Personal, Psychosocial, and Occupational Resources for Preventing Persistent Low Back Pain in Primary Care

Abstract

Introduction Socioeconomic costs of persistent low back pain (LBP) exceed the costs of acute and subacute LBP by far. This makes the early identification of modifiable factors of the progression of acute/subacute LBP essential to the persistent state. Modifiable protective factors could be addressed proactively, for example, in workplace interventions, to limit the associated socioeconomic burden. Aim of our study was to identify modifiable protective factors against the progression of acute/subacute LBP to the persistent state. Materials and Methods Prospective cohort study of patients attending a health practitioner for their first episode of acute/subacute LBP. Patients were assessed at baseline addressing occupational, psychological, biomedical and demographic lifestyle factors and followed up over 12 weeks according to the recommendations from the Multinational Musculoskeletal Inception Cohort Study (MMICS) Statement. We completed Pearson correlations between these baseline factors and the presence of nonpersistent LBP at 12-week follow-up. For those factors found to be significant, multivariate logistic regression analyses were performed. Results The final two predictor model (χ2 = 34.7, df = 7, p < 0.001) included “social support” (OR 1.78; 95% CI, 1.20–2.66) and “mental health” (OR 1.06; 95% CI, 1.02–1.10). All factors and control variables predicted 24% variance in nonpersistent LBP. The accuracy of the model was 72%, with 81% (sensitivity) of nonpersistent and 60% (specificity) of persistent LBP patients correctly identified. Conclusion In this study of patients with acute/subacute LBP from a primary care setting, good “social support” reduced the likelihood of persistent LBP at 12 weeks. Findings from this study confirm the importance of personal and psychosocial resources for preventing the development of persistent LBP. Resources, easily identified with use of widely available screening tools, will facilitate the provision of necessary strategies to reduce the societal and financial burden of persistent LBP. The benefit of including modifiable protective factors such as “social support” in screening tools is that these factors can be addressed in primary and secondary prevention, for example, in workplace intervention. Further research is required to confirm the role of different types of “social support” and “social support at work” regarding their prognostic influence on the development of persistent LBP. I confirm having declared any potential conflict of interest for all authors listed on this abstract Yes Disclosure of Interest None declared