title: Prognostic factors for musculoskeletal pain in primary care: a systematic review.
abstract: BACKGROUND
  Estimating the future course of musculoskeletal pain is an important consideration in the primary care consultation for patients and healthcare professionals. Studies of prognostic indicators tend to have been viewed in relation to each site separately, however, an alternative view is that some prognostic indicators may be common across different sites of musculoskeletal pain.
  
  
  OBJECTIVE
  To identify generic prognostic indicators for patients with musculoskeletal pain in primary care.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  Observational cohort studies in primary care.
  
  
  METHODS
  MEDLINE, EMBASE, PsychINFO and CINAHL electronic databases were searched from inception to April 2006. Inclusion criteria were that the study was a primary care-based cohort, published in English and contained information on prognostic indicators for musculoskeletal conditions.
  
  
  RESULTS
  Forty-five studies were included. Eleven factors, assessed at baseline, were found to be associated with poor outcome at follow up for at least two different regional pain complaints: higher pain severity at baseline, longer pain duration, multiple-site pain, previous pain episodes, anxiety and/or depression, higher somatic perceptions and/or distress, adverse coping strategies, low social support, older age, higher baseline disability, and greater movement restriction.
  
  
  CONCLUSIONS
  Despite substantial heterogeneity in the design and analysis of original studies, this review has identified potential generic prognostic indicators that may be useful when assessing any regional musculoskeletal pain complaint. However, Its unclear whether these indicators, used alone, or in combination, can correctly estimate the likely course of individual patients' problems. Further research is needed, particularly in peripheral joint pain and using assessment methods feasible for routine practice.
authors: Primary Care Musculoskeletal Research Centre, Keele University, Staffordshire. c.d.mallen@cphc.keele.ac.uk
authors: Christian D
authors: CD
authors: Mallen
authors: George
authors: G
authors: Peat
authors: Elaine
authors: E
authors: Thomas
authors: Kate M
authors: KM
authors: Dunn
authors: Peter R
authors: PR
authors: Croft
mesh_terms: D000223:Adaptation, Psychological; D001008:Anxiety Disorders / Q000209:etiology; D015331:Cohort Studies; D003866:Depressive Disorder / Q000209:etiology; D005194:Family Practice; D006801:Humans; D009140:Musculoskeletal Diseases / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology; D010146:Pain / Q000209:etiology* / Q000523:psychology; D010147:Pain Measurement; D011379:Prognosis; D012720:Severity of Illness Index
references: J Rehabil Med. 2003 Jul;35(4):168-73
references: 12892242
references: J Fam Pract. 1988 Nov;27(5):483-9
references: 2973513
references: J Clin Epidemiol. 1997 Jan;50(1):31-43
references: 9048688
references: Clin J Pain. 1998 Sep;14(3):209-15
references: 9758070
references: J Public Health (Oxf). 2004 Sep;26(3):277-84
references: 15454597
references: Spine (Phila Pa 1976). 2005 Aug 1;30(15):1786-92
references: 16094282
references: Spine (Phila Pa 1976). 2005 Apr 15;30(8):976-82
references: 15834343
references: Arthritis Rheum. 2005 Dec 15;53(6):920-30
references: 16342106
references: Spine (Phila Pa 1976). 1997 Jul 1;22(13):1515-21
references: 9231972
references: Scand J Rheumatol. 2002;31(4):239-44
references: 12369657
references: BMJ. 1994 Feb 26;308(6928):577-80
references: 8148683
references: J Clin Epidemiol. 2000 Sep;53(9):964-72
references: 11004423
references: Pain. 2006 Feb;120(3):276-85
references: 16426760
references: Br J Gen Pract. 2003 Jan;53(486):26-30
references: 12564273
references: Pain. 2003 Jul;104(1-2):303-22
references: 12855341
references: CMAJ. 2005 Jun 7;172(12):1559-67
references: 15939915
references: Man Ther. 2004 Feb;9(1):30-5
references: 14723859
references: BMJ. 1996 Sep 7;313(7057):601-2
references: 8806252
references: Spine (Phila Pa 1976). 1993 Jun 1;18(7):855-62
references: 8316884
references: Br Med J. 1966 Jul 9;2(5505):82-4
references: 20791052
references: Am J Epidemiol. 2004 May 1;159(9):882-90
references: 15105181
references: Br J Gen Pract. 1992 Nov;42(364):462-4
references: 1472392
references: Arthritis Rheum. 2004 Apr 15;51(2):168-76
references: 15077256
references: Health Expect. 2002 Jun;5(2):114-26
references: 12031052
references: Spine (Phila Pa 1976). 1995 Feb 15;20(4):478-84
references: 7747233
references: Pain. 2004 Jun;109(3):420-31
references: 15157703
references: Pain. 1996 May-Jun;65(2-3):197-204
references: 8826507
references: Br J Gen Pract. 1996 Sep;46(410):519-23
references: 8917870
references: Scand J Work Environ Health. 2004 Feb;30(1):47-55
references: 15018028
references: Spine (Phila Pa 1976). 2001 Apr 1;26(7):758-64; discussion 765
references: 11295896
references: Eur J Pain. 2002;6(3):229-37
references: 12036310
references: Pain. 1999 Mar;80(1-2):113-9
references: 10204723
references: Spine (Phila Pa 1976). 2005 Aug 15;30(16):E459-70
references: 16103840
references: Fam Pract. 1999 Jun;16(3):223-32
references: 10439974
references: Br J Gen Pract. 2005 Mar;55(512):199-204
references: 15808035
references: Ann Rheum Dis. 2005 Sep;64(9):1331-6
references: 15708885
references: BMJ. 2000 Jun 10;320(7249):1574-7
references: 10845965
references: Spine (Phila Pa 1976). 1995 Mar 15;20(6):722-8
references: 7604349
references: Spine (Phila Pa 1976). 2000 Jan;25(1):115-20
references: 10647169
references: Spine (Phila Pa 1976). 2000 May 1;25(9):1148-56
references: 10788861
references: Rheumatology (Oxford). 2002 May;41(5):503-8
references: 12011372
references: BMJ. 1999 Jun 19;318(7199):1662-7
references: 10373170
references: Pain. 2001 May;92(1-2):195-200
references: 11323140
references: Pain. 2005 Sep;117(1-2):162-70
references: 16099095
references: Eur J Pain. 2006 Jan;10(1):1-11
references: 16291293
references: J R Coll Gen Pract. 1986 Jun;36(287):271-3
references: 2945009
references: Spine (Phila Pa 1976). 1983 Mar;8(2):145-50
references: 6222487
references: Ann Rheum Dis. 2003 Jul;62(7):644-50
references: 12810427
references: Spine (Phila Pa 1976). 2006 Mar 15;31(6):658-64
references: 16540870
references: Ann Rheum Dis. 2003 Aug;62(8):755-60
references: 12860731
references: Pain. 1998 Jul;77(1):1-13
references: 9755013
references: J Manipulative Physiol Ther. 2004 Oct;27(8):493-502
references: 15510092
references: Br J Gen Pract. 2000 Jul;50(456):537-41
references: 10954933
references: Br Med J (Clin Res Ed). 1983 Feb 12;286(6364):523-5
references: 6218860
references: J Fam Pract. 1999 Apr;48(4):299-303
references: 10229256
references: J Clin Epidemiol. 2006 Aug;59(8):765-9
references: 16828667
references: J R Coll Gen Pract. 1981 Apr;31(225):209-16
references: 6456338