Identifying Preoperative Predictors of Clinically Meaningful Outcomes in Chronic Low Back Pain: A Detailed Mcid-based Analysis

Introduction: Investigate the preoperative factors that predict successful treatment outcomes in chronic low back pain patients using the Minimal Clinically Important Difference (MCID) for disability (ODI) and pain (VAS).

Methods: Logistic regression and random forest models were used to predict the likelihood of achieving MCID for both disability (ODI ≥ 8.71) and pain (VAS ≥ 1.19).

Results: The study population had an average age of 51 years (n=156). 52% were prescribed physical therapy, while 16% were on opioids pre-intervention. Logistic regression models showed that patients with higher baseline ODI and VAS scores were significantly more likely to achieve MCID, with odds ratios indicating that for every unit increase in baseline ODI, the odds of achieving MCID for disability increased by 8.4%. Similarly, higher baseline VAS was associated with a higher likelihood of pain improvement (p < 0.001). Preoperative opioid use was negatively associated with achieving MCID for disability. The success rate for achieving MCID in disability was 28.96%, while for pain, it was 32.79%. Random forest models provided insights into the variable importance, with physical therapy, baseline ODI, and age being key predictors for successful outcomes. Patient clustering revealed that younger patients with mild symptoms were less likely to achieve MCID, while middle-aged patients with severe preoperative disability and pain had the highest likelihood of success. In Cluster 2, 67.5% of patients achieved MCID for disability and 52.5% for pain, representing the most successful profile.

Conclusion : This study confirms the importance of baseline disability and pain in predicting successful outcomes for chronic low back pain patients. Patients with higher preoperative ODI and VAS scores, along with those receiving physical therapy, were more likely to achieve clinically meaningful improvements. Our findings align with existing literature, supporting the emphasis on targeting severe cases for interventions such as physical therapy while being cautious with opioid use. Clinicians should prioritize physical therapy and tailor interventions based on baseline severity, while limiting the use of opioids to maximize patient recovery.