Predictors for Poor Outcomes at Six Months on Pain, Disability, Psychological and Health Status in Greek Patients with Chronic Low Back Pain After Receiving Physiotherapy: A Prospective Cohort Study.

Abstract

Background: Although previous studies have suggested a variety of sociodemographic and psychological factors as predictors of poor outcomes in patients with chronic low back pain (CLBP), longitudinal studies remain rare. Objectives: To examine the prognostic indicators for poor outcome at 6 months on pain, disability, quality of life, anxiety, depression and somatic symptom disorders (SSDs) in Greek backache patients and to evaluate the medium-term effects of a conservative physiotherapeutic approach (massage, ultrasound, transcutaneous electrical nerve stimulation, low-level laser and exercise program). Methods: A prospective cohort study of 145 volunteers receiving treatment for CLBP in a physiotherapy unit was conducted using random systematic sampling. The intervention was assessed by comparing pre-treatment, post-treatment and six-month measurements with Friedman's test and the Bonferroni correction, using the pain numerical rating scale (PNRS), Roland-Morris disability questionnaire (RMDQ), EuroQol-5-dimension-5-level (EQ-5D-5L), Hospital Anxiety and Depression Scale (HADS) and Somatic Symptom Scale-8 (SSS-8). Multiple linear regression analysis was carried out to determine the impact of demographics and pre-treatment scores with scores at six months. Results: The mean age was 60.6 years (±14.7). Post-treatment, statistically significant improvements were observed across all outcome measures, including PNRS, RMDQ, EQ-5D-5L and SSS-8 (all p ≤ 0.001), with anxiety showing a notable reduction (p = 0.002). After examining the multiple regression analysis, pre-treatment SSS-8 emerged as a predictor of elevated levels of pain, disability, anxiety and depression at 6 months. Conclusions: The findings yielded not only somatic symptom burden, greater age and pain intensity as prognostic indicators for poor outcomes at six months, but also reported favorable medium-term effects for a conventional physiotherapy regimen in CLBP management, as well.