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

Coste, Joël; Delecoeuillerie, G; Lara, A. Cohen de; Parc, J. M. Le; Paolaggi, J B

doi:10.1136/bmj.308.6928.577

Cited by 369 publications

(207 citation statements)

References 21 publications

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“…Interestingly, neither having a history of LBP nor emotional distress had any predictive power, in contrast to the common picture seen for recovery from LBP [9,11,28] and also reported for lumbopelvic pain postpartum [2,26,29].…”

Section: Discussionmentioning

confidence: 73%

Prognostic factors for recovery from postpartum pelvic girdle pain

Vøllestad

Stuge

2009

Eur Spine J

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Pelvic girdle pain (PGP) has a high incidence during pregnancy and in some women pain will persist for years. Most studies have used pain as the outcome measure, and little attention is given to functioning or disability. A better understanding of prognostic factors for recovery seems important for clinical care and treatment. The aim of the present paper was to identify prognostic factors for recovery from postpartum PGP and disability, and to determine the impacts of prognostic factors when pain intensity and disability are used as outcome measures. Seventy-eight women with diagnosed PGP were included 6-16 weeks postpartum. Possible prognostic factors were obtained through clinical tests and questionnaires at baseline. The clinical tests were posterior pelvic pain provocation (P4) test, active straight leg raise (ASLR) test and pain provocation of long dorsal sacroiliac ligament (LDL). One year postpartum outcome measures were obtained by Oswestry disability index (ODI ver 2.0) and worst evening pain (VAS 0-100). Multiple linear regression and logistic regression analyses were used to identify significant prognostic factors. At baseline 60% believed they would recover and 40% were uncertain or believed they would not recover. Fifty per cent had a history of low back pain (LBP), and 20% had high emotional distress (HSCL25-item C1.75). About 75% had positive LDL and P4 at both sides and 24% had pain located to all three pelvic joints. Forty per cent had ASLR scores of at least 4 (sum score range 0-10). Multivariate analyses showed consistently that ASLR and belief in improvement were statistical significant predictors for both disability and pain as outcome measures. ASLR score \4 predicted 10 points lower ODI and 19 points lower evening pain compared with having ASLR score of at least 4. Pain location was a statistical significant predictor in only one analysis. History of LBP or high psychological distress was not prognostic for recovery. ASLR test and belief in improvement are predictors of clinical significance in women having PGP postpartum.

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Section: Discussionmentioning

confidence: 73%

Prognostic factors for recovery from postpartum pelvic girdle pain

Vøllestad

Stuge

2009

Eur Spine J

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“…In our study 50% of the patients returned to work within 8 weeks and 75% within 18 weeks. In studies in a primary care setting the rate of return to work was much higher and functional disability at inclusion was lower (16,(26)(27)(28). Patients in studies in a specialized clinic or a rehabilitation center represented more chronic cases when compared with patients in this study (29)(30)(31).…”

Section: Discussionmentioning

confidence: 75%

Prognostic factors for chronic disability from acute low-back pain in occupational health care

Weide¹,

Verbeek²,

Sallé³

et al. 1999

Scand J Work Environ Health

120

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Prognostic factors for chronic disability from acute low-back pain in occupational health care by van der Weide WE, Verbeek JHAM, Sallé HJA, van Objectives This study attempted to determine the prognostic indicators of low-back pain in an occupational health setting. Methods The identification of prognostic factors of (i) functional disability after 3 months' follow-up, (ii) functional disability after 12 months' follow-up, and (iii) time to return to work among 120 workers who reported to an occupational health unit and were off work with low-back pain for at least 10 days. Crude and adjusted odds ratios and hazard ratios with 95% confidence intervals were estimated for the 3 outcome measures.Results Factors related to a longer time to return to work were radiating pain, high functional disability at the beginning of the study, problems in relations with colleagues, and high work tempo and work quantity. High functional disability at the beginning of the study and a high avoidance coping style predicted functional disability at 3 months. Functional disability at 12 months was more accurately predicted by work-related and psychosocial factors. C O~C~U S~O~S Especially radiating pain and functional disability predict a long duration of low-back pain in occupational health practice. Occupational physicians should also note work-related and psychosocial characteristics.Key terms functional disability, health care workers, prognosis, return to work.Musculoskeletal disorders, especially low-back pain, are common reasons for absence from work (1). Especially for patients with chronic low-back pain, sickness absence is a major consequence of their health problems. A recent population-based prevalence study reported work absenteeism in the last 12 months for 32% of chronic patients (2). Approximately 22% of all disability pensions in The Netherlands are due to musculoskeletal disorders. About half of this musculoskeletal category consists of patients who are disabled because of low-back pain (3).Diagnoses for sickness benefits show similar figures for back pain (4).To intervene more efficiently occupational physicians should be able to identify patients with a high risk of chronic disability. However, in spite of the magnitude of the problem, little is known about the course of and prognostic factors for low-back pain among sick employees. Most studies about this topic concern patients in general practice or patients in a rehabilitation center, and the results will differ from those involving workers on sick leave with low-back pain who visit their occupational physicians (5,6). Patients with chronic low-back pain in primary care usually have little sickness absence, and patients from a rehabilitation center form a selection of more problematic cases (7).In 5 prospective studies on the prognosis of acute low-back pain in an occupational health setting, only pain intensity and radicular signs were positively related to duration of sick leave or work status at follow-up in more than 1 study (8)(9)(10)(11)(12). Three fac...

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“…In Sweden, annual costs for those sick-listed due to low back or neck problems have been estimated at 3.5 billion euros, corresponding to nearly one-third of the nation's total health-care costs (1995) [27]. Around 80% of people with back problems are pain-free within 2 weeks, and over 90% are within 3 months [5]. Nevertheless, the extremely high prevalence translates into a substantial number of people in absolute figures, with high demands for health services and consequent costs, especially for loss of production [1,28,33,38,42].…”

Section: Introductionmentioning

confidence: 99%

The costs for persons sick-listed more than one month because of low back or neck problems. A two-year prospective study of Swedish patients

Hanssoń¹,

Hansson²

2004

Eur Spine J

116

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The total costs for patients who are sick-listed due to back and neck problems have not previously been determined prospectively on an individual basis. This study aimed to determine the total cost to a society, based on individually assessed costs of health services and loss of production in people who are sick-listed 28 days or more for back or neck problems. Detailed data on individuals' health-care consumption due to back or neck problems was collected through prospectively entered diaries and questionnaires, after 4 weeks, 3 months, 1 and 2 years, in a consecutively selected cohort of 1,822 employed persons aged between 18 and 59 years. Costs for health care and production losses due to work absenteeism were determined individually and combined to render total costs to society. The costs for all medical services during the 2-year study were 6.9% of total costs for back and neck problems. The single most expensive medical service was surgery. Transferred to a national level, annual total costs for back and neck problems corresponded to 1% of GNP. In conclusion, direct healthservice costs were a small fraction of the total costs, consequently indirect costs offer the greatest potential for savings.

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

Cited by 369 publications

References 21 publications

Prognostic factors for recovery from postpartum pelvic girdle pain

Prognostic factors for recovery from postpartum pelvic girdle pain

Prognostic factors for chronic disability from acute low-back pain in occupational health care

The costs for persons sick-listed more than one month because of low back or neck problems. A two-year prospective study of Swedish patients

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