Prognosis of acute low back pain: design of a prospective inception cohort study

Nicholas Henschke,Christopher G Maher,Jane Bleasel,John York,James H Mcauley,Robert D Herbert,Kathryn M Refshauge,Robert G Cumming,Anurina Das

doi:10.1186/1471-2474-7-54

Nicholas Henschke, Christopher G Maher + Show 7 more

Open Access

https://doi.org/10.1186/1471-2474-7-54

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Abstract

BackgroundClinical guidelines generally portray acute low back pain as a benign and self-limiting condition. However, evidence about the clinical course of acute low back pain is contradictory and the risk of subsequently developing chronic low back pain remains uncertain. There are few high quality prognosis studies and none that have measured pain, disability and return to work over a 12 month period. This study aims to provide the first estimates of the one year prognosis of acute low back pain (pain of less than 2 weeks duration) in patients consulting primary care practitioners. A secondary aim is to identify factors that are associated with the prognosis of low back pain.Methods/DesignThe study is a prospective inception cohort study. Consecutive patients consulting general medical practitioners, physiotherapists and chiropractors in the Sydney metropolitan region will complete a baseline questionnaire regarding their back pain. Subsequently these patients will be followed up by telephone 6 weeks, 3 months and 12 months after the initial consultation. Patients will be considered to have recovered from the episode of back pain if they have no pain and no limitation of activity, and have returned to pre-injury work status. Life tables will be generated to determine the one year prognosis of acute low back pain. Prognostic factors will be assessed using Cox regression.DiscussionThis study will provide the first estimates of the one year prognosis of acute low back pain in a representative sample of primary care patients.

Highlights

Clinical guidelines generally portray acute low back pain as a benign and self-limiting condition
A common theme is that acute low back pain should be managed in primary care because it is generally benign: recovery tends to be both rapid and complete, and the few cases of serious disease can be readily detected with a clinical assessment [2]
The study will be an inception cohort study. It is part of a larger cohort study which will assess the accuracy of the diagnostic triage for detecting serious spinal pathology in patients presenting with acute low back pain

Summary

Introduction

Clinical guidelines generally portray acute low back pain as a benign and self-limiting condition. This study aims to provide the first estimates of the one year prognosis of acute low back pain (pain of less than 2 weeks duration) in patients consulting primary care practitioners. A common theme is that acute low back pain should be managed in primary care because it is generally benign: recovery tends to be both rapid and complete, and the few cases of serious disease can be readily detected with a clinical assessment [2]. Without a comprehensive understanding of the clinical course of low back pain, clinicians will be unable to provide accurate information to patients regarding their prognosis [5]

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