Prognosis of chronic low back pain: design of an inception cohort study

Luciola Da Cunha Menezes Costa,Anurina Das,Leonardo Op Costa,James H Mcauley,Christopher G Maher,Kathryn M Refshauge,Nicholas Henschke,Robert D Herbert

doi:10.1186/1471-2474-8-11

Luciola Da Cunha Menezes Costa, Anurina Das + Show 6 more

Open Access

https://doi.org/10.1186/1471-2474-8-11

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Abstract

BackgroundAlthough clinical guidelines generally portray chronic low back pain as a condition with a poor prognosis this portrayal is based on studies of potentially unrepresentative survival cohorts. The aim of this study is to describe the prognosis of an inception cohort of people with chronic low back pain presenting for primary care.Methods/DesignThe study will be an inception cohort study with one year follow-up. Participants are drawn from a cohort of consecutive patients presenting with acute low back pain (less than 2 weeks duration) to primary care clinics in Sydney, Australia. Those patients who continue to experience pain at three months, and are therefore classified as having chronic back pain, are invited to participate in the current study. The cohort will be followed up by telephone at baseline, 9 months and 12 months after being diagnosed with chronic low back pain. Recovery from low back pain will be measured by sampling three different outcomes: pain intensity, interference with function due to pain, and work status. Life tables will be generated to determine the one year prognosis of chronic low back pain. Prognostic factors will be assessed using Cox regression.DiscussionThis study will determine the prognosis of chronic non-specific low back pain in a representative cohort of patients sourced from primary care. The results of this study will improve understanding of chronic low back pain, allowing clinicians to provide more accurate prognostic information to their patients.

Highlights

Clinical guidelines generally portray chronic low back pain as a condition with a poor prognosis this portrayal is based on studies of potentially unrepresentative survival cohorts
Clinical guidelines and textbooks typically portray chronic low back pain as a condition with a poor prognosis: they indicate that recovery is unlikely and that most people are troubled by frequent recurrences or exacerbations over time [1]
By sampling incident cases of chronic low back pain from a larger cohort of people with acute low back pain we will be able to study a representative cohort of patients

Summary

Introduction

Clinical guidelines generally portray chronic low back pain as a condition with a poor prognosis this portrayal is based on studies of potentially unrepresentative survival cohorts. Clinical guidelines and textbooks typically portray chronic low back pain as a condition with a poor prognosis: they indicate that recovery is unlikely and that most people are troubled by frequent recurrences or exacerbations over time [1]. This conclusion is based on studies with suboptimal designs[3,4]. Most studies of chronic low back pain follow survival cohorts which sample prevalent cases. A stronger design involves sampling in a representative way from a population that is at risk of developing chronic low back pain and identifying an inception cohort from incident cases

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