title: Clinical course in patients seeking primary care for back or neck pain: a prospective 5-year follow-up of outcome and health care consumption with subgroup analysis.
abstract: METHODS
  Prospective follow-up.
  
  
  OBJECTIVE
  To describe the 5-year clinical course in a cohort of patients treated for back or neck pain in primary care and compare results with the 1-year outcome both for the whole group and for subgroups.
  
  
  BACKGROUND
  A randomized study showed a decrease in perceived pain and disability after treatment by chiropractic or physiotherapy, but many reported recurrence or continual pain at the 1-year follow-up. Knowledge of the clinical course over longer follow-up periods is limited.
  
  
  METHODS
  A 5-year follow-up questionnaire was sent to 314 individuals. Main outcome measures were pain intensity, Oswestry score, and general health. Recurrence, health care consumption, and other measures were described.
  
  
  RESULTS
  Fifty-two percent of respondents reported pain (visual analog scale, >10 mm) and back-related disability (Oswestry, >10%) at the 5-year follow-up. This was similar to 1-year results, and 84% of these were the same individuals. Sixty-three percent reported recurrence or continual pain, and 32% reported health care consumption at the 5-year follow-up.
  
  
  CONCLUSIONS
  In a cohort of individuals of working age seeking primary care for nonspecific back or neck pain, it can be expected that about half of the population will report pain and disability at the 5-year follow-up. A significant proportion will report recurrence or continual pain and health care consumption. Pain and disability were associated with recurrence or continual pain and health care consumption. Further analysis is needed to identify additional predictors for 5-year outcome, taking into account 1-year follow-up results. Since many patients will have recurrence or continual pain, health policies and clinical decision models for long-term outcome must allow for these aspects.
authors.affiliation: Department of Health and Society, Division of Physiotherapy, Faculty of Health Sciences, Linköping University, Linköping, Sweden. paul.enthoven@ihs.liu.se
authors.forename: Paul
authors.initials: P
authors.lastname: Enthoven
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Skargren
authors.forename: Birgitta
authors.initials: B
authors.lastname: Oberg
mesh_terms: D000328:Adult; D000368:Aged; D001416:Back Pain / Q000145:classification / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy; D015331:Cohort Studies; D015897:Comorbidity; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D026882:Manipulation, Chiropractic / Q000706:statistics & numerical data; D008875:Middle Aged; D019547:Neck Pain / Q000145:classification / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy; D010147:Pain Measurement; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D026741:Physical Therapy Modalities / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012008:Recurrence; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome