Acute low back pain: predictive index of chronicity from a cohort of 2487 subjects. Spine Group of the Société Française de Rhumatologie.
Low back pain (LBP)-related disability involves patients with chronic outcome.


OBJECTIVE
To identify the factors predictive of chronic evolution of acute LBP and to develop a predictive clinical index.


METHODS
Prospective investigation of 2487 employed patients referred for their first consultation with acute LBP (less than eight days). Chronic evolution defined by persistence of symptoms, unchanged or worse, at seven weeks. A predictive index was developed according to a logistic regression model.


RESULTS
One hundred fifty-five patients (6.2%) were considered to have unchanged or worsened LBP at the time of final evaluation, which was carried out on average 42 +/- 15 days after the initial visit, and were thus regarded as having a chronic outcome. When comparing patients with chronic outcome and the others, there were 25 elementary characteristics for which the degree of significance of the bilateral test was less than 0.01. They were introduced into a logistic regression model. Five parameters appeared to be related to chronic outcome: characteristics of current episode (isolated acute low back pain, acute exacerbation of chronic low back pain, sciatica), two daily living activity items, duration of certificate to remain off work and taking part in a sport. They were used to develop an easily applied index providing identification, as of the initial consultation, of the risk of chronic evolution.


CONCLUSIONS
The early recognition of patients with LBP with high risk of chronic outcome can be achieved with an easily applied clinical index.
Valat
J P
JP
Université François Rabelais, Faculté de Médecine, Tours, France.
Goupille
P
P
Rozenberg
S
S
Urbinelli
R
R
Allaert
F
F
D000203:Activities of Daily Living; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D004185:Disability Evaluation; D005103:Expert Systems; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D017116:Low Back Pain / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome