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

• Published in: BMJ 2008-07, Vol.337 (7662), p.154-157
• Main Authors: Henschke, Nicholas, Maher, Christopher G, Refshauge, Kathryn M, Herbert, Robert D, Cumming, Robert G, Bleasel, Jane, York, John, Das, Anurina, McAuley, James H
• Format: Article
• Language: English
• Subjects: Adult; Australia; Back pain; Biological and medical sciences; Chiropractic - statistics & numerical data; Chiropractors; Cohort analysis; Cohort Studies; Confidence interval; Disabilities; Disabled Persons; Diseases of the osteoarticular system; Diseases of the spine; Family Practice - statistics & numerical data; Female; General aspects; General practice; Humans; Length of Stay; Low back pain; Low Back Pain - therapy; Male; Medical prognosis; Medical sciences; Miscellaneous; New South Wales; Pain; Pathology; Patients; Physical therapy; Physical Therapy Modalities - statistics & numerical data; Primary care; Primary health care; Primary Health Care - statistics & numerical data; Prognosis; Public health. Hygiene; Public health. Hygiene-occupational medicine; Recovery (Medical); Variables
• ISSN: 0959-8138; 0959-8146; 0959-535X; 1468-5833; 1756-1833
• DOI: 10.1136/bmj.a171

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.