Centralization Phenomenon as a Prognostic Factor

  • Current studies indicate that psychosocial factors play dominant predictive roles, and measures from physical examination have limited power in predicting chronic disability.
  • The frequently cited reason for the lack of predictive power for conventional physical measures and treatments for patients with nonspecific low back pain syndromes is that nonspecific low back pain is ill defined and rarely has a confirmed diagnosis.
  • Waddell hypothesized that observing patient progress with time, which is operationally defined here as a dynamic assessment, may be more predictive of long-term outcomes than a singular or static assessment, and he recommended making these dynamic assessments early after the onset of acute pain.
  • Interest in centralization has increased because of its reported predictive value in identifying patients who will respond satisfactorily to conservative intervention. Studies have shown that patients who are classified as centralizers return to work sooner and have greater improvement in pain and function compared with patients classified as noncentralizers
  • It was hypothesized that a noncentralization pain pattern determined early during treatment would be an important independent variable predicting future chronic pain and disability. The design was prospective with follow-up evaluation 1 year after discharge from physical therapy services.
  • The following dependent variables were assessed 1 year after discharge: 1) maximal pain intensity, 2) work status, 3) sick leave or downtime at work, 4) activity interference or downtime at home, and 5) continued health care utilization
  • Being classified in the noncentralization group was a predictor of those who did not return to work, continued to report pain symptoms, had extended activity interference or downtime at home, and continued to use health care resources. Having leg pain at intake was a predictor of those who had high sick leave or downtime at work
  • Patients classified in the noncentralization category were at higher risk for delayed recovery and the development of chronic low back pain and disability. These patients should be monitored and may need to be referred early for multidisciplinary evaluation
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