Risk of Recurrence of Low Back Pain: A Systematic Review

Abstract

Study Design Systematic review. Background While most people with acute low back pain (LBP) recover quickly, recurrences are believed to be common. To our knowledge, no published high-quality systematic review has assessed the risk of recurrent LBP or the factors that would predict LBP recurrence. Objectives The aim of this study was to investigate the risk of, and prognostic factors for, a recurrence of LBP in patients who have recovered from a previous episode of LBP within the last year. Methods Systematic searches were conducted in the MEDLINE, Embase, and CINAHL databases. We included longitudinal studies of adults who had recovered from a previous episode of LBP within 12 months. The primary outcome was a new episode of LBP. Secondary outcomes were other types of recurrence (eg, episodes causing care seeking). Results Eight studies were included in the review: 7 observational studies and 1 randomized trial (2 publications). Six studies reported recurrence proportions for the primary outcome of an episode of LBP. Meta-analysis was not conducted due to the low quality and heterogeneity of studies. Only 1 study was considered an inception cohort study; it reported a 1-year recurrence proportion of 33%. A history of previous episodes of LBP prior to the most recent episode was the only factor that consistently predicted recurrence of LBP. Conclusion The available research does not provide robust estimates of the risk of LBP recurrence and provides little information about factors that predict recurrence in people recently recovered from an episode of LBP. Level of Evidence Prognosis, 1a-. Prospectively registered in PROSPERO on February 9, 2016 (CRD42016030220). J Orthop Sports Phys Ther 2017;47(5):305-313. Epub 29 Mar 2017. doi:10.2519/jospt.2017.7415.

Keywords: inception cohort; prognosis; risk factors; spine.