Predictors of return-to-activity rate in patients with spinal cord injury with chronic low back pain

Ingrid Olsen; M. Larsen; B. Karlsson

doi:10.5281/zenodo.22815173

Authors

Ingrid Olsen Department of Rehabilitation Research, Volga Research Center for Rehabilitation Research Author https://orcid.org/6908-9435-7483-3669
M. Larsen Department of Clinical Rehabilitation Research, Mekong Academy of Rehabilitation Research Author https://orcid.org/6493-0790-5194-9597
B. Karlsson Department of Rehabilitation Research, Yangtze Institute of Physical Medicine Author https://orcid.org/0132-2998-3898-3959

DOI:

https://doi.org/10.5281/zenodo.22815173

Keywords:

spinal cord injury, chronic low back pain, return to activity, return to work, rehabilitation predictors

Abstract

Graphical abstract

Background: Chronic low back pain is one of the most common secondary complications after spinal cord injury, and it frequently limits the return to work, exercise, and community participation that constitute successful long-term rehabilitation.

Objective: This review synthesizes the published evidence on biomechanical, injury-related, psychosocial, and treatment-related predictors of return-to-activity rate among patients with spinal cord injury who also have chronic low back pain.

Methods: We synthesized cohort studies, randomized behavioral trials, biomechanical investigations, and systematic reviews addressing pain phenotype, propulsion mechanics, psychological adjustment, vocational rehabilitation, and participation outcomes after spinal cord injury.

Findings: Musculoskeletal pain predicts less activity limitation than neuropathic pain; propulsion technique, seating, and transfer mechanics independently predict pain and disability; depression and catastrophizing predict slower recovery; and structured multidisciplinary pain management and vocational rehabilitation predict higher return-to-activity rates than usual care.

Conclusions: Return-to-activity rate after spinal cord injury with chronic low back pain is best predicted by a multifactorial model spanning biomechanics, psychology, treatment access, and environment, and rehabilitation strategies that address all of these domains together are more likely to restore work, exercise, and community participation than those targeting pain intensity alone.

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