Can general practitioners predict the outcome of episodes of back pain?

Roland, Martin; Morrell, D C; Morris, Richard

doi:10.1136/bmj.286.6364.523

Cited by 36 publications

(40 citation statements)

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“…Most of these factors are similar to the risk factors identified for chronicity, disability and cost claims [3,9,17,19]. The predictors of expected poor outcome identified in our study generally corresponded to those reported for poor outcome in previous studies of primary care patients: being female and aged [31,33], history of back pain (e.g., previous treatment for back pain) [11], high BMI [3,5,26], and being an unmarried employee [8] were all associated with a longer predicted recovery time. It therefore seems that the risk factors for chronicity identified in previous studies may be detected early in acute low back pain, by both the patients and their physicians, as risk factors for chronicity.…”

Section: Discussionsupporting

confidence: 86%

“When will I recover?” A national survey on patients’ and physicians’ expectations concerning the recovery time for acute back pain

et al. 2009

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The objective of this study was to compare patients' and physicians' expectations concerning the recovery time for acute back pain, and their determinants. A French national observational survey was performed between October and December 2005. Each physician was asked to include the first three patients aged between 20 and 70 years presenting with acute back pain (VAS [ 40 mm) of less than 1 month's duration. A total number of 1982 patients, with a mean age of 48.4 ± 11.8 years (52.2% men), were enrolled by 834 physicians. Patients and their physicians expected recovery to take the same amount of time in 60.3% of cases (Kappa = 0.43). In 17.4% of cases, patients predicted a shorter recovery time than physicians, and in 22.4% of cases, patients predicted a longer recovery time. Both patients and physicians expected recovery time to be longer in women, and in older, unmarried, obese, and non working patients. Expected recovery time was also longer in patients with no sports activities, low back pain (as opposed to pain at other sites), a high level of disability, a history of back pain, and no triggering factor. The intensity of pain and the number of days of sick leave taken did not affect the patient's prediction of recovery time, but did affect the physicians' expectations. Physicians considered professional status, analgesic intake and previous sick leave to be independent predictive factors, whereas patients did not. Expected recovery time, assessed shortly after the onset of acute back pain is influenced by most of the clinical and demographic factors usually considered risk factors for chronic low back pain. Patients' predictions of recovery time should be assessed in acute back pain, to identify risks for expected chronicity.

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Section: Discussionsupporting

confidence: 86%

“When will I recover?” A national survey on patients’ and physicians’ expectations concerning the recovery time for acute back pain

et al. 2009

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“…However, two supplementary variables associated with lost work time were male sex and poor job satisfaction. This role of sex on absence from work has been described only once before 11. Manual work and job difficulty were not related to absenteeism, in contrast with studies*RF 7,27,30-32* in which analyses were not adjusted for job satisfaction or compensation status.…”

Section: Discussionmentioning

confidence: 64%

“…10,11,25,26 This is consistent with certain people being highly prone to develop chronic pain. Initial disability rather than initial pain intensity seemed predictive of poor recovery, as reported 11. Pain worse on standing or lying was also predictive of poor recovery; these variables may identify different aetiological subgroups.…”

Section: Discussionmentioning

confidence: 64%

Clinical course and prognostic factors in acute low back pain: an inception cohort study in primary care practice

Coste

Delecoeuillerie

Lara

et al. 1994

BMJ

367

182

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The recovery rate from acute low back pain was much higher than reported in other studies. Those studies, however, did not investigate groups of patients enrolled shortly after the onset of symptoms and often mixed acute low back pain patients with patients with exacerbations of chronic pain or sciatica. Several sociodemographic and clinical factors were of prognostic value in acute low back pain. Factors which influenced the outcome in terms of episode recovery (mainly physical severity factors) were only partly predictive of absenteeism from work. Time off work and return to work depended more on sociodemographic and job related influences.

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“…Low back pain should be viewed as a chronic problem with an untidy pattern of grumbling symptoms and periods of relative freedom from pain and disability interspersed with acute episodes, exacerbations, and recurrences. This takes account of two consistent observations about low back pain: firstly, a previous episode of low back pain is the strongest risk factor for a new episode, 11 12 and, secondly, by the age of 30 years almost half the population will have experienced a substantive episode of low back pain 13. These figures simply do not fit with claims that 90% of episodes of low back pain end in complete recovery.…”

Section: Discussionmentioning

confidence: 99%

Outcome of low back pain in general practice: a prospective study

Croft

Macfarlane

Papageorgiou

et al. 1998

BMJ

603

350

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Objectives: To investigate the claim that 90% of episodes of low back pain that present to general practice have resolved within one month. Design: Prospective study of all adults consulting in general practice because of low back pain over 12 months with follow up at 1 week, 3 months, and 12 months after consultation. Setting: Two general practices in south Manchester. Subjects: 490 subjects (203 men, 287 women) aged 18-75 years. Main outcome measures: Proportion of patients who have ceased to consult with low back pain after 3 months; proportion of patients who are free of pain and back related disability at 3 and 12 months. Results: Annual cumulative consultation rate among adults in the practices was 6.4%. Of the 463 patients who consulted with a new episode of low back pain, 275 (59%) had only a single consultation, and 150 (32%) had repeat consultations confined to the 3 months after initial consultation. However, of those interviewed at 3 and 12 months follow up, only 39/188 (21%) and 42/170 (25%) respectively had completely recovered in terms of pain and disability. Conclusions:The results are consistent with the interpretation that 90% of patients with low back pain in primary care will have stopped consulting with symptoms within three months. However most will still be experiencing low back pain and related disability one year after consultation.

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Can general practitioners predict the outcome of episodes of back pain?

Cited by 36 publications

References 0 publications

“When will I recover?” A national survey on patients’ and physicians’ expectations concerning the recovery time for acute back pain

“When will I recover?” A national survey on patients’ and physicians’ expectations concerning the recovery time for acute back pain

Clinical course and prognostic factors in acute low back pain: an inception cohort study in primary care practice

Outcome of low back pain in general practice: a prospective study

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