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American Journal of Epidemiology Advance Access published online on February 22, 2006
American Journal of Epidemiology, doi:10.1093/aje/kwj100
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American Journal of Epidemiology Copyright © 2006 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.
Received August 4, 2005
Accepted December 5, 2005

ORIGINAL CONTRIBUTIONS

Characterizing the Course of Low Back Pain: A Latent Class Analysis

Kate M. Dunn 1 *, Kelvin Jordan 1, and Peter R. Croft 1

1 From the Primary Care Sciences Research Centre, Keele University, Keele, United Kingdom

* To whom correspondence should be addressed.
Kate M. Dunn, E-mail: k.m.dunn{at}cphc.keele.ac.uk


  Abstract

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.

Keywords: classification; cohort studies; longitudinal studies; low back pain; primary health care; prospective studies; statistics.
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