title: Prognostic occupational factors for persistent low back pain in primary care.
abstract: OBJECTIVE
  To reduce the socio-economic burden of persistent low back pain (LBP), factors influencing the progression of acute/subacute LBP to the persistent state must be identified at an early stage.
  
  
  METHODS
  Prospective inception cohort study of patients attending a health practitioner for their first episode of acute/subacute or recurrent LBP. Patients were assessed at baseline addressing occupational, psychological, biomedical and demographic/lifestyle factors and followed up over 6 months. Multivariate logistic regression analysis was performed separately for the variables groups of the four different domains, controlling for age, gender and body mass index. The overall predictive value was calculated for the full regression models of the different domains. Finally, all significant variables from the different domains were combined into a final predictor model.
  
  
  RESULTS
  The final four-predictor model predicted 51 % of variance of persistent LBP and included 'resigned attitude towards the job' (OR 1.73; 95 % CI 1.16-2.59), 'social support at work' (OR 0.54; 95 % CI 0.32-0.90), 'functional limitation' (OR 1.05; 95 % CI 1.01-1.10) and 'duration of LBP' (OR 1.04; 95 % CI 1.02-1.06). The accuracy of the model was 83 %, with 92 % of non-persistent and 67 % of persistent LBP patients correctly identified.
  
  
  CONCLUSIONS
  In this study of patients with acute/subacute LBP, 'resigned attitude towards the job' increased the likelihood of persistent LBP at 6 month. Addressing this factor with workplace interventions has the potential to modify the outcome. In patients experiencing 'social support at work', the development of persistent LBP was less likely and might therefore be considered as potential resource for prevention of persistent LBP.
authors.affiliation: University of Western Australia, Western Australian Institute for Medical Research, Nedlands, WA, Australia. markus.melloh@uwa.edu.au
authors.forename: Markus
authors.initials: M
authors.lastname: Melloh
authors.forename: Achim
authors.initials: A
authors.lastname: Elfering
authors.forename: Cathy M
authors.initials: CM
authors.lastname: Chapple
authors.forename: Anja
authors.initials: A
authors.lastname: Käser
authors.forename: Cornelia
authors.initials: C
authors.lastname: Rolli Salathé
authors.forename: Thomas
authors.initials: T
authors.lastname: Barz
authors.forename: Christoph
authors.initials: C
authors.lastname: Röder
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Theis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001290:Attitude; D015331:Cohort Studies; D005260:Female; D015438:Health Behavior; D006304:Health Status; D006801:Humans; D007588:Job Satisfaction; D008019:Life Style; D017116:Low Back Pain / Q000453:epidemiology* / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000453:epidemiology* / Q000523:psychology*; D016272:Occupational Health; D009790:Occupations / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011379:Prognosis; D012944:Social Support; D012959:Socioeconomic Factors; D055815:Young Adult