Prognosis in Patients with Recent Onset Low Back Pain in Australian Primary Care: Inception Cohort Study

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British Medical Journal 2008 (Jul 7); 337: a171

Henschke N, Maher CG, Refshauge KM, Herbert RD,
Cumming RG, Bleasel J, York J, Das A, McAuley JH.

Musculoskeletal Division,
The George Institute for International Health,
Sydney, Australia.

This BMJ study contradicts previous Clinical Practice Guidelines that suggest that recovery from an episode of recent onset low back pain is usually rapid and complete. Their findings with 973 consecutive primary care patients was that recovery was slow for most patients, and almost 1/3 of patients did not recover within one year (when following standard medical recommendations).

OBJECTIVE:   To estimate the one year prognosis and identify prognostic factors in cases of recent onset low back pain managed in primary care.

DESIGN:   Cohort study with one year follow-up.

SETTING:   Primary care clinics in Sydney, Australia.

PARTICIPANTS:   An inception cohort of 973 consecutive primary care patients (mean age 43.3, 54.8% men) with non-specific low back pain of less than two weeks’ duration recruited from the clinics of 170 general practitioners, physiotherapists, and chiropractors.

MAIN OUTCOME MEASURES:   Participants completed a baseline questionnaire and were contacted six weeks, three months, and 12 months after the initial consultation. Recovery was assessed in terms of return to work, return to function, and resolution of pain. The association between potential prognostic factors and time to recovery was modelled with Cox regression.

RESULTS:   The follow-up rate over the 12 months was more than 97%. Half of those who reduced their work status at baseline had returned to previous work status within 14 days (95% confidence interval 11 to 17 days) and 83% had returned to previous work status by three months. Disability (median recovery time 31 days, 25 to 37 days) and pain (median 58 days, 52 to 63 days) took much longer to resolve. Only 72% of participants had completely recovered 12 months after the baseline consultation. Older age, compensation cases, higher pain intensity, longer duration of low back pain before consultation, more days of reduced activity because of lower back pain before consultation, feelings of depression, and a perceived risk of persistence were each associated with a longer time to recovery.

CONCLUSIONS:   In this cohort of patients with acute low back pain in primary care, prognosis was not as favourable as claimed in clinical practice guidelines. Recovery was slow for most patients. Nearly a third of patients did not recover from the presenting episode within a year.


From the FULL TEXT Article


On any given day 12-33% of people report low back pain. [1] The costs of treatment are enormous: in Australia, a country of 21 million people, the treatments costs are about $A1bn (£0.5bn, €0.6bn, $0.9bn) a year. [2]

There is evidence that the type of advice given to patients can alter the course of an episode of low back pain. [3, 4] For this reason, most management guidelines recommend that patients should be reassured that they have a favourable prognosis. This recommendation is commonly supported with the statement that 90% of patients recover within six weeks. [5, 6] Such statements, however, might be too optimistic. While patients typically improve rapidly, the risk of developing chronic low back pain (that is, pain persisting for more than three months) is uncertain. [7, 8, 9] Estimates of this risk vary from 2% [10] to 56%. [11]

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