/aje/kwj100
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Original Contribution |
Characterizing the Course of Low Back Pain: A Latent Class Analysis
From the Primary Care Sciences Research Centre, Keele University, Keele, United Kingdom
Correspondence to Dr. Kate M. Dunn, Primary Care Sciences Research Centre, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom (e-mail: k.m.dunn{at}cphc.keele.ac.uk).
Understanding the course of back pain is important for clinicians and researchers, but analyses of longitudinal data from multiple time points are lacking. A prospective cohort study of consecutive back pain consulters from five general practices in the United Kingdom was carried out between 2001 and 2003 to identify groups defined by their pain pathways. Patients were sent monthly questionnaires for a year. Longitudinal latent class analysis was performed by using pain intensity scores for 342 consulters. Analysis yielded four clusters representing different pathways of back pain. Cluster 1 ("persistent mild"; n = 122) patients had stable, low levels of pain. Patients in cluster 2 ("recovering"; n = 104) started with mild pain, progressing quickly to no pain. Cluster 3 ("severe chronic"; n = 71) patients had permanently high pain. For patients in cluster 4 ("fluctuating"; n = 45), pain varied between mild and high levels. Distinctive patterns for each cluster were maintained throughout follow-up. Clusters showed statistically significant differences in disability, psychological status, and work absence (p < 0.001). This is the first time, to the authors' knowledge, that latent class analysis has been applied to longitudinal data on back pain patients. Identification of four distinct groups of patients improves understanding of the course of back pain and may provide a basis of classification for intervention.
classification; cohort studies; longitudinal studies; low back pain; primary health care; prospective studies; statistics
Abbreviations: RMDQ, Roland-Morris Disability Questionnaire
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