Sannes Ann-Christin, Feller Daniel, Pripp Are Hugo, Chiarotto Alessandro, Kretz Grøndahl Lise, Killingmo Rikke Munk, Axén Iben, Storheim Kjersti, Grotle Margreth, Vigdal Ørjan Nesse
Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
Department of Research and Development in Mental Health, Akershus University Hospital, Lørenskog, Norway.
BMJ Open. 2025 Aug 24;15(8):e102318. doi: 10.1136/bmjopen-2025-102318.
The objective was to develop, internally and externally validate a prognostic model for symptom dissatisfaction, assessed by the patient acceptable symptom state (PASS), for older adults (≥55 years) seeking primary care for a new episode of back pain.
Development, internal and external validation of a prognostic model using data from two prospective cohort studies with a 1-year follow-up was conducted.
The Norwegian cohort (n=452) was used for model development and internal validation. External validation was conducted using the Dutch cohort (n=675).
The outcome was defined as symptom dissatisfaction based on the PASS at 12 months follow-up. A logistic regression model was developed using backward selection and internally validated using 200 bootstrap samples. External validation included recalibration of the model intercept and slope. Model performance was measured using Nagelkerke-R, area under the curve (AUC) and calibration slope, calibration in-the-large (CITL) and calibration plots.
At 12 months, ~55% reported dissatisfaction in both cohorts. The final model included disability, catastrophising, recent back pain episode, spinal rotation pain, baseline symptom satisfaction, symptom duration and recovery expectation as predictors. The internally validated model showed acceptable discrimination (AUC 0.75, 95% CI 0.71 to 0.78), R was 0.23, the calibration slope and CITL being 0.89 (95% CI 0.73 to 1.08) and 0.01 (95% CI -0.16 to 0.15), respectively. External validation performance after recalibration yielded AUC 0.68 (95% CI 0.65 to 0.70), slope 0.86 (95% CI 0.67 to 1.05) and CITL 0.08 (95% CI -0.01 to 0.16).
This prognostic model could be a useful tool for predicting PASS outcomes among older adults with back pain. The external validation results imply that more research is needed to optimise predictions.
NCT04261309.
本研究旨在开发并进行内部和外部验证一种用于评估症状不满的预后模型，该模型通过患者可接受症状状态（PASS）进行评估，针对因新发背痛寻求初级保健的老年人（≥55岁）。
利用两项前瞻性队列研究的数据进行预后模型的开发、内部和外部验证，随访时间为1年。
挪威队列（n = 452）用于模型开发和内部验证。使用荷兰队列（n = 675）进行外部验证。
结局定义为基于12个月随访时的PASS的症状不满。使用向后选择法建立逻辑回归模型，并使用200个自助抽样样本进行内部验证。外部验证包括对模型截距和斜率的重新校准。使用Nagelkerke-R、曲线下面积（AUC）、校准斜率、整体校准（CITL）和校准图来衡量模型性能。
在12个月时，两个队列中约55%的人报告有不满。最终模型纳入了残疾、灾难化思维、近期背痛发作、脊柱旋转疼痛、基线症状满意度、症状持续时间和恢复期望作为预测因素。内部验证的模型显示出可接受的区分度（AUC为0.75，95%CI为0.71至0.78），R为0.23，校准斜率和CITL分别为0.89（95%CI为0.73至1.08）和0.01（95%CI为-0.16至0.15）。重新校准后的外部验证性能得出AUC为0.68（95%CI为0.65至0.70），斜率为0.86（95%CI为0.67至1.05），CITL为0.08（95%CI为-0.01至0.16）。
该预后模型可能是预测背痛老年人PASS结局的有用工具。外部验证结果表明需要更多研究来优化预测。
NCT04261309。
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