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Prognostic Factors for Persistent Leg-Pain in Patients Hospitalized With Acute Sciatica

Fjeld, Olaf MD; Grotle, Margreth PT, PhD; Siewers, Vibeke PT, MSc; Pedersen, Linda M. PhD; Nilsen, Kristian Bernhard MD, PhD; Zwart, John-Anker MD, PhD

doi: 10.1097/BRS.0000000000001773
Clinical Case Series

Study Design. Prospective cohort study.

Objective. To identify potential prognostic factors for persistent leg-pain at 12 months among patients hospitalized with acute severe sciatica.

Summary of Background Data. The long-term outcome for patients admitted to hospital with sciatica is generally unfavorable. Results concerning prognostic factors for persistent sciatica are limited and conflicting.

Methods. A total of 210 patients acutely admitted to hospital for either surgical or nonsurgical treatment of sciatica were consecutively recruited and received a thorough clinical and radiographic examination in addition to responding to a comprehensive questionnaire. Follow-up assessments were done at 6 weeks, 6 months, and 12 months. Potential prognostic factors were measured at baseline and at 6 weeks. The impact of these factors on leg-pain was analyzed by multiple linear regression modeling.

Results. A total of 151 patients completed the entire study, 93 receiving nonrandomized surgical treatment. The final multivariate models showed that the following factors were significantly associated with leg-pain at 12 months: high psychosocial risk according to the Örebro Musculosceletal Pain Questionnaire (unstandardized beta coefficient 1.55, 95% confidence interval [CI] 0.72–2.38, P < 0.001), not receiving surgical treatment (1.11, 95% CI 0.29–1.93, P = 0.01), not actively employed upon admission (1.47, 95% CI 0.63–2.31, P < 0.01), and self-reported leg-pain recorded 6 weeks posthospital admission (0.49, 95% CI 0.34–0.63, P < 0.001). Interaction analysis showed that the Örebro Musculosceletal Pain Questionnaire had significant prognostic value only on the nonsurgically treated patients (3.26, 95% CI 1.89–4.63, P < 0.001).

Conclusion. The results suggest that a psychosocial screening tool and the implementation of a 6-week postadmission follow-up has prognostic value in the hospital management of severe sciatica.

Level of Evidence: 2

*Research Unit for Musculoskeletal Disorders (FORMI), Oslo University Hospital, Norway

Department of Neurology, Oslo University Hospital, Norway

Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway

§Faculty of Health Science, Oslo and Akershus University College, Norway

Department of Clinical Neurosciences, Norwegian University of Science and Technology, Trondheim, Norway

||Department of Work Psychology and Physiology, National Institute of Occupational Health, Oslo, Norway.

Address correspondence and reprint requests to Olaf Fjeld, MD, FORMI, Oslo University Hospital, Ullevål, P.O. Box 4956 Nydalen, 0424 Oslo, Norway; E-mail: fjeldo@tcd.ie

Received 23 February, 2016

Revised 2 June, 2016

Accepted 16 June, 2016

The manuscript submitted does not contain information about medical device(s)/drug(s).

South-Eastern Norway Regional Health Authority (project number 2012/1108) funds were received in support of this work.

No relevant financial activities outside the submitted work.

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