Prognostic factors for musculoskeletal pain in primary care: a systematic review.
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.
Mallen
Christian D
CD
Primary Care Musculoskeletal Research Centre, Keele University, Staffordshire. c.d.mallen@cphc.keele.ac.uk
Peat
George
G
Thomas
Elaine
E
Dunn
Kate M
KM
Croft
Peter R
PR
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
J Rehabil Med. 2003 Jul;35(4):168-73
12892242
J Fam Pract. 1988 Nov;27(5):483-9
2973513
J Clin Epidemiol. 1997 Jan;50(1):31-43
9048688
Clin J Pain. 1998 Sep;14(3):209-15
9758070
J Public Health (Oxf). 2004 Sep;26(3):277-84
15454597
Spine (Phila Pa 1976). 2005 Aug 1;30(15):1786-92
16094282
Spine (Phila Pa 1976). 2005 Apr 15;30(8):976-82
15834343
Arthritis Rheum. 2005 Dec 15;53(6):920-30
16342106
Spine (Phila Pa 1976). 1997 Jul 1;22(13):1515-21
9231972
Scand J Rheumatol. 2002;31(4):239-44
12369657
BMJ. 1994 Feb 26;308(6928):577-80
8148683
J Clin Epidemiol. 2000 Sep;53(9):964-72
11004423
Pain. 2006 Feb;120(3):276-85
16426760
Br J Gen Pract. 2003 Jan;53(486):26-30
12564273
Pain. 2003 Jul;104(1-2):303-22
12855341
CMAJ. 2005 Jun 7;172(12):1559-67
15939915
Man Ther. 2004 Feb;9(1):30-5
14723859
BMJ. 1996 Sep 7;313(7057):601-2
8806252
Spine (Phila Pa 1976). 1993 Jun 1;18(7):855-62
8316884
Br Med J. 1966 Jul 9;2(5505):82-4
20791052
Am J Epidemiol. 2004 May 1;159(9):882-90
15105181
Br J Gen Pract. 1992 Nov;42(364):462-4
1472392
Arthritis Rheum. 2004 Apr 15;51(2):168-76
15077256
Health Expect. 2002 Jun;5(2):114-26
12031052
Spine (Phila Pa 1976). 1995 Feb 15;20(4):478-84
7747233
Pain. 2004 Jun;109(3):420-31
15157703
Pain. 1996 May-Jun;65(2-3):197-204
8826507
Br J Gen Pract. 1996 Sep;46(410):519-23
8917870
Scand J Work Environ Health. 2004 Feb;30(1):47-55
15018028
Spine (Phila Pa 1976). 2001 Apr 1;26(7):758-64; discussion 765
11295896
Eur J Pain. 2002;6(3):229-37
12036310
Pain. 1999 Mar;80(1-2):113-9
10204723
Spine (Phila Pa 1976). 2005 Aug 15;30(16):E459-70
16103840
Fam Pract. 1999 Jun;16(3):223-32
10439974
Br J Gen Pract. 2005 Mar;55(512):199-204
15808035
Ann Rheum Dis. 2005 Sep;64(9):1331-6
15708885
BMJ. 2000 Jun 10;320(7249):1574-7
10845965
Spine (Phila Pa 1976). 1995 Mar 15;20(6):722-8
7604349
Spine (Phila Pa 1976). 2000 Jan;25(1):115-20
10647169
Spine (Phila Pa 1976). 2000 May 1;25(9):1148-56
10788861
Rheumatology (Oxford). 2002 May;41(5):503-8
12011372
BMJ. 1999 Jun 19;318(7199):1662-7
10373170
Pain. 2001 May;92(1-2):195-200
11323140
Pain. 2005 Sep;117(1-2):162-70
16099095
Eur J Pain. 2006 Jan;10(1):1-11
16291293
J R Coll Gen Pract. 1986 Jun;36(287):271-3
2945009
Spine (Phila Pa 1976). 1983 Mar;8(2):145-50
6222487
Ann Rheum Dis. 2003 Jul;62(7):644-50
12810427
Spine (Phila Pa 1976). 2006 Mar 15;31(6):658-64
16540870
Ann Rheum Dis. 2003 Aug;62(8):755-60
12860731
Pain. 1998 Jul;77(1):1-13
9755013
J Manipulative Physiol Ther. 2004 Oct;27(8):493-502
15510092
Br J Gen Pract. 2000 Jul;50(456):537-41
10954933
Br Med J (Clin Res Ed). 1983 Feb 12;286(6364):523-5
6218860
J Fam Pract. 1999 Apr;48(4):299-303
10229256
J Clin Epidemiol. 2006 Aug;59(8):765-9
16828667
J R Coll Gen Pract. 1981 Apr;31(225):209-16
6456338