Background: Many studies have investigated predictors of outcome in low back pain (LBP) patients, including the role of coping. However, the relative importance of different coping strategies is unclear.

Objective: To systematically review prospective cohort studies to determine the role of specific coping strategies in the prediction of LBP outcome in primary care settings.

Methods: Medline, PsychINFO, and Embase electronic databases were searched from inception to April 2008. Prospective cohort studies focusing on aspects of coping with LBP in settings relevant to primary care were included. Studies were excluded if they focused on specific populations (e.g. nursing staff) or patients aged under 18 years, or if they were not published in English. Prior to data extraction, studies were quality assessed and coping strategies were conceptualised as either cognitive or behavioural.

Results: 782 potentially relevant articles were identified, of which 34 were included with an average follow-up of 10 months. There was considerable variability in the prognostic risk factors measured. Fear avoidance beliefs were most frequently associated with outcome. Negative affect, anxiety and depression, use of active or passive coping strategies, and catastrophizing were also commonly associated with outcome. Behavioural coping strategies were measured by only 5 of the 34 studies.

Conclusion: Despite considerable heterogeneity, most studies were of acceptable quality, enabling the identification of several key coping strategies predictive of LBP outcome. However, the majority of studies focused on cognitive coping factors only. Therefore further research is needed, particularly to investigate the influence of behavioural coping strategies on LBP outcome.