Predictors of disability in low back pain

January 01, 0001

Predictors of disability in low back pain

Low back pain is common and can be disabling. These US authors examine what characteristics are associated with the development of persistent disabling symptoms. They performed a systematic review using MEDLINE (1966-January 2010) and EMBASE (1974-February 2010) plus reviewed the bibliographies of retrieved articles. They included prospective studies of patients with early back pain (less than eight weeks) and calculated likelihood ratios (LRs) for prediction of persistent disabling low back pain with various clinical exam findings.

The researchers report: "A total of 20 studies evaluating 10,842 patients were identified. Presence of nonorganic signs (median LR, 3.0), high levels of maladaptive pain coping behaviors (median LR, 2.5), high baseline functional impairment (median LR, 2.1), presence of psychiatric comorbidities (median, 2.2), and low general health status (median LR, 1.8) were the most useful predictors of worse outcomes at 1 year. Low levels of fear avoidance (median LR, 0.39) and low baseline functional impairment (median LR, 0.40) were the most useful items for predicting recovery at 1 year. Results were similar for outcomes at 3 to 6 months. Variables related to the work environment, baseline pain, and presence of radiculopathy were less useful for predicting worse outcomes (median LRs approximately 1.5), and a history of prior low back pain episodes and demographic variables were not useful (median LRs approximately 1.0). Several risk prediction instruments were useful for predicting outcomes, but none were extensively validated, and some validation studies showed LRs similar to estimates for individual risk factors."

The authors concluded: "The most helpful components for predicting persistent disabling low back pain were maladaptive pain coping behaviors, nonorganic signs, functional impairment, general health status, and presence of psychiatric comorbidities."

This study lays down some important groundwork, but further study is needed to elucidate interventions to reduce disability in at risk patients.


For the full abstract, click here.

JAMA 303(13):1295-1302, 7 April 2010 © 2010 American Medical Association
Will This Patient Develop Persistent Disabling Low Back Pain? Roger Chou, Paul Shekelle.

Category: M. Musculoskeletal. Keywords: low back pain, disability, predictors, functional impairment, non- organic signs, systematic review, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 30 April 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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