The Prognosis of Low Back Pain in General Practice

Hoogen, H.J.M. van den; Koes, Bart W.; Devillé, W.L.J.M.; Eijk, J.T.M. van; Bouter, Lex M.

doi:10.1097/00007632-199707010-00019

Cited by 145 publications

(75 citation statements)

References 16 publications

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“…Therefore, it is plausible that our study population represents workers with new episodes of low-back pain in these occupational health services. Due to this restriction of duration of sick leave at inclusion we could not study this factor, which was found to be an important prognostic factor in other studies (6).…”

Section: Discussionmentioning

confidence: 94%

“…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).…”

mentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 94%

mentioning

confidence: 99%

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

View full text Add to dashboard Cite

show abstract

“…27 The analyses were adjusted for baseline values and for health insurance (which differed between the 2 groups at baseline). 28 The analyses of pain and physical functioning also were adjusted for potential prognostic variables based on the literature (ie, sex, 29,30 duration of the current episode of back pain, 31 previous back pain episode [s], 32 and education 33 ). All multilevel analyses were performed with MLwiN (version 1.10).…”

Section: Discussionmentioning

confidence: 99%

Implementation of Clinical Guidelines on Physical Therapy for Patients With Low Back Pain: Randomized Trial Comparing Patient Outcomes After a Standard and Active Implementation Strategy

Bekkering¹,

Tulder²,

et al. 2005

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Background and Purpose. An active strategy was developed for the implementation of the clinical guidelines on physical therapy for patients with low back pain. The effect of this strategy on patients' physical functioning, coping strategy, and beliefs regarding their low back pain was studied. Subjects. One hundred thirteen primary care physical therapists treated a total of 500 patients. Methods. The physical therapists were randomly assigned to 1 of 2 groups. The control group received the guidelines by mail (standard passive method of dissemination). The intervention group, in contrast, received an additional active training strategy consisting of 2 sessions with education, group discussion, role playing, feedback, and reminders. Patients with low back pain, treated by the participating therapists, completed questionnaires on physical functioning, pain, sick leave, coping, and beliefs. Results. Physical functioning and pain in the 2 groups improved substantially in the first 12 weeks. Multilevel longitudinal analysis showed no differences between the 2 groups on any outcome measure during follow-up. Discussion and Conclusion. The authors found no additional benefit to applying an active strategy to implement the physical therapy guidelines for patients with low back pain. Active implementation strategies are not recommended if patient outcomes are to be improved.

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“…Furthermore, our data confirm that patients' subjective estimation of pain and disability already displays a prognostic value for therapy outcome that cannot be increased significantly by the assessment of physical parameters [50,53]. This finding makes it questionable whether the administrative burden associated with the assessment of somatic parameters and the conduct of performance tests is worth the small increase in predictability.…”

Section: C) D)mentioning

confidence: 53%

The value of physical performance tests for predicting therapy outcome in patients with subacute low back pain: a prospective cohort study

et al. 2009

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Considering the enormous costs of intensive multidisciplinary treatment, predictive tests for therapy outcome are needed to evaluate patients' performance potential and increase cost effectiveness. Somatic parameters are commonly used to evaluate health status and serve as an additional means of forecasting the prognosis, yet little is known of their validity. In this study, we investigated the prognostic value of somatic parameters regarding the outcome of multidisciplinary treatment in patients with subacute low back pain. The study was designed as a prospective cohort study of 162 patients. Somatic parameters were assessed with three physical performance tests (Villiger test, Oesch test, Biering-Sørensen test) before treatment (T0), after 3 weeks' inpatient therapy (T1) and at 6-month follow-up (T2). Psychometric characteristics of subjective pain perception (VAS), a pain disability index (PDI) and a physical capability index (FFbH-R) were recorded. Correlation coefficients between the physical performance test scores and psychometric characteristics were calculated. To predict therapy outcome, discriminant analyses were performed. A control group (n = 30) was evaluated at similar time points without receiving any therapy. Our results demonstrate good discrimination between patients and controls by means of the investigated performance tests and exhibit a significant negative correlation with the psychometric data. Lower outcome values at study entry correlated with higher pain intensity and disability after multidisciplinary treatment. However, the statistical magnitude of correlation was relatively low and further discriminant analysis did not reveal any predictive value. Consequently the physical performance tests do not have a prognostic value regarding therapy outcome.

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The Prognosis of Low Back Pain in General Practice

Abstract: Only a few variables appear to be related to the clinical course of low back pain seen in general practice. In particular, the duration preceding the initial visit and, unexpectedly, receiving physical therapy were both associated with a longer duration of low back pain.

Cited by 145 publications

References 16 publications

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

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

Implementation of Clinical Guidelines on Physical Therapy for Patients With Low Back Pain: Randomized Trial Comparing Patient Outcomes After a Standard and Active Implementation Strategy

The value of physical performance tests for predicting therapy outcome in patients with subacute low back pain: a prospective cohort study

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