Cross-sectional differences of physical and psychosocial measures in low back pain according to pain chronification risk groups.
Elisabeth Fehrmann, Linda Fischer-Grote, Julian Dietl and 3 others
PMID 40833248WHAT IT FOUND
Patients with low back pain at high risk of chronification had significantly worse physical strength and higher pain than those at low risk.
High-risk patients were also more likely to refuse or be excluded from strength testing, suggesting physical deconditioning and fear are linked.
Key findings
01High-risk patients had significantly lower maximum back flexion and extension strength, range of motion, and hand grip strength compared to low-risk patients.
02High-risk patients reported higher pain intensity, greater disability, more anxiety and depression, and lower quality of life than low-risk patients.
03Only 33% of high-risk patients participated in maximum strength testing, compared to 74% of low-risk patients, with exclusion often due to pain or physician judgement.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
There was significant selection bias in the physical testing data: high-risk patients were far less likely to complete strength tests than low-risk patients. This means the physical deficits reported for the high-risk group may actually be underestimates, as the weakest or most fearful patients were excluded. The sample was predominantly middle-aged and employed, so results may not generalise to older adults or those outside the workforce. The study is cross-sectional, so it cannot determine whether psychological risk factors cause physical deconditioning or vice versa. Gender interactions in strength measures were based on small subgroups of high-risk patients, limiting certainty in those specific findings.
Declared interests
The authors declare no conflicts of interest.
The easy way to misread this
Do not assume that the absence of physical test data for high-risk patients means they are physically capable. The study shows high-risk patients were significantly more likely to be excluded from or refuse strength testing, likely because they were too weak or in too much pain to participate.