2012년 10월 26일 금요일

The prognosis of acute low back pain in primary care in the United States: a 2-year prospective cohort study

Spine (Phila Pa 1976). 2012 Apr 15;37(8):678-84.


Title:
The prognosis of acute low back pain in primary care in the United States: a 2-year prospective cohort study


Authors
1. Mehling WE
2. Gopisetty V
3. Bartmess E
4. Acree M
5. Pressman A
6. Goldberg H
7. Hecht FM
8. Carey T
9. Avins AL


Study Design

Prospective cohort study


Objective

1. Define the prognosis of patients seen in a US primary care setting with acute LBP of well-defined duration with & without sciatica.

2. Permit comparability across LBP studies.


Summary of Background Data

1. Practice guidelines for acute LBP based on return-to-work outcomes underestimate the development of chronic pain in the primary care setting.

2. Because of differences in inclusion criteria, chronic pain definitions, and national health systems, prognostic cohort studies have reported a wide range of results limiting interpretation and generalization.

3. Current data from carefully designed prognostic studies of acute LBP are lacking for the US primary care system.


Methods

1. Members of a large health service organization were enrolled after seeking medical care for acute LBP, with or without sciatica, of up to 30 days duration, with no episode in the past 12 months and no history of spine surgery.

* Entry Criteria for Acute LBP in this study
First clinic visit within 1 month of onset with no history of LBP in the prior 12 months, spine surgery or other painful conditions

2. Phone interviews at baseline (6 months & 2 years)

3. Based on receiver operating characteristic analyses, a combination of global perceived recovery with pain intensity was used as primary outcome for chronic pain.

4. Recurrence and multiple secondary outcomes were assessed to allow for comparison with other studies.


Results

1. In 605 patients,
* Average pain intensity of 5.6 (numeric rating scale = 0-10)
* Average disability of 15.8 (Roland-Morris scale = 0-24)

2. 8% had declared sick leave between pain onset and baseline interview.

3. 13% of 521 experienced chronic pain at 6 months and 19% of 443 at 2 years.

4. 54% had experienced at least 1 LBP recurrence at 6 months, and 47% in the subsequent 18 months.



Conclusion

1. Prognosis of strictly defined acute LBP, with or without sciatica, is less favorable than commonly stated in practice guidelines based on failure to return to work.

2. Broad initiatives to develop new means for the primary and secondary prevention of recurrent and chronic LBP are urgently needed.





"This comes from Spine (c) 2012 Lippincott Williams & Wilkins, Inc."