The Use of Nonorganic Signs and Symptoms as a Screening Tool for Return-to-Work in Patients With Acute Low Back Pain.The Use of Nonorganic Signs and Symptoms as a Screening Tool for Return-to-Work in Patients With Acute Low Back Pain Fritz fritz n. Informal A condition in which something does not work properly: Our television is on the fritz. [Perhaps from German Fritz JM, Wainner RS, Hicks Hicks , Edward 1780-1849. American painter of primitive works, notably The Peaceable Kingdom, of which nearly 100 versions exist. GE (Department of Physical Therapy and School of Health and Rehabilitation rehabilitation: see physical therapy. Sciences, University of Pittsburgh, Pittsburgh, Pa), Spine. 2000;15:1925-1931. This study had 2 objectives. The first was to determine cutoff points Cutoff point The lowest rate of return acceptable on investments. for sensitivity, specificity, and likelihood ratios (LR) of nonorganic signs and symptoms in predicting return to work in patients with acute low back pain (LBP LBP In currencies, this is the abbreviation for the Lebanese Pound. Notes: The currency market, also known as the Foreign Exchange market, is the largest financial market in the world, with a daily average volume of over US $1 trillion. ). The second objective was to determine the ability of each nonorganic sign and symptom--individually and when combined into a nonorganic index (NI)--to predict return to work within 4 weeks of the onset of acute LBP. Sixty-nine subjects (27 women, 42 men) with an average age of 37.3 [+ or -] 9.7 years participated in this study. They were referred for physical therapy within 19 days of the onset of LBP. The subjects had an average score on the Oswestry Disability Questionnaire of 44.3 [+ or -] 16.5. Thirty-three subjects (48%) reported no previous incidences of LBP. All subjects were either off from work or performing modified job duties as a result of their LBP, and they had no history of back surgery. The initial examination included the Oswestry Disability Questionnaire, a nonorganic symptoms questionnaire, and an assessment of nonorganic signs. Seven nonorganic symptoms were evaluated, and the number of positive responses was recorded for a nonorganic symptom symptom /symp·tom/ (simp´tom) any subjective evidence of disease or of a patient's condition, i.e., such evidence as perceived by the patient; a change in a patient's condition indicative of some bodily or mental state. score of 0 to 7. Five categories of nonorganic signs were tested, and each patient was assigned a nonorganic sign score based on the number of positive signs identified in that patient. By summing the scores from the signs and symptoms tests, an NI was calculated that had a possible score of 0 to 12. Sensitivity, specificity, and LR values were calculated. Following the initial examination and evaluation, all patients received physical therapy intervention, which emphasized active exercises, followed by re-evaluation 4 weeks later. Treatment outcomes were categorized cat·e·go·rize tr.v. cat·e·go·rized, cat·e·go·riz·ing, cat·e·go·riz·es To put into a category or categories; classify. cat as "full return to work without restrictions" or as "continuation of work modifications." Receiver operator characteristic (ROC) curves were constructed to determine overall diagnostic accuracy of the nonorganic signs and symptoms and NI. The sensitivity, specificity, and LR values showed that the best cutoffs for defining a positive nonorganic test were if 2 or more signs, 3 or more symptoms, or 3 or more signs and symptoms were present. Areas under the ROC curves ROC curve acronym for receiver operating characteristic curve. A graphical method of assessing the characteristic of a diagnostic test. ranged between 0.60 and 0.63, indicating the poor predictive ability of the nonorganic signs, symptoms, and NI in determining return to work within 4 weeks of the onset of pain. The authors concluded that alternative screening tools should be sought for early identification of patients at risk for a delay in returning to work. Teresa M Miller, PT, MS SUNY Downstate Medical Center The State University of New York Health Science Center at Brooklyn, better known as SUNY Downstate Medical Center, is an academic medical center and is the only one of its kind in the Borough of Brooklyn in New York City. Brooklyn, NY |
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