Acute low back pain: systematic review of its prognosis

Pengel, Liset; Herbert, Robert D.; Maher, Chris G; Refshauge, Kathryn

doi:10.1136/bmj.327.7410.323

Cited by 743 publications

(533 citation statements)

References 32 publications

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“…Previous studies have shown that both influence outcome and return to work [26,27], but our findings indicate that, in this context, neither exerted an influence that could explain the differences between care settings in the SBT predictive ability.…”

Section: Discussioncontrasting

confidence: 79%

The predictive ability of the STarT Back Screening Tool in a Danish secondary care setting

et al. 2013

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Introduction The predictive ability of the STarT Back Tool (SBT) in secondary care settings has not been investigated. The aim of this study was to determine the SBT's predictive ability in a Danish secondary care setting and compare this to a Danish primary care setting. Methods Poor clinical outcome at 6 months ([30 points on a 0-100 Roland Morris Disability Scale) was calculated in secondary care (n = 960) and primary care (n = 172) cohorts. The cohorts were stratified into SBT subgroups and estimates of additional risk for poor outcome were calculated [relative risk (RR), unadjusted and adjusted odds ratios]. The discriminative ability was determined using the area under the curve statistic. Results In secondary care 69.0 % and in primary care 40.2 % had poor outcome on activity limitation. Although significant, the predictive ability of the SBT in secondary care (medium-risk RR 1.5, high-risk RR 1.7) was not as strong as in primary care (medium-risk RR 2.3, high-risk RR 3.5). Adjusting for episode duration and pain intensity only changed the predictive ability marginally in secondary care. The discriminative ability of the SBT was similar in both cohorts despite differences in the predictive ability. Conclusion The SBT had less predictive ability in a Danish secondary care setting compared to a Danish primary care setting for persistent activity limitation at 6 months follow-up. SBT-targeted treatment implications in secondary care were not investigated in this study.

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Section: Discussioncontrasting

confidence: 79%

The predictive ability of the STarT Back Screening Tool in a Danish secondary care setting

et al. 2013

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“…2 Most patients improve within a month with conservative management and do not require immediate diagnostic testing. 3,4 Randomized controlled trials have found no significant differences in clinical outcomes (pain, function, and quality of life) in patients with nonspecific acute low back pain between those receiving immediate lumbar imaging (radiography, computed tomography [CT] or magnetic resonance imaging [MRI]) and those who receive usual clinical care without imaging. [5][6][7] The lack of benefits is accompanied by potential harms.…”

Section: Introductionmentioning

confidence: 99%

Variation among Primary Care Physicians in the Use of Imaging for Older Patients with Acute Low Back Pain

2015

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BACKGROUND: Diagnostic imaging is not recommended in the evaluation and management of non-specific acute low back pain. OBJECTIVE: To estimate the variation among primary care providers (PCPs) in the use of diagnostic imaging for older patients with non-specific acute low back pain. DESIGN AND PARTICIPANTS: Retrospective cohort study using 100 % Texas Medicare claims data. We identified 145,320 patients aged 66 years and older with nonspecific acute low back pain during the period January 1, 2007, through November 30, 2011, cared for by 3297 PCPs. MAIN MEASURES: We tracked whether each patient received lumbar imaging (radiography, computed tomography [CT], or magnetic resonance imaging [MRI]) within 4 weeks of the initial visit. Multilevel logistic regression models were used to estimate physician-level variation in imaging use. KEY RESULTS: Among patients, 27.2 % received radiography and 11.1 % received CT or MRI within 4 weeks of the initial visit for low back pain. PCPs varied substantially in the use of imaging. The average rate of radiography within 4 weeks was 53.9 % for PCPs in the highest decile, compared to 6.1 % for PCPs in the lowest decile. The average rates of CT/MRI within 4 weeks were 18.5 % vs. 3.2 % for PCPs in the highest and lowest deciles, respectively. The specific physician seen by a patient accounted for 25 % of the variability in whether imaging was performed, while only 0.44 % of the variance was due to measured patient characteristics and 1.4 % to known physician characteristics. Use of imaging by individual physicians was stable over time. CONCLUSIONS: PCPs vary substantially in the use of imaging for non-specific acute low back pain. Providerlevel measures can be employed to provide feedback to physicians in an effort to modify imaging use.KEY WORDS: back pain; care management; practice variation; primary care; quality assessment.

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“…However, the DMC3 study, which is a population-based study carried out in the Netherlands, showed that 95% of LBP people described the pain as continuous or recurrent [17]. Pengel et al [18] found that most people with acute LBP experienced rapid improvements in pain and disabilities within 1 month but that the cumulative risks of at least one recurrence within 3 and 12 months were 26% (95% CI: 19-34) and 73% (95% CI: 59-88), respectively. Hestbaek et al [19] showed that the percentage of people with LBP who still experienced pain after 12 months was 42-75% (average 62%).…”

Section: Discussionmentioning

confidence: 99%

Low back pain deprives the Japanese adult population of their quality of life: a questionnaire survey at five healthcare facilities in Japan

Suka

Yoshida

2008

Environ Health Prev Med

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Objectives To estimate the degree to which low back pain (LBP) deprives the Japanese adult population of their quality of life (QOL) in terms of quality-adjusted life-years (QALYs). Methods A questionnaire survey was conducted among participants of health examinations at five healthcare facilities in Japan. Age-and sex-specific mean values of the EQ-5D score were calculated for (1) those who reported LBP and interference with daily activities (IDA) due to the pain (n = 251), (2) those who reported LBP but no IDA (n = 955), and (3) those who reported no musculoskeletal pain (n = 2887). To estimate the loss of QALYs due to LBP in the Japanese adult population, we multiplied the age-and sex-specific mean differences of the EQ-5D scores between the LBP with (or without) IDA group and the no pain group by the corresponding age-and sex-specific numbers of people with LBP with (or without) IDA in Japan.

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Acute low back pain: systematic review of its prognosis

Abstract: Objectives To describe the course of acute low back pain and sciatica and to identify clinically important prognostic factors for these conditions. Design Systematic review.

Cited by 743 publications

References 32 publications

The predictive ability of the STarT Back Screening Tool in a Danish secondary care setting

The predictive ability of the STarT Back Screening Tool in a Danish secondary care setting

Variation among Primary Care Physicians in the Use of Imaging for Older Patients with Acute Low Back Pain

Low back pain deprives the Japanese adult population of their quality of life: a questionnaire survey at five healthcare facilities in Japan

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