Prognosis in patients with recent onset low back pain in Australian primary care: inception cohort study

Abstract

Objective To estimate the one year prognosis and identify prognostic factors in cases of recent onset low back pain managed in primary care. Design Cohort study with one year follow-up. Setting Primary care clinics in Sydney, Australia. Participants An inception cohort of 973 consecutive primary care patients (mean age 43.3, 54.8% men) with non-specific low back pain of less than two weeks' duration recruited from the clinics of 170 general practitioners, physiotherapists, and chiropractors. Main outcome measures Participants completed a baseline questionnaire and were contacted six weeks, three months, and 12 months after the initial consultation. Recovery was assessed in terms of return to work, return to function, and resolution of pain. The association between potential prognostic factors and time to recovery was modelled with Cox regression. Results The follow-up rate over the 12 months was more than 97%. Half of those who reduced their work status at baseline had returned to previous work status within 14 days (95% confidence interval 11 to 17 days) and 83% had returned to previous work status by three months. Disability (median recovery time 31 days, 25 to 37 days) and pain (median 58 days, 52 to 63 days) took much longer to resolve. Only 72% of participants had completely recovered 12 months after the baseline consultation. Older age, compensation cases, higher pain intensity, longer duration of low back pain before consultation, more days of reduced activity because of lower back pain before consultation, feelings of depression, and a perceived risk of persistence were each associated with a longer time to recovery. Conclusions In this cohort of patients with acute low back pain in primary care, prognosis was not as favourable as claimed in clinical practice guidelines. Recovery was slow for most patients. Nearly a third of patients did not recover from the presenting episode within a year.

Cost-effectiveness of guideline-endorsed treatments for low back pain: a systematic review

“…Three studies had follow-up periods that are likely to be too short to fully appreciate the economic consequences for the chronic population under investigation [44][45][46]. Based on recent large cohort studies on the prognosis of acute [51] and chronic [52] LBP, we recommend a follow-up period of at least 3 months for acute LBP and at least 12 months for chronic LBP. In addition, to help readers assess the extent to which the results of studies are applicable to different healthcare systems, we recommend that economic evaluations report unit costs as well as reporting a breakdown of costs and resource utilization.…”

Red flags presented in current low back pain guidelines: a review

“…Low back pain remains a common condition among primary care patients with an estimated lifetime prevalence of 13.8 % for chronic pain and 80 % for any episode of pain [1][2][3]. European guidelines for the management of low back pain in primary care define low back pain as ''pain and discomfort'' localized below the costal margin and above the inferior gluteal folds, with or without leg pain.…”

Predictors for chronic neck and low back pain in office workers: a 1‐year prospective cohort study

“…Neck and low back pain occur episodically over a lifetime with variable recovery between episodes 13) . In a working population, between 60−80% of workers with neck pain reported neck pain 1 year later 14) , whereas between 24−61% of patients with recent onset of low back pain developed chronicity 15,16) . Neck and low back pain often leads to activity limitations, sickness absence, or long-term work disability.…”