The LBP patient perception scale: A new predictor of LBP episode outcomes among primary care patients

Objective: To describe a new tool designed to capture patients' perception of their low back pain (LBP) episodes-the patient perception scale (PPS) and test its ability to predict episode outcomes. Methods: Thirty-two family physicians recruited 526 low back pain patients during an office visit. Physicians completed a short questionnaire at the index visit, which included both their assessments of patients' patient perception scale (PPS-doc) and contact information. Patients were then interviewed by telephone within 2 weeks after the index visit, with follow-up telephone contacts at 2, 4, 8 and 12 months. The patient perception scale as reported by the physician (PPS-doc) and patient (PPS-pt), each constituent question, and different combinations were analyzed for their ability to predict patient outcomes. Results: Patients' responses (PPS-pt) proved predictive for all outcome items. PPS-doc was much less predictive. Measures of patient centeredness did not perform well in this study. Conclusion: By using a short scale based on the patient's perception of pain (PPS-pt), it is possible to predict adverse outcomes of a low back pain episode. The patient perception scale should be evaluated further and perhaps combined with other instruments for targeting care and chronicity prevention efforts in low back pain. Practice implications: The PPS-pt could potentially be used as part of the standard initial patient evaluation of new LBP patients, as a proxy for "yellow flags" (markers of psychosocial risk) where a positive score might be the equivalent to high-risk identification. The apparent advantage of this scale is its brevity and simplicity of administration. The separation, through this scale of pain episodes into simple and complex LBP might be a useful tool for helping direct resources and avoiding chronicity.