Prognosis and quality of life in patients with acute low back pain: insights from a comprehensive inception cohort study.
OBJECTIVE
To investigate the respective contribution of various biologic and psychosocial factors, especially initial health-related quality of life (HRQOL), in the natural history of acute low back pain (LBP) and to evaluate the impact of this condition on HRQOL.


METHODS
For 3 months, we assessed 113 patients consulting for nonspecific acute LBP of <72 hours duration at inclusion and treated with acetaminophen. Endpoints included pain, disability assessed by the Roland Disability Questionnaire, and HRQOL assessed by the Short Form 36 health survey (SF-36).


RESULTS
Seventy-three percent of patients recovered within 2 weeks and 5% of patients developed chronic LBP. Prior low back surgery, higher initial disability questionnaire score, lower SF-36 score, and temporary compensation status were independently associated with delayed recovery. The impact of the acute LBP episode on HRQOL was brief and moderate, except for patients with comorbidity, psychiatric disorders, those of foreign origin, unemployed, or with job dissatisfaction. The impact of compensation status, sick leave, and bed rest was more profound and lasting.


CONCLUSIONS
This study highlights the large contribution of work-related factors, but also initial HRQOL, to the prognosis of LBP. It also suggests that LBP impairs HRQOL mainly through compensation and inappropriate medical care, and that, in turn, impaired HRQOL favors the condition becoming chronic. These findings have implications for future research into the management of LBP.
Coste
Joël
J
Hôpital Cochin, Paris, France. coste@cochin.univ-paris5.fr
Lefrançois
Gérard
G
Guillemin
Francis
F
Pouchot
Jacques
J
D000082:Acetaminophen / Q000627:therapeutic use; D000208:Acute Disease; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D015331:Cohort Studies; D004185:Disability Evaluation; D004651:Employment; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017116:Low Back Pain / Q000188:drug therapy / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D011379:Prognosis; D011584:Psychology; D011788:Quality of Life; D020127:Recovery of Function; D012219:Rheumatology; D018582:Sick Leave
D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen