title: What is the best time point to identify patients at risk of developing persistent low back pain?
abstract: BACKGROUND
  Early identification of patients at risk of developing persistent low back pain (LBP) is crucial.
  
  
  OBJECTIVE
  Aim of this study was to identify in patients with a new episode of LBP the time point at which those at risk of developing persistent LBP can be best identified.
  
  
  METHODS
  Prospective cohort study of 315 patients presenting to a health practitioner with a first episode of acute LBP. Primary outcome measure was functional limitation. Patients were assessed at baseline, three, six, twelve weeks and six months looking at factors of maladaptive cognition as potential predictors. Multivariate logistic regression analysis was performed for all time points.
  
  
  RESULTS
  The best time point to predict the development of persistent LBP at six months was the twelve-week follow-up (sensitivity 78%; overall predictive value 90%). Cognitions assessed at first visit to a health practitioner were not predictive.
  
  
  CONCLUSIONS
  Maladaptive cognitions at twelve weeks appear to be suitable predictors for a transition from acute to persistent LBP. Already three weeks after patients present to a health practitioner with acute LBP cognitions might influence the development of persistent LBP. Therefore, cognitive-behavioral interventions should be considered as early adjuvant LBP treatment in patients at risk of developing persistent LBP.
authors.affiliation: Centre for Health Sciences, School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland Centre for Medical Research, QEII Medical Centre, University of Western Australia, Nedlands, WA, Australia.
authors.forename: Markus
authors.initials: M
authors.lastname: Melloh
authors.affiliation: Department of Work and Organizational Psychology, Institute for Psychology, University of Berne, Berne, Switzerland.
authors.forename: Achim
authors.initials: A
authors.lastname: Elfering
authors.affiliation: Department of Work and Organizational Psychology, Institute for Psychology, University of Berne, Berne, Switzerland.
authors.forename: Anja
authors.initials: A
authors.lastname: Käser
authors.affiliation: Department of Work and Organizational Psychology, Institute for Psychology, University of Berne, Berne, Switzerland.
authors.forename: Cornelia
authors.initials: C
authors.lastname: Rolli Salathé
authors.affiliation: Centre for Health Sciences, School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland.
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Crawford
authors.affiliation: Department of Orthopaedic Surgery, Asklepios Klinikum Uckermark, Schwedt/Oder, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Barz
authors.affiliation: Institute for Evaluative Research in Orthopaedic Surgery, MEM Research Center, University of Berne, Berne, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Zweig
authors.affiliation: Institute for Evaluative Research in Orthopaedic Surgery, MEM Research Center, University of Berne, Berne, Switzerland.
authors.forename: Emin
authors.initials: E
authors.lastname: Aghayev
authors.affiliation: Institute for Evaluative Research in Orthopaedic Surgery, MEM Research Center, University of Berne, Berne, Switzerland.
authors.forename: Christoph
authors.initials: C
authors.lastname: Röder
authors.affiliation: Centre for Musculoskeletal Outcomes Research, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Theis
mesh_terms: D000208:Acute Disease; D000222:Adaptation, Physiological; D000328:Adult; D059350:Chronic Pain / Q000523:psychology*; D003071:Cognition; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017116:Low Back Pain / Q000523:psychology*; D008297:Male; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012680:Sensitivity and Specificity
keywords: Prospective cohort study; maladaptive cognitions; persistent low back pain; predictors; prognosis; risk factors