Prognosis in patients with recent onset low back pain in Australian primary care: inception cohort study

Abstract

Objective: To estimate the one year prognosis and identify prognostic factors in cases of recent onset low back pain managed in primary care.

Design: Cohort study with one year follow-up.

Setting: Primary care clinics in Sydney, Australia.

Participants: An inception cohort of 973 consecutive primary care patients (mean age 43.3, 54.8% men) with non-specific low back pain of less than two weeks' duration recruited from the clinics of 170 general practitioners, physiotherapists, and chiropractors.

Main outcome measures: Participants completed a baseline questionnaire and were contacted six weeks, three months, and 12 months after the initial consultation. Recovery was assessed in terms of return to work, return to function, and resolution of pain. The association between potential prognostic factors and time to recovery was modelled with Cox regression.

Results: The follow-up rate over the 12 months was more than 97%. Half of those who reduced their work status at baseline had returned to previous work status within 14 days (95% confidence interval 11 to 17 days) and 83% had returned to previous work status by three months. Disability (median recovery time 31 days, 25 to 37 days) and pain (median 58 days, 52 to 63 days) took much longer to resolve. Only 72% of participants had completely recovered 12 months after the baseline consultation. Older age, compensation cases, higher pain intensity, longer duration of low back pain before consultation, more days of reduced activity because of lower back pain before consultation, feelings of depression, and a perceived risk of persistence were each associated with a longer time to recovery.

Conclusions: In this cohort of patients with acute low back pain in primary care, prognosis was not as favourable as claimed in clinical practice guidelines. Recovery was slow for most patients. Nearly a third of patients did not recover from the presenting episode within a year.

Fig 1 Flowchart of participants through study

Fig 2 Kaplan-Meier estimate of time to complete recovery, determined by phone follow-up at six weeks, three months, and 12 months. Participants were interviewed to establish if they had recovered (no pain for one month AND no disability for one month AND returned to previous work status for one month). If they had recovered they were asked to nominate start date of one month period. This date was used to determine time to recovery. Curves are not smoothed but appear so because of large sample size