Clinical Classification and Risk of Chronification among Patients Presenting with Low Back Pain at Tertiary Care Level in Tanzania.

Abstract

Low Back Pain, is the leading cause of years lived with disability globally, work absenteeism, early retirement and inability to participate in the expected social roles in rural and urban Africa. The impact of low back pain to individuals and healthcare system, can not be ignored, considering its prevalence and socioeconomic consequences. It is imperative that the correct diagnosis be made in early stages to avoid improper treatment, chronification and misuse of resources. In turn, this practice will enable practitioners to come up with working diagnoses which inform management decisions. Thus, matching the right treatment to the right diagnosis at the right time. This study was aimed at classifying people presenting with LBP at the Physiotherapy outpatients’ departments of MNH and MOI, into different clinical sub-groups. Secondly, determining the levels of risk of chronification among patients within the two institutions. Finally, establishing the relationship between the LBP clinical subgroups and the levels of risk of chronification. Cluster sampling followed by simple random sampling methods were used to determine the sample size from the two clusters. Based on departmental records from the two hospitals, a ratio of 2:1 was employed to proportionately distribute the sample size within the two clusters. A cross-sectional sample size of 310 patients presenting with LBP, were randomly selected from the Physiotherapy outpatient registers of the two tertiary hospitals in Tanzania. Both written and verbal consent were sought from study participants before their enrolment. Participants were classified into clinical subgroups using the diagnostic checklist and levels of risk of chronification was established using the STarT Back Screening Tool. The descriptive and inferential statistics were analysed using SPSS version 25. Chi-square statistical test was performed to test association between clinical subgroups and levels of risk of chronification. The results on the bivariate analysis were interpreted within the 95 % Confidence Interval and the level of significance (p-value≤ 0.005) which indicate the statistical significance of the two variables. Low Back Pain was classified into mainly four groups namely Nociceptive pain (n=227, 73.2%), Neuropathic pain (n=45, 14.5%), Functional instability (n=21, 6.8%) and Other diagnoses (n= 17, 5.5%). Regarding the levels of risk of chronification, 49.03% were at low risk, 24.2% medium risk and 26.8% were at high risk of developing persistent pain and disability. Furthermore, results indicated that there was significantly strong and positive relationship between Neuropathic LBP, Functional instability and high risk of chronification. In conclusion, this study has established that majority of the patients had Nociceptive followed by Neuropathic LBP. Overall, the study has established that over a quarter (¼) of people presenting with LBP, were at high risk of chronification. More specifically, patients with Neuropathic and Functional instability LBP were at higher risk of chronification.