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Predicting who develops chronic low back pain in primary care: a prospective study.
E Thomas1, A J Silman, P R Croft
1Arthritis Research Campaign Epidemiology Unit, School of Epidemiology and Health Sciences, Medical School, University of Manchester, Manchester M13 9PT.
BMJ (Clinical Research Ed.)
|June 18, 1999
Summary
Persistent disabling low back pain affects one-third of patients and is linked to psychological distress, poor health, and lifestyle factors. The premorbid state significantly influences long-term outcomes.
Area of Science:
- Musculoskeletal health
- Epidemiology of chronic pain
- Clinical psychology
Background:
- Low back pain (LBP) is a leading cause of disability worldwide.
- Understanding factors predicting persistent LBP is crucial for effective management.
- Previous research has focused on acute episode characteristics, with less emphasis on premorbid influences.
Purpose of the Study:
- To quantify the relative contribution of premorbid and episode-specific factors in determining long-term disabling symptoms of low back pain.
- To identify key predictors for persistent disabling low back pain.
Main Methods:
- Prospective cohort study involving 180 patients consulting for low back pain.
- Follow-up at 1 week, 3 months, and 12 months post-consultation.
- Assessment of persistent disabling low back pain as the main outcome measure.
Main Results:
- One-third of participants experienced persistent disabling low back pain at 12 months.
- Factors associated with persistence included increasing age, prior LBP history, and female gender.
- Significant predictors included premorbid psychological distress, poor self-rated health, low physical activity, smoking, employment dissatisfaction, symptom duration, radiating leg pain, widespread pain, and reduced spinal mobility.
Conclusions:
- The persistence of disabling low back pain is influenced by both clinical factors related to the pain episode and the patient's premorbid state.
- A multivariate model identified distinct risk groups for persistent symptoms, ranging from 6% to 70% likelihood.