Prognosis and quality of life in patients with acute low back pain: Insights from a comprehensive inception cohort study

Coste, Joël; Lefrançois, G.; Guillemin, Françis; Pouchot, J.

doi:10.1002/art.20235

Cited by 69 publications

(47 citation statements)

References 35 publications

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“…However, our current results suggest that some of the strongest predictors of persistence are measures of symptom severity and duration. These results are similar to those from recent adult studies that found that episode-specific factors, such as duration of symptoms, were associated with poor prognosis (26,27,37). It is intuitive that symptoms of longer initial duration are more likely to be persistent.…”

Section: Discussionsupporting

confidence: 90%

Predicting persistent low back pain in schoolchildren: A prospective cohort study

Jones¹,

Macfarlane²

2009

Arthritis & Rheumatism

106

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Objective. Low back pain (LBP) is common in children but the prognostic indicators are poorly understood. We report the results of a prospective study to determine the risk factors for chronic LBP in children. Methods. A total of 330 children with LBP were identified from a cross-sectional survey in schools in Northwest England. Data were collected by self-completion questionnaire on a number of potential risk factors for LBP persistence, including lifestyle factors, the occurrence of other symptoms, behavioral and emotional characteristics, and symptom severity and duration. Participants were then followed over the following 4 years to determine persistent symptoms. Results. Complete followup data were available from 178 children, of whom 46 (26%) reported persistent LBP. Forward stepwise Poisson regression identified 5 independent predictors of pain persistence: peer relationship problems, being of smaller stature, the prior report of widespread body pain, long duration of LBP episodes, and radiating leg pain. Of children with none of these factors at baseline, <5% went on to report persistent LBP. In contrast, of those with 4 or 5 factors, nearly 80% experienced persistent symptoms. Conclusion. Although childhood consultations for LBP are infrequent, we have shown that ϳ25% of children 11-14 years of age with LBP still report symptoms 4 years later. These children can be identified early by a combination of clinical markers and etiologic factors. This provides a basis for considering interventions for secondary prevention; the challenge will be to determine whether we can intervene to alter symptom trajectory at an early stage.

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Section: Discussionsupporting

confidence: 90%

Predicting persistent low back pain in schoolchildren: A prospective cohort study

Jones¹,

Macfarlane²

2009

Arthritis & Rheumatism

106

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“…Only a small proportion of eligible studies explicitly excluded patients with leg pain or sciatica, 17,18 while most studies either did not provide any information on this distinction (12 cohorts) or included some patients with leg pain or sciatica (19 cohorts). It was common for authors to refer to the presence of leg pain as sciatica without differentiating whether the pain was somatic or radicular.…”

Section: Limitationsmentioning

confidence: 99%

The prognosis of acute and persistent low-back pain: a meta-analysis

Costa

Maher

Hancock

et al. 2012

CMAJ

484

235

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Research CMAJ Background: Although low-back pain is a highly prevalent condition, its clinical course remains uncertain. Our main objective was to systematically review the literature on the clinical course of pain and disability in patients with acute and persistent low-back pain. Our secondary objective was to investigate whether pain and disability have similar courses. Methods:We performed a meta-analysis of inception cohort studies. We identified eligible studies by searching MEDLINE, Embase and CINAHL. We included prospective studies that enrolled an episode-inception cohort of patients with acute or persistent low-back pain and that measured pain, disability or recovery. Two independent reviewers extracted data and assessed methodologic quality. We used mixed models to determine pooled estimates of pain and disability over time.Results: Data from 33 discrete cohorts (11 166 participants) were included in the review. The variance-weighted mean pain score (out of a maximum score of 100) was 52 (95% CI 48-57) at baseline, 23 (95% CI 21-25) at 6 weeks, 12 (95% CI 9-15) at 26 weeks and 6 (95% CI 3-10) at 52 weeks after the onset of pain for cohorts with acute pain. Among cohorts with persistent pain, the variance-weighted mean pain score (out of 100) was 51 (95% CI 44-59) at baseline, 33 (95% CI 29-38) at 6 weeks, 26 (95% CI 20-33) at 26 weeks and 23 (95% CI 16-30) at 52 weeks after the onset of pain. The course of disability outcomes was similar to the time course of pain outcomes in the acute pain cohorts, but the pain outcomes were slightly worse than disability outcomes in the persistent pain cohorts. Interpretation:Patients who presented with acute or persistent low-back pain improved markedly in the first six weeks. After that time improvement slowed. Low to moderate levels of pain and disability were still present at one year, especially in the cohorts with persistent pain. Abstract

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“…Job dissatisfaction 21 , previous sick leave for LBP 5 , somatic distress 22,23 , depression 24,25,26 27,28,29 , fear of movement 17 and passive coping 23,30 have all been shown to predict long-term status when measured at baseline. We assessed patients' anxiety, somatic distress, depression and mental well-being at baseline and found little of importance in determining long-term pain or disability with these measures.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

Predicting Outcome in Acute Low Back Pain Using Different Models of Patient Profiling

Wand¹,

McAuley²,

Marston³

et al. 2009

Spine

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Tel +61 8 9433 0203Fax +61 8 9433 0210Competing interest: No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subjects of this manuscript Acknowledgements: We would like to thank Christien Bird, Maureen MacDowell, Anne Golden and Mary Sexton for their initial contribution to this study. Ethical approval: Ethical approval was obtained from the Health Authorities Research Ethics Committee 3 Abstract Study DesignProspective observational study of prognostic indicators, utilising data from a randomised, controlled trial of physiotherapy care of acute low back pain (ALBP) with follow up at 6 weeks, 3 months and 6 months. ObjectiveTo evaluate which patient profile offers the most useful guide to long-term outcome in ALBP. Summary of Background DataThe evidence used to inform prognostic decision-making is derived largely from studies where baseline data is used to predict future status. Clinicians often see patients on multiple occasions so may profile patients in a variety of ways. It is worth considering if better prognostic decisions can be made from alternative profiles. MethodsClinical, psychological and demographic data were collected from a sample of 54 ALBP patients. Three clinical profiles were developed from information collected at baseline, information collected at 6 weeks, and the change in status between these two time points. A series of regression models were used to determine the independent and relative contributions of these profiles to the prediction of chronic pain and disability. 4 ResultsThe baseline profile predicted long-term pain only. The 6-week profile predicted both long-term pain and disability. The change profile only predicted long-term disability (p < 0.01). When predicting long-term pain, after the baseline profile had been added to the model, the 6-week profile did not add significantly when forced in at the second step (p>0.05). A similar result was obtained when the order of entry was reversed. When predicting long-term disability, after the 6-week profile was entered at the first step, the change profile was not significant when forced in at the second step. However, when the change profile was entered at the first step and the 6-week clinical profile was forced in at the second step, a significant contribution of the 6-week profile was found. ConclusionsThe profile derived from information collected at 6 weeks provided the best guide to long-term pain and disability. The baseline profile and change in status offered less predictive value.Key words: acute low back pain; clinical guidelines; prognosis; physiotherapy. Key points• International guidelines for ALBP use information about prognosis to shape care pathways for ALBP patients. 5• This information is derived largely from studies that have assessed patients at a single (early) time point.• The clinical situation provides a much richer source of information and potential for varying models of patient profiling.• The 6...

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Prognosis and quality of life in patients with acute low back pain: Insights from a comprehensive inception cohort study

Cited by 69 publications

References 35 publications

Predicting persistent low back pain in schoolchildren: A prospective cohort study

Predicting persistent low back pain in schoolchildren: A prospective cohort study

The prognosis of acute and persistent low-back pain: a meta-analysis

Predicting Outcome in Acute Low Back Pain Using Different Models of Patient Profiling

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