title: Prognostic indicators of low back pain in primary care: five-year prospective study.
abstract: Back pain is common and many people experience long-term problems, yet little is known about what prognostic factors predict long-term outcomes. This study's objective was to determine which factors predict short- and long-term outcomes in primary care consulters with low back pain (LBP). Analysis was carried out on 488 patients who had consulted their physician about LBP. Patients were followed up at 6 months and 5 years. Clinically significant LBP at follow-up was defined as a score of 2, 3, or 4 on the Chronic Pain Grade, indicating substantial pain and disability. Cox regression was used to estimate relative risks (RRs) with 95% confidence intervals (CIs) on 32 potential predictive factors, organized into domains (demographic, physical, psychological, and occupational). Baseline pain intensity conferred a 12% increase in risk (RR = 1.12, 95% CI = 1.03-1.20), and patients' belief that their LBP would persist conferred a 4% increase in risk (RR = 1.04, 95% CI = 1.01-1.07) for poor outcome at 6 months. Outcome at 5 years was best predicted by a model with the same factors as in the 6-month model: pain intensity increased risk by 9% (RR = 1.09, 95% CI = .997-1.20), and a belief that their LBP would persist increased risk by 6% (RR = 1.06, 95% CI = 1.03-1.09). Both predictors have the potential to be targets for clinical intervention.
  
  
  CONCLUSIONS
  Few studies have investigated factors that predict long-term back pain. This study has shown that pain intensity experienced during a period of primary care consultation, and patients' perception about whether their back pain will persist, were significant predictors of poor outcome at 6 months and at 5 years.
authors.affiliation: Arthritis Research UK Primary Care Centre, Keele University, Keele, Staffordshire, UK. p.campbell@keele.ac.uk
authors.forename: Paul
authors.initials: P
authors.lastname: Campbell
authors.forename: Nadine E
authors.initials: NE
authors.lastname: Foster
authors.forename: Elaine
authors.initials: E
authors.lastname: Thomas
authors.forename: Kate M
authors.initials: KM
authors.lastname: Dunn
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D017116:Low Back Pain / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009790:Occupations; D017063:Outcome Assessment, Health Care; D010147:Pain Measurement; D011237:Predictive Value of Tests; D011320:Primary Health Care; D011379:Prognosis; D011581:Psychological Tests; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult
keywords: Prognosis; cohort; longitudinal; low back pain; prospective