Risk factors for low back pain outcome: Does it matter when they are measured?

Abstract

Background:The early identification of factors that increase risk of poor recovery from acute low back pain (LBP) is critical to prevent the transition to chronicity. Although most studies of risk factors for poor outcome in LBP tend to investigate the condition once it is already persistent, there is evidence to suggest that this differs from risk factors measured during the early-acute stage. This study aimed to identify early risk factors for poor outcome in the short-and longterm in individuals with acute LBP, and to compare this with factors identified at 3 months in the same cohort.Methods: One hundred and thirty-three individuals were recruited within 2 weeks of an acute LBP episode and completed questionnaires related to their sociodemographic, psychological, clinical and history/treatment status at baseline and 3 months later, and their pain-level fortnightly for 12 months.Results: Of the 133 participants recruited, follow-up data were provided by 120 at 3 months, 97 at 6 months, 85 at 9 months and 94 at 12 months. Linear regression identified various factors at baseline (acute phase) and 3 months later that predicted short-and long-term outcome (pain level, change in pain). Key findings were that: (1) depressive symptoms at baseline most consistently predicted worse outcome; (2) psychological factors in general at 3 months were more predictive of outcome than when measured at baseline; (3) early health care utilization predicted better outcome, whereas use of pain medication later (3 months) predicted worse outcome; and (4) sex and BMI predicted outcome inconsistently over 12-months. Conclusions:The results highlight the multidimensional nature of risk factors for poor outcome in LBP and the need to consider time variation in these factors.Significance: This study attempts to consider the impact of time variation of candidate risk factors on long-term outcome from the very early onset of acute low back pain. Risk factors across domains (sociodemographic, psychological, clinical, history/treatment) were identified, but their relationship with outcome often depended on when (acute phase vs. 3 months later) they were measured after back pain onset. Findings highlight the need to consider both a diverse range of factors and their potential time variance when assessing risk of poor outcome.

The clinical course of acute, subacute and persistent low back pain: a systematic review and meta-analysis

“… § Analyses included 3 (uncorrected) 84 , 114 , 120 or 3 (corrected) 84 , 114 , 120 cohorts for pain, and 3 (uncorrected) 84 , 114 , 120 or 3 (corrected) 84 , 114 , 120 cohorts for disability. ¶ Analyses included 6 (uncorrected) 41 , 66 , 85 , 92 , 109 , 127 or 5 (corrected) 41 , 66 , 92 , 109 , 127 cohorts for pain, and 6 (uncorrected) 41 , 66 , 85 , 92 , 109 , 127 or 4 (corrected) 41 , 66 , 92 , 109 cohorts for disability. ** Analyses included 3 (uncorrected) 99 , 114 , 117 or 3 (corrected) 99 , 114 , 117 cohorts for pain.…”

“… ¶ Analyses included 6 (uncorrected) 41 , 66 , 85 , 92 , 109 , 127 or 5 (corrected) 41 , 66 , 92 , 109 , 127 cohorts for pain, and 6 (uncorrected) 41 , 66 , 85 , 92 , 109 , 127 or 4 (corrected) 41 , 66 , 92 , 109 cohorts for disability. …”

Characterization of pain-related behaviors in a rat model of acute-to-chronic low back pain: single vs. multi-level disc injury

“…In humans, psychosocial factors are the strongest predictors of poor long-term outcome ( 97 , 98 ). Some of these factors such as mood and depressive symptoms are thought to have a more influential impact on outcome during the early than later stages of LBP ( 99 ). This might be explained by underlying inflammatory processes.…”

Falta de conhecimento sobre os fatores de risco não ocupacionais da dor lombar entre profissionais de saúde ocupacional brasileiros: um estudo observacional transversal

“…19 Devido à natureza multidimensional da dor lombar, certos fatores de risco (por exemplo, sintomas depressivos, índice de massa corporal, sexo, fatores psicológicos, nível de dor) predizem resultados ruins em diferentes estágios do curso da dor lombar. 20 As atitudes dos profissionais de saúde no tratamento de pessoas com lombalgia são influenciadas pelas crenças desses profissionais. 21 Como resultado, as crenças dos profissionais afetam as crenças dos pacientes sobre dor lombar.…”