Early predictors of the long-term outcome of low back pain--results of a 22-year prospective cohort study.
BACKGROUND
poor outcome of low back pain in patients seen in general practice is related to the pain history, physical impairment and working conditions, at least in short-term follow-ups. We do not know if these findings hold, seen from the perspective of decades.


OBJECTIVE
to show if patients consulting the GP for the first time regarding an episode of low back pain have excess poor outcome 22 years later and, if so, whether the best predictors are data based on the symptoms, clinical signs or work history. The design of the study is a 22-year follow-up of an inception cohort of 78 patients with low back pain. The setting of the study is a single general practice in a suburb of Copenhagen, Denmark.


METHODS
selected predictors were separated into pain characteristics, clinical signs and indicators related to the work history. Outcome measures were the 1-year period prevalence of low back pain, use of painkillers for low back pain, use of health care providers, impairments due to low back pain and unfitness for work caused by low back pain. The influence of the predictors was assessed by relative risks.


RESULTS
after 22 years, four out of five patients still experienced low back pain. The perception of poor working conditions correlates with recurrent low back pain, intake of painkillers and limitations to daily life.


CONCLUSIONS
compared with pain history and clinical findings, the perception of workload is a better predictor of the long-term outcome of low back pain.
Lønnberg
F
F
The Research Unit for General Practice, Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark. f.lonnberg@gpmed.ku.dk
Pedersen
P A
PA
Siersma
V
V
D005260:Female; D005500:Follow-Up Studies; D058006:General Practice; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D005082:Physical Exertion; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D014937:Work; D016526:Workload