History

History
Outlined below are common history questions to obtain from a patient with low back pain.

Demographics: Age, sex, height, weight
Occupation: Type of work and activities performed, loads encountered, sustained postures, repetitive movements
Mechanism of injury
How long since initial injury, previous history of LBP, what was done in the past and response: Acute, subacute, chronic, acute on chronic
Pain characteristics
Location, description, patterns, aggravating and relieving factors
VAS: Test-retest reliability has shown fair to good reliability (ICC .66-.93) in low back pain patients on the same day, before and after seeing their physician (Roach et al., 1997)
Pain body diagram: Test-retest reliability has shown fair to good reliability (ICC .58-.94) in low back pain patients on the same day, before and after seeing their physician (Roach et al., 1997)
Radiation, response to coughing or sneezing (Increased intrathecal pressure)
Sensation, muscle weakness noticed
Prior activity level
ADL’s
Recreational activities
Sleep: postures, patterns
Stress levels
Aggravating and relieving factors
Medication
OTC, prescription
Patient Goals for Rehabilitation
Depression

  • Depression is common in patients with low back pain (Main et al, 1992) and is associated with increased pain intensity, increased physical and psychosocial disability, increased medication use, and increased likelihood of unemployment (Sullivan, 1992). The presence of depression is associated with poor outcomes as well (Linton, 2000; Pincus et al, 2002.
  • In Haggman et al (2004), a two item screening test was more accurate in screening for depressive symptoms than the physical therapists’ rating were. The DASS-21 was used as the reference standard. AUC values for detecting mild, moderate, severe and extreme depression were 0.77, 0.79, 0.81, 0.81 respectively. AUC can be thought of as the probability of correctly classifying a patient as having depressive symptoms from randomly selected pairs of patients who do and do not have depressive symptoms. An AUC of 1.0 is perfect discrimination, and an AUC of 0.5 is no better than chance.

The positive likelihood ratio for patients answering yes to one question for mild, moderate, severe, and extreme depressive symptoms was 3.4, 2.76, 2.44, and 2.25. The positive likelihood ratio for patients answering yes to two questions for mild, moderate, severe, and extreme depressive symptoms was 5.4, 4.61, 4.32, and 3.89 respectively. A positive likelihood ratio describes how many times more likely a positive test result is to be found in people with depressive symptoms than in those without depressive symptoms. The point prevalence of any depressive symptoms was 40.1% in this study. Another study showed a point prevalence of 26 % (Hope & Forshaw, 1999)
The two question screening was as follows:
• “During the past month, have you often been bothered by feeling down, depressed, or hopeless?” and
• “During the past month, have you often been bothered by little interest or pleasure in doing things?”

Screening for Cancer
• In a systematic review, A previous history of cancer (LR+ = 23.7), elevated ESR (LR+ = 18.0), reduced hematocrit (LR+ = 18.2), and overall clinician judgement (LR+ = 12.1) increased the probability of malignancy when present. A combination of age >/=50 years, a previous history of cancer, unexplained weight loss, and failure to improve after 1 month had a reported sensitivity of 100%. (Henschke N et al, Eur Spine J, 2007)

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