Abstract
Purpose
To compare the contribution of physical, psychological and social indicators to predicting disability after one year between consulters with low back pain (LBP) of less than 3 months duration and more than 3 months duration.
Methods
Data from two large prospective cohort studies of consecutive patients consulting with LBP in general practices were merged, with disability measured by the Roland Morris Disability Questionnaire (RMDQ). There were complete data for 258 cases with acute/subacute LBP and 668 cases with chronic LBP at 12 months follow-up. Univariate and adjusted multivariate regression analyses of various potential prognostic indicators for disability at 12 months were carried out.
Results
There were significant differences between those with acute/subacute versus chronic LBP with regard to baseline characteristics and clinical course of disability during the year of follow-up. The final multivariate regression models, adjusting for baseline disability scores, age, gender, and study sample, showed that being non-employed, having widespread pain, a high level of Chronic Pain Grade, and catastrophising were the strongest prognostic indicators for disability at 12 months in both those with acute/subacute and those with chronic LBP. Fear of pain was significantly associated with disability in chronic LBP but not in acute/subacute LBP.
Conclusion
Despite significant differences between acute/subacute and chronic LBP in baseline characteristics and clinical course over one year, a similar set of prognostic indicators influence long-term disability in both groups. This provides further evidence that chronicity is determined early in an episode of LBP and highlights again the potential for prevention if these prognostic factors can be systematically identified and targeted.
Conflicts of interest. None
Sources of funding. Funding for the two cohort studies: Wellcome Trust (BaRNS), the Arthritis Research Campaign (BeBack). Thanks to the research teams, GP practices and patients that supported each of the two cohort studies. NEF was funded through a Primary Care Career Scientist award from the National Institute of Health Research, UK. KMD is funded through a Research Career Development Fellowship from the Wellcome Trust.
