Low back pain: what determines functional outcome at six months? An observational study

Abstract

BackgroundThe rise in disability due to back pain has been exponential with escalating medical and societal costs. The relative contribution of individual prognostic indicators to the pattern of recovery remains unclear. The objective of this study was to determine the prognostic value of demographic, psychosocial, employment and clinical factors on outcome in patients with low back painMethodsA prospective cohort study with six-month follow-up was undertaken at a multidisciplinary back pain clinic in central London employing physiotherapists, osteopaths, clinical psychologists and physicians, receiving referrals from 123 general practitioners. Over a twelve-month period, 593 consecutive patients referred from general practice with simple low back pain were recruited. A baseline questionnaire was developed to elicit information on potential prognostic variables. The primary outcome measures were change in 24-item Roland Morris disability questionnaire score at six months as a measure of low back related functional disability and the physical functioning scale of the SF-36, adjusted for baseline scores.ResultsRoland Morris scores improved by 3.8 index points (95% confidence interval 3.23 to 4.32) at six months and SF-36 physical functioning score by 10.7 points (95% confidence interval 8.36 to 12.95). Ten factors were linked to outcome yet in a multiple regression model only two remained predictive. Those with episodic rather than continuous pain were more likely to have recovered at six months (odds ratio 2.64 confidence interval 1.25 to 5.60), while those that classified themselves as non-white were less likely to have recovered (0.41 confidence interval 0.18 to 0.96).ConclusionsAnalysis controlling for confounding variables, demonstrated that participants showed greater improvement if their episodes of pain during the previous year were short-lived while those with Middle Eastern, North African and Chinese ethnicity demonstrated minimal improvement. The study did not support previous findings that a wide range of factors could predict outcome.

Predictors for Half-Year Outcome of Impairment in Daily Life for Back Pain Patients Referred for Physiotherapy: A Prospective Observational Study

“…A connected predictor was found to be of relevance by another group of researchers, who adopted a follow-up similar to ours. Harms et al found an episodic pain character to be advantageous [19].…”

“…An additional value of these large trials (n≥500) is the setting, since patient samples were from primary health care, which occurs rather seldom. Harms et al accomplished a cohort study at a multidisciplinary back pain clinic, in which among others physiotherapists were practicing [19].…”

The added prognostic value of MRI findings for recovery in patients with low back pain in primary care: a 1-year follow-up cohort study

“…Negative beliefs about LBP was only reported in one other study as an independent risk factor for poor recovery [31], and was associated with high back pain intensity levels in a cross-sectional study [32]. Continuous back pain was reported as a factor for poor recovery in only one study [33]. The question about the presence of continuous back pain independent of posture or activity is often used in primary care, but is not often examined in prognostic studies.…”

Development of a standard set of outcome measures for non-specific low back pain in Dutch primary care physiotherapy practices: a Delphi study

“…More than 12 weeks In addition, on the guideline search we found 15 studies in our systematic search on PubMed and included 10 systematic reviews for selecting individual prognostic factors [57][58][59][60][61][62][63][64][65][66][67]. We found that catastrophizing and somatization seem to be negatively associated with recovery of NSLBP [58,59].…”