BACKGROUND:Complex regional pain syndrome (CRPS) is a debilitating condition characterised by significant heterogeneity. Early diagnosis is critical, but limited data exists on the condition's early stages. This study aimed to characterise (very) early CRPS patients and explore potential subgroups to enhance understanding of its mechanisms. METHODS:A total of 113 early CRPS patients were recruited, with 89 undergoing physical assessments. Data included demographic information, work-related factors, CRPS history and clinical features, body perception disturbances, quantitative sensory testing (QST), and a visuospatial attention task. RESULTS:QST identified deficits in detecting thermal and mechanical stimuli, alongside increased sensitivity to thermal and blunt pressure painful stimuli. Participants reported body perception disturbances similar to those of persistent CRPS. Visuospatial biases were observed in two subgroups of patients. Latent class analysis (LCA) of 85 participants, based on five clinical parameters, identified four profiles: Mild, Moderate, Body Representation Disturbance (BRD), and Pressure Allodynia CRPS. The Mild and Moderate profiles were associated with higher-intensity trauma, with the latter showing worse outcomes. BRD and Pressure Allodynia CRPS followed mild trauma but exhibited the poorest outcomes. BRD CRPS displayed significant body perception disturbances, while Pressure Allodynia CRPS presented the highest sensitivity to pressure and psychosocial risk of chronification. Neither condition duration nor skin temperature effectively distinguished subgroups. CONCLUSIONS:These findings emphasise the heterogeneity within (very) early CRPS patients and support the absence of a minimum required duration prior to the CRPS diagnosis. Central/systemic mechanisms may play critical roles in severe cases. SIGNIFICANCE:This study identifies distinct (very) early CRPS profiles, suggesting different pathophysiological mechanisms and challenging traditional classifications. It paves the way for improved diagnosis and tailored treatments.

Complex regional pain syndrome (CRPS) is a challenging condition with unpredictable clinical evolution. Identifying early prognostic factors could transform patient management and improve outcomes. This prospective study followed 113 patients with early CRPS (<6 months) over 1 year to assess clinical evolution and investigate key predictors of chronification. Participants underwent repeated clinical assessments, quantitative sensory testing, and self-reported evaluations at 4 time points over 1 year. Multivariable mixed-effect models were used to identify independent early prognostic factors. Despite some improvement, 35% of the participants still met Budapest criteria at 1 year, with persistent pain, disability, and impaired quality of life. Sensory profiles appeared to stabilize after a few months, while body perception disturbance scores did not change during the follow-up period. Psychosocial factors, such as baseline disability, psychosocial severity, and social support, as well as body mass index and allodynia, were predictors of long-term outcomes. Biopsychosocial Early CRPS profiles defined through a latent class analysis carried out on the basis of data measured at inclusion revealed distinct clinical trajectories and showed stronger prognostic value than previously suggested CRPS classifications (eg, based on skin temperature). These findings highlight the importance of an early assessment incorporating biopsychosocial elements to stratify risk and tailor interventions. Our study paves the way for the development of a clinical tool to predict CRPS evolution, potentially enabling tailored treatments. Future research should validate these predictive models and explore their integration into routine practice, potentially improving the management of early CRPS.

Background: Spinal cord stimulation (SCS) serves as a treatment option for neuropathic pain conditions. Despite its widespread use and technological advancements over the last decade, the long‐term efficacy of SCS remains a topic of debate. Consequently, there is an increasing demand for real‐world, long‐term data regarding its effectiveness. Material and Methods: In 2018, the Belgian government launched a nationwide platform to monitor all SCS therapies. Five and a half years after its start, a full data extraction was conducted. In the present study, we update the findings of Bernaerts et al. (2024) from the 3‐week trial period and the long‐term follow‐up of patients with persistent spinal pain syndrome and focus on the completion rates of the follow‐ups and the battery lifetime of the implantable pulse generators (IPGs). Results: Findings indicate that “yellow flags” or psychological variables can be confirmed as significant predictors of recovery and satisfaction following the trial. Additionally, these yellow flags were able to predict long‐term disability. Analysis revealed that patients who completed the follow‐up module displayed more active and less passive coping strategies for their pain, along with lower levels of illness anxiety prior to the trial’s start, better physical and psychological functioning, and greater recovery and satisfaction with the trial’s outcomes. However, adherence to the chronic follow‐up module declined over time. Moreover, we investigated the battery life of both rechargeable and nonrechargeable batteries across various indication types. The real‐world dataset indicated no significant differences in battery lifetime between rechargeable and nonrechargeable IPGs for each indication type. Conclusions: The long‐term outcomes of neuromodulation are intricate and influenced by various factors. Data extracted from the Neuro‐Pain® registry increasingly enable us to identify confounding factors and predictors of treatment success with greater precision. Trial Registration: ClinicalTrials.gov identifier: NCT06835868

IntroductionSpinal cord stimulation is a common treatment option for neuropathic pain conditions. Despite its extensive use and multiple technological evolutions, long term efficacy of spinal cord stimulation is debated. Most studies on spinal cord stimulation include a rather limited number of patients and/or follow-ups over a limited period. Therefore, there is an urgent need for real-world, long-term data.MethodsIn 2018, the Belgian government initiated a nationwide secure platform for the follow-up of all new and existing spinal cord stimulation therapies. This is a unique approach used worldwide. Four years after the start of centralized recording, the first global extraction of data was performed.ResultsHerein, we present the findings, detailing the different steps in the centralized procedure, as well as the observed patient and treatment characteristics. Furthermore, we identified dropouts during the screening process, the reasons behind discontinuation, and the evolution of key indicators during the trial period. In addition, we obtained the first insights into the evolution of the clinical impact of permanent implants on the overall functioning and quality of life of patients in the long-term.DiscussionAlthough these findings are the results of the first data extraction, some interesting conclusions can be drawn. The long-term outcomes of neuromodulation are complex and subject to many variables. Future data extraction will allow us to identify these confounding factors and the early predictors of success. In addition, we will propose further optimization of the current process.

Background Many applied postgraduate pain training programs are monodisciplinary, whereas interdisciplinary training programs potentially improve interdisciplinary collaboration, which is favourable for managing patients with chronic pain. However, limited research exists on the development and impact of interdisciplinary training programs, particularly in the context of chronic pain. Methods This study aimed to describe the development and implementation of an interdisciplinary training program regarding the management of patients with chronic pain, which is part of a type 1 hybrid effectiveness-implementation study. The targeted groups included medical doctors, nurses, psychologists, physiotherapists, occupational therapists, dentists and pharmacists. An interdisciplinary expert panel was organised to provide its perception of the importance of formulated competencies for integrating biopsychosocial pain management with a cognitive behavioural approach into clinical practice. They were also asked to provide their perception of the extent to which healthcare professionals already possess the competencies in their clinical practice. Additionally, the expert panel was asked to formulate the barriers and needs relating to training content and the implementation of biopsychosocial chronic pain management with a cognitive behavioural approach in clinical practice, which was complemented with a literature search. This was used to develop and adapt the training program to the barriers and needs of stakeholders. Results The interdisciplinary expert panel considered the competencies as very important. Additionally, they perceived a relatively low level of healthcare professionals’ possession of the competencies in their clinical practice. A wide variety of barriers and needs for stakeholders were formulated and organized within the Theoretical Domain Framework linked to the COM-B domains; ‘capability’, ‘opportunity’, and ‘motivation’. The developed interdisciplinary training program, including two workshops of seven hours each and two e-learning modules, aimed to improve HCP’s competencies for integrating biopsychosocial chronic pain management with a cognitive behavioural approach into clinical practice. Conclusion We designed an interdisciplinary training program, based on formulated barriers regarding the management of patients with chronic pain that can be used as a foundation for developing and enhancing the quality of future training programs.

ABSTRACT:Advancements in clinical science have shown the necessity for a paradigm shift away from a biomedical toward a biopsychosocial approach. Yet, the translation from clinical science into clinical practice is challenging. The aim of this study was to assess the short-term and mid-term changes in pain knowledge and attitudes and guideline-adherent recommendations of healthcare professionals (HCP) by means of an interdisciplinary training program (ITP) about chronic pain. Belgian HCPs, with a priority for medical doctors, physiotherapists, occupational therapists, nurses, psychologists, and pharmacists in primary care, participated in the ITP, which contained 2 e-learning modules and two 7-hour workshops provided in small interdisciplinary groups in 5 cities. The objective of ITP was to improve HCP's competencies for integrating biopsychosocial chronic pain management with a cognitive behavioral approach into clinical practice. Primary outcomes were changes in knowledge and attitudes about pain and guideline-adherent recommendations for continuation of physical activity, sports, and work; avoiding bed rest; and not supporting opioid usage measured through 2 clinical vignettes. They were measured before, immediately after, and 6 months after the ITP. Changes were analyzed using (generalized) linear mixed models. A total of 405 HCPs participated. The knowledge and attitudes about pain scores improved at post-training (Δ = 9.04, 95% confidence interval 7.72-10.36) and at 6-month follow-up (Δ = 7.16, 95% confidence interval 5.73-8.59). After the training program, HCPs provided significantly more recommendations in accordance with clinical guidelines. Thus, an ITP can improve the biopsychosocial perspective of chronic pain management among HCPs in the short-term and mid-term.

BACKGROUND:Patients suffering from complex regional pain syndrome (CRPS) are increasingly shown to be affected by cognitive difficulties. While these cognitive symptoms were initially described as limited to the perception, representation and use of the body, that is, the somatic space, they were recently shown to also extend to the perception of extra-somatic space. CRPS patients seem indeed to pay less attention to visual stimuli occurring in the same side of space as their affected limb and especially those occurring close to that limb. The aim of the present study was to more precisely characterize these visuospatial biases, by investigating whether they may be dependent on the visually perceived proximity between the visual stimuli and the affected limb.METHODS:Upper-limb CRPS patients and matched control participants performed temporal order judgements on visual stimuli, one presented in either side of space, while they could either see their hands near the visual stimuli or not.RESULTS:Visuospatial biases were not modulated by the availability of visual feedback about the hands. However, secondary analyses revealed that these biases depended on the type of rehabilitation program that the patients followed: whereas patients who did not follow any specific program presented significant biases to the detriment of visual stimuli in the affected side of space, patients who did follow a CRPS-specialized program did not.CONCLUSIONS:Patients' cognitive strategies will be important to consider when studying inter-individual differences in the cognitive symptomatology and associated cognitive-based rehabilitation procedures in CRPS.SIGNIFICANCE:The existence of biases in visuospatial perception in Complex Regional Pain Syndrome has been reported but not always systematically replicated. We show that these biases might depend on the type of general rehabilitation program that the patients follow. Patients' individual cognitive strategies will be important to consider when studying the cognitive symptomatology of CRPS.

Background: Chronic pain prevalence is very high in the general population, much higher than can be managed by chronic pain centers. Therefore, most pain patients are cared for by first-line professionals. However, general practitioners often feel ill at ease with these patients, and only a few studies assess the burden of chronic pain in general practice. To better estimate the resources needed to support these professionals, a good knowledge of (sub)acute and chronic pain prevalence and prognosis in general practices is needed.Methods: We report cross-sectional data from a larger longitudinal study performed in French-speaking general practices in Belgium in November 2018. Fifth-year medical students performing a one-month internship collected data for every third patient they saw each day: demographic information, pain characteristics, lifestyle, general health perception and the short orebro Musculoskeletal Pain Screening Questionnaire in the French language.Results: 3882 patients (participation rate 66%) accepted to take part in the study. 22 and 50% of these suffered from (sub)acute and chronic pain, respectively. Pain was more often the motive of the consultation for (sub)acute than for chronic pain patients. Pain intensity and functional impact were moderate, irrespective of pain duration. 70% of (sub)acute and 31% of chronic pain patients were at low risk of chronicity.Conclusion: In our sample, chronic pain patients constituted 33-50% of patient contacts in general practice, indicating the high importance of providing adequate support to general practitioners and other first-line professionals, ie, by reinforcing collaboration with chronic pain centers.

Contexte et objectif : Plusieurs facteurs de risque associés à l’apparition d’un SDRC ont été découverts, mais les preuves scientifiques concernant les facteurs pronostiques associés à la progression de cette pathologie restent rares. Toutefois, la détection et la prise en charge de ces facteurs sont nécessaires pour élaborer des stratégies de prévention secondaire. L’objectif de cette revue systématique était d’identifier les facteurs pronostiques chez les adultes souffrant d’un SDRC précoce. Base de données et traitement des données : PubMed, Embase, PsycINFO, Cochrane Library et Scopus, publiées entre janvier 1990 et novembre 2021. Deux investigateurs indépendants ont sélectionné les études transversales et longitudinales s’intéressant aux facteurs pronostiques précoces (< 12 semaines après l’apparition de la maladie) de la douleur, du score de sévérité du SDRC, de l’incapacité fonctionnelle, du retour au travail ou de la qualité de vie. L’outil QUIPS (Quality In Prognostic Studies) a été utilisé pour évaluer le risque de biais. Une métasynthèse qualitative a été réalisée. Résultats : Sur 4 652 articles différents, six études répondaient aux critères d’inclusion. Nous avons identifié 21 facteurs précoces associés à un pronostic défavorable dans le SDRC de type I. Six d’entre eux présentaient un niveau de preuves modéré : intensité de la douleur, incapacité fonctionnelle, anxiété, peur du mouvement (kinésiophobie), sexe féminin et intensité du traumatisme physique déclencheur. Seules deux études présentaient un risque de biais globalement faible. Conclusions : Cette étude a révélé un manque important d’informations sur les facteurs pronostiques précoces dans le SDRC. Un seul article s’est intéressé au lien entre le risque de chronicité et les caractéristiques psychologiques. Il est indispensable de réaliser des études de plus grande envergure, avec une population bien définie et des mesures validées.

Part of the multifaceted pathophysiology of Complex Regional Pain Syndrome (CRPS) is ascribed to lateralized maladaptive neuroplasticity in sensorimotor cortices, corroborated by behavioral studies indicating that patients present difficulties in mentally representing their painful limb. Such difficulties are widely measured with hand laterality judgment tasks (HLT), which are also used in the rehabilitation of CRPS to activate motor imagery and restore the cortical representation of the painful limb. The potential of these tasks to elicit motor imagery is critical to their use in therapy, yet, the influence of the body’s biomechanical constraints (BMC) on HLT reaction time, supposed to index motor imagery activation, is rarely verified. Here we investigated the influence of BMC on the perception of hand postures and movements in upper-limb CRPS. Patients were slower than controls in judging hand laterality, whether or not stimuli corresponded to their painful hand. Reaction time patterns reflecting BMC were mostly absent in CRPS and controls. A second experiment therefore directly investigated the influence of implicit knowledge of BMC on hand movement judgments. Participants judged the perceived path of movement between two depicted hand positions, with only one of two proposed paths that was biomechanically plausible. While the controls mostly chose the biomechanically plausible path, patients did not. These findings show non-lateralized body representation impairments in CRPS, possibly related to difficulties in using correct knowledge of the body’s biomechanics. Importantly, they demonstrate the challenge of reliably measuring motor imagery with the HLT, which has important implications for the rehabilitation with these tasks.

Objective The aim of this observational longitudinal study was to investigate the impact of lifestyle factors on the prognosis of patients with pain. Methods This study was part of a large prospective longitudinal study conducted in general practice (GP). Participants completed questionnaires at baseline (T0) and one year later (T1). Outcomes analysed were the EQ-5D index, presence of pain and the ability to perform a light work for 1 hour without difficulty. Results Among 377 individuals with pain at T0, 294 still reported pain at T1. This subgroup had a significantly higher BMI, more painful sites, higher pain intensity, more sleep problems, poorer general self-rated health (GSRH) and higher Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) score at T0 than pain-free individuals at T1. There were no differences in age, sex, physical activity and smoking. In multivariable analyses, the number of painful sites, GSRH, sleep problems, pain duration, pain intensity and 2 short-form 10-item Örebro musculoskeletal pain questionnaire (SF-ÖMPSQ) items were independently associated with at least one outcome 1 year later. Only GSRH was strongly associated with all outcomes. The accuracy of GSRH at T0 to classify participants according to dichotomous outcomes was overall moderate (0.7 < AUC <0.8). Conclusions Lifestyle factors appear to have little influence on the outcome of patients with pain in GP. Conversely, poorer GSRH – which probably integrates the subjects’ perception of several factors – could be considered a negative prognostic factor in patients with pain.

Prevention of chronic pain relies on accurate detection of at-risk patients. Screening tools have been validated mainly in (sub) acute spinal pain and the need of more generic tools is high. We assessed the validity of the French version of the short Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) in patients with a large range of pain duration and localization. First, we re-analyzed data from a 6-month longitudinal study of 73 patients with (sub) acute spinal pain consulting in secondary line settings. Secondly, we performed a new 12-month longitudinal study of 542 primary care patients with (sub) acute and chronic pain in different localizations (spinal, limbs, “non-musculoskeletal”). The area under the receiver operating characteristic curve and cutoff scores were computed and compared for different subpopulations and ÖMPSQ subscores. Data from patients suffering from (sub) acute and chronic spinal pain consulting in both primary and secondary care settings confirmed the validity of the short French ÖMPSQ version and its subsets. In the primary care cohort, the performance of the questionnaire and its psychosocial subscore was variable but at least “fair” in most populations ((sub) acute and chronic, spinal and limb pain). Cutoff scores showed quite large variability depending on the outcome and the subpopulation considered. These results confirm the usefulness of the short French ÖMPSQ for prediction of the evolution of (sub) acute and chronic patients with spinal and limb pain, whatever its duration. However, increasing population heterogeneity results in slightly worse predictive performance and largely variable cutoff scores. Consequently, it might be difficult to choose universal cutoff scores and other criteria, such as patients’ values and the available resources for patient management, should be taken into account.

Background: Stratified approaches to spinal pain that address psychosocial risk factors reduce long-term disability to a moderate extent. Identifying and managing other risk factors might help improve outcomes. Objective: This systematic review of longitudinal studies aimed to evaluate possible associations between the onset of chronic spinal pain (including low back, back and neck pain) and putative modifiable lifestylerelated risk or protective factors. Methods: This systematic review of longitudinal studies published during the last 2 decades followed PRISMA guidelines. Two reviewers screened Medline, Scopus, Pedro, Cochrane Library, Psycinfo, Science Direct, PTSDpubs and Google Scholar for relevant studies. The QUIPS tool was used to assess the risk of bias. A qualitative meta-synthesis of relevant factors was performed. Results: Of 3716 unique records, 14 studies met the inclusion criteria (10 with low risk of bias and 4 moderate risk of bias). The highest bias observed was attrition. For chronic low back pain, we found moderate evidence for the involvement of high body weight, waist circumference, and hip circumference and conflicting evidence for high body mass index (BMI), smoking, and physical activity. For chronic neck pain, we found strong evidence for high BMI in women, moderate evidence for sleep disorders in women and conflicting evidence for high BMI in men and physical activity. For chronic back pain, we found limited evidence for gardening/ yard work in men and more than one adult at home. Effect sizes were small. Conclusions: Several modifiable lifestyle-related factors were identified. Evidence is still sparse and there is a need for more studies. PROSPERO database registration: Ref 172,112 CRD42020172112. (c) 2022 Elsevier Masson SAS. All rights reserved.

Bien que la littérature décrive plusieurs vignettes cliniques (associées à des questions) destinées à évaluer les attitudes/comportements des professionnels de la santé face à un patient souffrant de lombalgie, ces vignettes sont généralement incomplètes et n’abordent que peu, voire pas, les facteurs psychosociaux. De plus, celles-ci n’examinent pas l’adéquation entre la prise en charge préconisée et les recommandations récentes de la HAS [1] et l’itinéraire de soins proposés par le KCE [2]. Dès lors, les objectifs de cette étude étaient : 1) de développer 3 vignettes originales (patient fictif souffrant d’une lombalgie non spécifique aiguë, subaiguë/récurrente ou chronique) et un questionnaire (pouvant être utilisé avec chaque vignette) répondant aux limites des outils existants afin d’apprécier les attitudes de (futurs) professionnels de la santé ; 2) de mesurer les qualités psychométriques de base (effet plancher/plafond, validité et reproductibilité) de ce nouvel outil. Une fois les 3 vignettes et le questionnaire (18 affirmations combinées à une échelle de degré d’accord de Likert) développés, deux groupes expérimentaux (un groupe d’experts et un groupe expérimental composé de professionnels de la santé diplômés et d’étudiants de dernière année (en kinésithérapie ou en médecine) ont été invités à compléter un questionnaire en ligne. Ils devaient, après avoir pris connaissance de chacune des 3 nouvelles vignettes cliniques, répondre au questionnaire (permettant l’obtention d’un score pour chaque vignette et d’un score global). Ils étaient également soumis à une vignette (et les questions qui y sont associées) fréquemment utilisée dans la littérature (Rainville et al., 2000). La validité de ce nouvel outil d’évaluation a été examinée, d’une part, en comparant les scores des groupes « experts » et « expérimental » et, d’autre part, en comparant les résultats obtenus à la vignette de Rainville et al. à ceux obtenus pour ces nouvelles vignettes. La reproductibilité test-retest a été évaluée en resoumettant le groupe expérimental au nouvel outil une à deux semaines plus tard. Après l’analyse des réponses des 8 « experts » recrutés, une des questions (sur la médication) a été retirée en raison de désaccords entre les réponses des experts. Cent onze participants ont été recrutés dans le groupe « expérimental ». L’analyse des scores aux questionnaires liés aux vignettes suggère : 1) l’absence d’effet plancher et plafond ; 2) une validité (scores significativement différents entre les 2 groupes et concordants avec les résultats à la vignette de Rainville et al.) ; une bonne reproductibilité (coefficient de corrélation intraclasse supérieure à 0,9 pour le score global et compris entre 0,83 et 0,91 pour chaque vignette). Ce nouvel outil autorisera l’identification des recommandations les moins suivies, la comparaison de différentes disciplines médicales et l’évaluation des effets de formations destinées à présenter les recommandations de bonne pratique. Cette étude a permis de développer 3 nouvelles vignettes permettant d’examiner de façon valide et reproductible si les croyances et attitudes des professionnels de la santé relatives à la prise en charge de la lombalgie sont en adéquation avec les dernières guidelines. La poursuite du développement de ce nouvel outil est nécessaire en examinant notamment ses autres qualités métrologiques telles que sa sensibilité au changement.

Several risk factors for the onset of CRPS have been found, but evidence for prognostic factors associated with the progression of this condition remains sparse. However, the detection and management of these factors are necessary to design secondary prevention strategies. The objective of this systematic review was to identify prognostic factors in adult individuals with early CRPS.

Complex regional pain syndrome (CRPS) is thought to be characterized by cognitive deficits affecting patients' ability to represent, perceive, and use their affected limb as well as its surrounding space. This has been tested, among others, by straight-ahead tasks testing oneself's egocentric representation, but such experiments lead to inconsistent results. Because spatial cognitive abilities encompass various processes, we completed such evaluations by varying the sensory inputs used to perform the task. Complex regional pain syndrome and matched control participants were asked to assess their own body midline either visually (ie, by means of a moving visual cue) or manually (ie, by straight-ahead pointing with one of their upper limbs) and to reach and point to visual targets at different spatial locations. Although the 2 former tasks only required one single sensory input to be performed (ie, either visual or proprioceptive), the latter task was based on the ability to coordinate perception of the position of one's own limb with visuospatial perception. However, in this latter task, limb position could only be estimated by proprioception, as vision of the limb was prevented. Whereas in the 2 former tasks CRPS participants' performance was not different from that of controls, they made significantly more deviations errors during the visuospatial task, regardless of the limb used to point or the direction of pointing. Results suggest that CRPS patients are not specifically characterized by difficulties in representing their body but, more particularly, in integrating somatic information (ie, proprioception) during visually guided movements of the limb.

Background: Prevention of chronicization of low back pain requires accurate detection of at-risk patients. Questionnaires have been validated, including the STarT Back Screening Tool (SBST) and the Orebro Musculoskeletal Pain Screening Questionnaire (OMPSQ). This review aims to compare these questionnaires in terms of predictive value and in terms of aims, to guide the choice in clinical practice. Methods: This study is a semi-systematic literature review. Studies evaluating at least one of the questionnaires and written between 1997 and October 10th 2017 were selected from Pubmed database. Inclusion criteria were pain duration < 3 months, outcomes including pain, function and/or global recovery. For work outcomes, inclusion criteria were extended to chronic patients. Studies had to provide information on sensitivity, specificity and area under the ROC Curve (AUC). Results: Twenty-eight studies met our inclusion criteria (7 SBST, 21 original OMPSQ, 3 short OMPSQ). The OMPSQ best predicted a Pain NRS >= 3 at 3 months (AUC = 0.64 (0.50-0.78)) and at 6 months (AUC between 0.70 (no confidence interval provided) and 0.84 (0.71-0.97)). The SBST and the OMPSQ are comparable to predict an Oswestry Disability Index >= 30% at 6 months. A single study showed no difference between the SBST and the OMPSQ to predict absenteeism >= 30 days at 6 months. The two questionnaires cannot be compared for "global recovery" outcomes. Conclusion: The OMPSQ seems better than the SBST for predicting "pain" and "work" outcomes, the SBST may be better for "function" outcomes. These results should be taken with caution because of the high heterogeneity between studies. It should be noted that the OMPSQ was elaborated with the aim of creating a prognostic tool while the SBST was devised as a treatment-allocating tool and is easier to use in clinical practice. This should guide the choice of using one questionnaire rather than the other. (C) 2018 Published by Elsevier Masson SAS.

Plusieurs outils ont été validés pour le dépistage du risque de développer une lombalgie chronique, dont le Örebro Musculoskeletal Pain Screening Questionnaire (OMPSQ, versions longue et courte) et le Start Back Screening Tool (SBST). L’objectif de ce travail est d’aider le clinicien à choisir l’outil qui convient le mieux à ses besoins. Une validation préliminaire de la version courte en français de l’OMPSQ montre des propriétés psychométriques comparables à celles de la version longue. Une revue de littérature a analysé 101 articles. Dans l’ensemble, les trois questionnaires ont des propriétés prédictives modérées. L’OMPSQ a été conçu comme un outil pronostique alors que le but du SBST est d’orienter le choix thérapeutique. Les connaissances et attitudes de professionnels de la réadaptation de deux hôpitaux de taille moyenne ont été évalués. La plupart des répondants ne connaissaient pas ces questionnaires. Lorsque les questionnaires leur étaient présentés, l’attitude globale était positive, même si plusieurs objections ont été formulées. En conclusion, des outils valides existent pour la détection des patients à risque. Cependant, un effort important est nécessaire pour former les professionnels de santé. How to assess the risk of chronizisation in the case of low back pain?

BACKGROUND:Prevention of chronicization of low back pain requires accurate detection of at-risk patients. Questionnaires have been validated, including the STarT Back Screening Tool (SBST) and the Örebro Musculoskeletal Pain Screening Questionnaire (OMPSQ). This review aims to compare these questionnaires in terms of predictive value and in terms of aims, to guide the choice in clinical practice. METHODS:This study is a semi-systematic literature review. Studies evaluating at least one of the questionnaires and written between 1997 and October 10th 2017 were selected from Pubmed database. Inclusion criteria were pain duration<3months, outcomes including pain, function and/or global recovery. For work outcomes, inclusion criteria were extended to chronic patients. Studies had to provide information on sensitivity, specificity and area under the ROC Curve (AUC). RESULTS:Twenty-eight studies met our inclusion criteria (7 SBST, 21 original OMPSQ, 3 short OMPSQ). The OMPSQ best predicted a Pain NRS≥3 at 3 months (AUC=0.64 (0.50-0.78)) and at 6 months (AUC between 0.70 (no confidence interval provided) and 0.84 (0.71-0.97)). The SBST and the OMPSQ are comparable to predict an Oswestry Disability Index≥30% at 6 months. A single study showed no difference between the SBST and the OMPSQ to predict absenteeism≥30 days at 6 months. The two questionnaires cannot be compared for "global recovery" outcomes. CONCLUSION:The OMPSQ seems better than the SBST for predicting "pain" and "work" outcomes, the SBST may be better for "function" outcomes. These results should be taken with caution because of the high heterogeneity between studies. It should be noted that the OMPSQ was elaborated with the aim of creating a prognostic tool while the SBST was devised as a treatment-allocating tool and is easier to use in clinical practice. This should guide the choice of using one questionnaire rather than the other.