Abstract
Background ContextEvidence is lacking on the prognosis and prognostic factors of back-related leg pain and sciatica in patients seeing their primary care physicians. This evidence could guide timely appropriate treatment and referral decisions. PurposeThe present study aims to describe the prognosis and prognostic factors in primary care patients with low back-related leg pain and sciatica. Study DesignThis is a prospective cohort study. Patient SampleThe present study included adults visiting their family doctor with back-related leg pain in the United Kingdom. Outcome MeasuresInformation about pain, function, psychological, and clinical variables, was collected. Good outcome was defined as 30% or more reduction in disability (Roland-Morris Disability Questionnaire). MethodsParticipants completed the questionnaires, underwent clinical assessments, received a magnetic resonance imaging scan, and were followed-up 12 months later. Mixed-effects logistic regression evaluated the prognostic value of six a priori defined variable sets (leg pain duration, pain intensity, neuropathic pain, psychological factors, clinical examination, and imaging variables). A combined model, including variables from all models, examined independent effects. The National Institute for Health Research funded the study. There are no conflicts of interest. ResultsA total of 609 patients were included. At 12 months, 55% of patients improved in both the total sample and the sciatica group. For the whole cohort, longer leg pain duration (odds ratio [OR] 0.41; confidence interval [CI] 0.19–0.90), higher identity score (OR 0.70; CI 0.53–0.93), and patient's belief that the problem will last a long time (OR 0.27; CI 0.13–0.57) were the strongest independent prognostic factors negatively associated with improvement. These last two factors were similarly negatively associated with improvement in the sciatica subgroup. ConclusionsThe present study provides new evidence on the prognosis and prognostic factors of back-related leg pain and sciatica in primary care. Just over half of patients improved at 12 months. Patient's belief of recovery timescale and number of other symptoms attributed to the pain are independent prognostic factors. These factors can be used to inform and direct decisions about timing and intensity of available therapeutic options.
Highlights
Low back pain (LBP) is the leading cause of years lived with disability worldwide [1] and one of the most common reasons for seeking healthcare for musculoskeletal pain [2]
Given the high probability of long-standing pain and disability in nonspecific LBP, and limited potential for diagnostic information to guide clinical decision-making, much research has focused on describing prognosis and identifying prognostic factors [7,8] which supports planning of healthcare resources and can underpin appropriate management decisions
We set out to investigate prognostic factors thought to be associated with long-term outcome in low back-related leg pain and in sciatica and examine their independent effect
Summary
Low back pain (LBP) is the leading cause of years lived with disability worldwide [1] and one of the most common reasons for seeking healthcare for musculoskeletal pain [2]. Knowledge of prognostic factors in LBP seems to have led to better treatment decision-making and improved health and cost outcomes [9] Such evidence is scarce for patients resenting to primary care with back-related leg pain and sciatica [10,11]. Evidence is lacking on the prognosis and prognostic factors of backrelated leg pain and sciatica in patients seeing their primary care physicians. This evidence could guide timely appropriate treatment and referral decisions. PURPOSE: The present study aims to describe the prognosis and prognostic factors in primary care patients with low back-related leg pain and sciatica. EMH: NIHR (Paid directly to institution/employer), pertaining to the submitted work; Grant: HTA NIHR Arthritis Research UK (Paid directly to institution/employer), outside the submitted work
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