Acute low back pain: systematic review of its prognosis

Abstract Objectives To describe the course of acute low back pain and sciatica and to identify clinically important prognostic factors for these conditions. Design Systematic review. Data sources Searches of Medline, Embase, Cinahl, and Science Citation Index and iterative searches of bibliographies. Main outcome measures Pain, disability, and return to work. Results 15 studies of variable methodological quality were included. Rapid improvements in pain (mean reduction 58% of initial scores), disability (58%), and return to work (82% of those initially off work) occurred in one month. Further improvement was apparent until about three months. Thereafter levels for pain, disability, and return to work remained almost constant. 73% of patients had at least one recurrence within 12 months. Conclusions People with acute low back pain and associated disability usually improve rapidly within weeks. None the less, pain and disability are typically ongoing, and recurrences are common.

[1]  G. Németh,et al.  Prediction of functional disability, recurrences, and chronicity after 1 year in 180 patients who required sick leave for acute low-back pain. , 2000, Journal of spinal disorders.

[2]  B. Koes,et al.  Clinical Guidelines for the Management of Low Back Pain in Primary Care: An International Comparison , 2001, Spine.

[3]  N. Laird,et al.  Meta-analysis in clinical trials. , 1986, Controlled clinical trials.

[4]  H. Sørensen,et al.  Long-term prognosis of acute low back pain in patients seen in general practice: a 1-year prospective follow-up study. , 1999, Family practice.

[5]  G. Waddell,et al.  Occupational health guidelines for the management of low back pain at work: evidence review. , 2001, Occupational medicine.

[6]  A. Yassi,et al.  Effect of an Early Intervention Program on the Relationship Between Subjective Pain and Disability Measures in Nurses With Low Back Injury , 1996, Spine.

[7]  L. Haugh,et al.  A controlled trial of an educational pamphlet to prevent disability after occupational low back injury. , 2000, Spine.

[8]  Douglas G Altman,et al.  Systematic reviews of evaluations of prognostic variables , 2001, BMJ : British Medical Journal.

[9]  M. Stokes,et al.  Evidence of lumbar multifidus muscle wasting ipsilateral to symptoms in patients with acute/subacute low back pain. , 1994, Spine.

[10]  A. W. Chavannes,et al.  A Randomized Trial of Exercise Therapy in Patients With Acute Low Back Pain: Efficacy on Sickness Absence , 1995, Spine.

[11]  L. Fillion,et al.  Biopsychosocial Determinants of Chronic Disability and Low-Back Pain: A Review , 2000, Journal of Occupational Rehabilitation.

[12]  C. Richardson,et al.  Long-Term Effects of Specific Stabilizing Exercises for First-Episode Low Back Pain , 2001, Spine.

[13]  R. Newcombe.  Two-sided confidence intervals for the single proportion: comparison of seven methods. , 1998, Statistics in medicine.

[14]  W. Sauerbrei,et al.  Dangers of using "optimal" cutpoints in the evaluation of prognostic factors. , 1994, Journal of the National Cancer Institute.

[15]  R. Gatchel,et al.  Psychosocial issues: their importance in predicting disability, response to treatment, and search for compensation. , 1999, Neurologic clinics.

[16]  W. Fordyce,et al.  Acute back pain: a control-group comparison of behavioral vs traditional management methods. , 1986 .

[17]  A. Field,et al.  A Systematic Review of Psychological Factors as Predictors of Chronicity/Disability in Prospective Cohorts of Low Back Pain , 2002, Spine.

[18]  R. Bunch.  A randomized, placebo-controlled trial of exercise therapy in patients with acute low back pain. , 1994, Spine.

[19]  J. McGavin,et al.  Effects of spinal flexion and extension exercises and their associated postures in patients with acute low back pain. , 1996, Spine.

[20]  L. Haugh,et al.  Early Prediction of Chronic Disability After Occupational Low Back Injury , 1996, Spine.

[21]  É. Legrand,et al.  Bed Rest or Normal Activity for Patients With Acute Low Back Pain: A Randomized Controlled Trial , 2002, Spine.

[22]  G. Pransky,et al.  Early prognosis for low back disability: intervention strategies for health care providers. , 2001, Disability and rehabilitation.

[23]  G. Németh,et al.  Conservative treatment in patients sick-listed for acute low-back pain: a prospective randomised study with 12 months’ follow-up , 1998, European Spine Journal.

[24]  A Yassi,et al.  Predictors of time loss after back injury in nurses. , 1999, Spine.

[25]  L. Klenerman,et al.  The Prediction of Chronicity in Patients With an Acute Attack of Low Back Pain in a General Practice Setting , 1995, Spine.

[26]  S. Linton.  Occupational Psychological Factors Increase the Risk for Back Pain: A Systematic Review , 2001, Journal of Occupational Rehabilitation.

[27]  J. Coste,et al.  Clinical course and prognostic factors in acute low back pain: an inception cohort study in primary care practice , 1994, BMJ.

[28]  L M Bouter,et al.  Method guidelines for systematic reviews in the Cochrane Collaboration Back Review Group for Spinal Disorders. , 1997, Spine.

[29]  I. Holme,et al.  The natural course of acute sciatica with nerve root symptoms in a double-blind placebo-controlled trial evaluating the effect of piroxicam. , 1993, Spine.

[30]  J. Vlaeyen,et al.  Pain‐related fear in acute low back pain: the first two weeks of a new episode , 2002, European journal of pain.