Abstract
Lack of standardization of terminology in low back pain (LBP) research has significantly impeded progress in this area. The diversity in existing definitions for a ‘recurrence of an episode of LBP’ and ‘recurrent LBP’ is an important example. The variety of definitions used by researchers working in this area has prevented comparison of results between trials and made meta-analyses of this data unfeasible. The aim of this study was to use a modified Delphi approach to gain consensus on definitions for a ‘recurrence of an episode of LBP’ (e.g. outcome event) and for ‘recurrent LBP’ (e.g. patient population). Existing definitions for both constructs were classified into the main features comprising the definition (e.g. ‘duration of pain’) and the items that defined each feature (e.g. ‘pain lasting at least 24 h’). In each round, participants were asked to rate the importance of each feature to a definition of a ‘recurrence of an episode of LBP’, and a definition of ‘recurrent LBP’ and rank the items (defining each feature) in order of decreasing importance. Forty-six experts in LBP research, from nine different countries, participated in this study. Four rounds were completed with responses rates of 94, 91, 83, and 97% in rounds 1, 2, 3, and 4, respectively. Consensus definitions were reached in both areas with 95% of panel members supporting the definition of a ‘recurrence of an episode of LBP’ and 92% of panel members supporting the definition of ‘recurrent LBP’. Future research is necessary to evaluate these definitions.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Maher CG, Moseley AM, Sherrington C, Elkins MR, Herbert RD (2008) A description of the trials, reviews, and practice guidelines indexed in the PEDro database. Phys Ther 88:1068–1077
Egger M, Smith GD, Phillips AN (1997) Meta-analysis: principles and procedures. BMJ 7121:1533–1537
Von Korff M (1994) Studying the natural history of back pain. Spine 19:2041S–2046S
Pengel L, Herbert R, Maher C, Refshauge K (2003) Acute low back pain: systematic review of its prognosis. BMJ 327:323
Stanton TR, Henschke N, Maher CG, Refshauge KM, Latimer J, McAuley JH (2008) After an episode of acute low back pain, recurrence is unpredictable and not as common as previously thought. Spine 33:2923–2928
Wasiak R, Kim J, Pransky G (2006) Work disability and costs caused by recurrence of low back pain: longer and more costly than in first episodes. Spine 31:219–225
Stanton TR, Latimer J, Maher CG, Hancock M (2009) Definitions of recurrence of an episode of low back pain: a systematic review. Spine 34:E316–E322
Stanton TR, Latimer J, Maher CG, Hancock MJ (2009) How do we define the condition ‘recurrent low back pain’? A systematic review. Eur Spine J 19:533–539
Dionne CE, Dunn KM, Croft PR, Nachemson AL, Buchbinder R, Walker BF, Wyatt M, Cassidy JD, Rossignol M, Leboeuf-Yde C, Hartvigsen J, Leino-Arjas P, Latza U, Reis S, Gil del Real MT, Kovacs FM, Oberg B, Cedraschi C, Bouter LM, Koes BW, Picavet SJ, van Tulder MW, Burton K, Foster NE, Macfarlane GJ, Thomas E, Underwood M, Waddell G, Shekelle P, Volinn E, Von Korff M (2008) A consensus approach toward the standardization of back pain definitions for use in prevalence studies. Spine 33:95–103
Wasiak R, Young AE, Dunn KM, Cote P, Gross DP, Heymans MW, von Korff M (2009) Back pain recurrence: an evaluation of existing indicators and direction for future research. Spine 34:970–977
Hasson F, Keeney S, McKenna H (2000) Research guidelines for the Delphi survey technique. J Adv Nurs 32:1008–1015
McKenna HP (1994) The Delphi Technique: a worthwhile research approach for nursing? J Adv Nurs 19:1221–1225
Powell C (2003) The Delphi technique: myths and realities. J Adv Nurs 41:376–382
de Vet HCW, Heymans MW, Dunn KM, Pope DP, van der Beek AJ, Macfarlane GJ, Bouter LM, Croft PR (2002) Episodes of low back pain: a proposal for uniform definitions to be used in research. Spine 27:2409–2416
Kuorinka I, Jonsson B, Kilbom A, Vinterberg H, Biering-Sorensen F, Andersson G, Jorgensen K (1987) Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon 18:233–237
Von Korff M, Jensen MP, Karoly P (2000) Assessing global pain severity by self-report in clinical and health services research. Spine 25:3140–3151
Kongsted A, Leboeuf-Yde C (2009) The Nordic back pain subpopulation program—individual patterns of low back pain established by means of text messaging: a longitudinal pilot study. Chiropr Osteopat 17. doi:10.1186/1746-1340-17-11
Acknowledgments
We would like to acknowledge the University of Sydney International Research Scholarship for Tasha Stanton’s PhD funding, the Australia’s National Health & Medical Research Council for funding of Professor Chris Maher’s research fellowship and the Australian Research Council for funding of Jane Latimer’s research fellowship.
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Appendix A
Appendix A
Panel members completing Round 4 included: Carlo Ammendolia, Steven Atlas, Tom Bendix, Tony Bohman, Alan Breen, David Cassidy, Leonardo Costa, Pierre Cote, Henrica CW de Vet, Clermont Dionne, Kate Dunn, Paul Enthoven, Manuela Ferreira, Simon French, Douglas Gross, Margreth Grotle, Jan Hartvigsen, Rob Herbert, Lise Hestbaek, Bart Koes, Vicki Kristman, Martyn Lewis, Jan Lonn, Pim Luijsterburg, Jon Lurie, Luciana Macedo, Wolf Mehling, Raymond Ostelo, James Rainville, Eva Rasmussen-Barr, William Shaw, Henry Tsao, Danielle van der Windt, Linda Van Dillen, Jeanine Verbunt, and Nina Vollestad.
Please note that the consensus definitions may not be representative of each panel member’s view.
Rights and permissions
About this article
Cite this article
Stanton, T.R., Latimer, J., Maher, C.G. et al. A modified Delphi approach to standardize low back pain recurrence terminology. Eur Spine J 20, 744–752 (2011). https://doi.org/10.1007/s00586-010-1671-8
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-010-1671-8