Biopsychosocial predictors of prognosis in musculoskeletal disorders: a systematic review of the literature (corrected and republished)

Abstract

Purpose: To review the prognostic factors of musculoskeletal disorders while adopting a multidimensional perspective and including studies on various pertinent outcomes to the adjustment process. We also aimed to highlight the overall and phase-specific evidence. Method: We searched the Psychinfo and Ovid Medline(R) databases as well as pertinent periodicals and reviews and retained prospective studies of subjects suffering from specific or non-specific musculoskeletal pain that adopted multivariate statistical analysis. Results: We selected 105 studies, of which 68 included biopsychosocial and sociodemographic variables. For those studies using a biopsychosocial framework, we determined the level of evidence for every prognostic factor with each outcome. Strong evidence was found for recovery expectations and disability management with work participation outcomes. With disability outcomes, strong evidence was also found for recovery expectations, coping and somatization. Comorbidity and duration of episode strongly predicted pain outcomes. Some differences coinciding with phases of chronicity were also identified. Conclusion: Although uncertainty remains about the role of many prognostic factors, we found strong evidence to support the predictive value of clinically significant variables. There is, however, a need for additional research and replication, adopting more homogenous models and measurement methods.

Implications for Rehabilitation

• Despite numerous studies, it remains difficult to identify a clear set of prognostic factors in musculoskeletal disorders.

• Outcomes in musculoskeletal disorders are determined by biopsychosocial prognostic variables although psychosocial factors appear predominant, as early as in the acute phase.

• There appears to be negligible differences between prognostic factors in acute, subacute and chronic phases and a biopsychosocial approach should be considered from the acute phase in rehabilitation practice.

• Outcomes in rehabilitation practice should also be evaluated from a biopsychosocial perspective.

Keywords::

• Biopsychosocial
• musculoskeletal
• prognostic factors
• psychosocial factors
• review

Supplementary information

Supplementary data for this article is available online.

Declaration of interest: This research was made possible by the grants from the Fonds pour la Formation de Chercheurs et l’Aide à la Recherche (FCAR) and the Institut Robert-Sauvé en santé et en sécurité du travail (IRSST).

Notes

¹Red flags: Potential physiological risk factors for developing chronic pain. Yellow flags: Potential psychosocial risk factors for developing chronic pain. Blue flags: Perceived occupational factors believed by patients to impede their recovery. Black flags: Objective workplace factors possibly leading to the onset of LBP or promoting disability after an acute episode (from Gatchel, 2004) [38].

²Here, the authors defined symptoms satisfaction as an adaptation of a measure of perceived well-being and considered it a valid measure of poor outcome from a patient’s perspective, which was highly correlated with symptoms severity and dysfunction. For this review, we considered it an approximate and subjective measure of health-related QOL.