RESUMO
Objective: The aim of this observational longitudinal study was to investigate the impact of lifestyle factors on the prognosis of patients with pain. Methods: This study was part of a large prospective longitudinal study conducted in general practice (GP). Participants completed questionnaires at baseline (T0) and one year later (T1). Outcomes analysed were the EQ-5D index, presence of pain and the ability to perform a light work for 1 hour without difficulty. Results: Among 377 individuals with pain at T0, 294 still reported pain at T1. This subgroup had a significantly higher BMI, more painful sites, higher pain intensity, more sleep problems, poorer general self-rated health (GSRH) and higher Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) score at T0 than pain-free individuals at T1. There were no differences in age, sex, physical activity and smoking. In multivariable analyses, the number of painful sites, GSRH, sleep problems, pain duration, pain intensity and 2 short-form 10-item Örebro musculoskeletal pain questionnaire (SF-ÖMPSQ) items were independently associated with at least one outcome 1 year later. Only GSRH was strongly associated with all outcomes. The accuracy of GSRH at T0 to classify participants according to dichotomous outcomes was overall moderate (0.7 < AUC <0.8). Conclusions: Lifestyle factors appear to have little influence on the outcome of patients with pain in GP. Conversely, poorer GSRH - which probably integrates the subjects' perception of several factors - could be considered a negative prognostic factor in patients with pain.
RESUMO
BACKGROUND AND OBJECTIVE: Several risk factors for the onset of CRPS have been found, but evidence for prognostic factors associated with the progression of this condition remains sparse. However, the detection and management of these factors are necessary to design secondary prevention strategies. The objective of this systematic review was to identify prognostic factors in adult individuals with early CRPS. DATABASE AND DATA TREATMENT: PubMed, Embase, PsycINFO, Cochrane Library and Scopus, were published between January 1990 and November 2021. Two independent investigators selected cross-sectional and longitudinal studies looking at early (<12 weeks from onset) prognostic factors for pain, CRPS severity score, disability, return to work, or quality of life. The quality in prognostic studies (QUIPS) tool was used to assess the risk of bias. A qualitative meta-synthesis was performed. RESULTS: Out of 4652 different articles, six studies met the inclusion criteria. We identified 21 early factors associated with a poorer prognosis in type I CRPS. We found moderate evidence to support six of them: higher pain intensity, self-rated disability, anxiety, pain-related fear, being a female and high-energy triggering event. Only two studies had an overall low risk of bias. CONCLUSIONS: This study showed an important lack of information on early prognostic factors in CRPS. Only one article investigated the link with psychological characteristics. There is a crucial need for larger studies, with a well-defined population using validated measures. SIGNIFICANCE: This systematic review highlights the lack of knowledge about early prognostic factors in CRPS. A few putative prognostic factors were identified. Most of the moderate evidence is related to a single cohort. Future research is required to find out which patients are vulnerable to chronification.
