title: Absence of low back pain to demarcate an episode: a prospective multicentre study in primary care.
abstract: BACKGROUND
  It has been proposed that an episode of low back pain (LBP) be defined as: "a period of pain in the lower back lasting for more than 24 h preceded and followed by a period of at least 1 month without LBP". Previous studies have tested the definition in the general population and in secondary care populations with distinctly different results. The objectives of this study (in a primary care population) were to investigate the prevalence of 1) the number of consecutive weeks free from bothersome LBP, 2) the prevalence of at least four consecutive weeks free from bothersome LBP at any time during the study period, and 3) the prevalence of at least four consecutive weeks free from bothersome LBP at any time during the study period among subgroups that reported >30 days or ≤30 days of LBP the preceding year.
  
  
  METHODS
  In this prospective multicentre study subjects with LBP (n = 262) were consecutively recruited from chiropractic primary care clinics in Sweden. The number of days with bothersome LBP was collected through weekly automated text messages. The maximum number of weeks in a row without bothersome LBP and the number of periods of at least four consecutive weeks free from bothersome LBP was counted for each individual and analysed as proportions.
  
  
  RESULTS
  Data from 222 recruited subjects were analysed, of which 59 % reported at least one period of four consecutive weeks free from bothersome LBP. The number of consecutive pain free weeks ranged from 82 (at least one) to 31 % (9 or more). In subjects with a total duration of LBP of ≤ 30 days the previous year, 75 % reported a period of 4 consecutive weeks free from bothersome LBP during the study period whereas this was reported by only 48 % of subjects with a total duration of LBP of >30 days the previous year.
  
  
  CONCLUSIONS
  Prevalence of four consecutive pain free weeks is found in the majority of subjects in this population logically reflects duration of LBP within the sample and may be applied on patients in primary care to demarcate a LBP episode.
authors.affiliation: Unit of Intervention and Implementation Research, Karolinska Institutet, Institute of Environmental Medicine, Nobels v 13, S-171 77 Stockholm, Sweden.
authors.forename: Andreas
authors.initials: A
authors.lastname: Eklund
authors.affiliation: Unit of Intervention and Implementation Research, Karolinska Institutet, Institute of Environmental Medicine, Nobels v 13, S-171 77 Stockholm, Sweden.
authors.forename: Irene
authors.initials: I
authors.lastname: Jensen
authors.affiliation: Unit of Intervention and Implementation Research, Karolinska Institutet, Institute of Environmental Medicine, Nobels v 13, S-171 77 Stockholm, Sweden.
authors.forename: Malin
authors.initials: M
authors.lastname: Lohela-Karlsson
authors.affiliation: Research Department, Spine Center of Southern Denmark, Institute for Regional Health Research, Hospital Lillebælt, University of Southern Denmark, Østre Hougvej 55, DK-5500 Middelfart, Denmark.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Leboeuf-Yde
authors.affiliation: Unit of Intervention and Implementation Research, Karolinska Institutet, Institute of Environmental Medicine, Nobels v 13, S-171 77 Stockholm, Sweden ; Research Department, Spine Center of Southern Denmark, Institute for Regional Health Research, Hospital Lillebælt, University of Southern Denmark, Østre Hougvej 55, DK-5500 Middelfart, Denmark.
authors.forename: Iben
authors.initials: I
authors.lastname: Axén
keywords: Absence; Chiropractic; Definition; Demarcation; Episode; LBP; Low back pain; Non-episode; Primary care; Recovery