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Predicting the transition from acute to persistent low back pain

Melloh, M. ; Elfering, A. ; Egli Presland, C. ; Röder, C. ; Hendrick, P. ; Darlow, B. ; Theis, J.-C

In: Occupational Medicine, 2011, vol. 61, no. 2, p. 127-131

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    Title
    • Predicting the transition from acute to persistent low back pain
    Author
    • Melloh, M.. Department of Orthopaedic Surgery, Dunedin School of Medicine, University of Otago, Private Bag 1921, Dunedin 9054, New Zealand
    • Elfering, A.. Department of Work and Organizational Psychology, Institute for Psychology, University of Berne, Uni Tobler, Muesmattstrasse 45, 3000 Berne 9, Switzerland
    • Egli Presland, C.. Department of Work and Organizational Psychology, Institute for Psychology, University of Berne, Uni Tobler, Muesmattstrasse 45, 3000 Berne 9, Switzerland
    • Röder, C.. Institute for Evaluative Research in Medicine, MEM Research Center, University of Berne, Stauffacherstrasse 78, 3014 Berne, Switzerland
    • Hendrick, P.. School of Physiotherapy, University of Otago, PO Box 56, Dunedin 9054, New Zealand
    • Darlow, B.. School of Physiotherapy, University of Otago, PO Box 56, Dunedin 9054, New Zealand
    • Theis, J.-C. Department of Orthopaedic Surgery, Dunedin School of Medicine, University of Otago, Private Bag 1921, Dunedin 9054, New Zealand
    Document Type
    • Postprint
    Language
    • English
    Published in
    • Occupational Medicine, 2011, vol. 61, no. 2, p. 127-131. Oxford University Press
    Other Version
    OAI-PMH Identifier
    • oai:doc.rero.ch:292869
    Summary
    Background Most people experience low back pain (LBP) at least once in their lifetime. Only a minority of them go on to develop persistent LBP. However, the socioeconomic costs of persistent LBP significantly exceed the costs of the initial acute LBP episode. Aims To identify factors that influence the progression of acute LBP to the persistent state at an early stage. Methods Prospective inception cohort study of patients attending a health practitioner for their first episode of acute LBP or recurrent LBP after a pain free period of at least 6 months. Patients were assessed at baseline addressing occupational and psychological factors as well as pain, disability, quality of life and physical activity and followed up at 3, 6, 12 weeks and 6 months. Variables were combined to the three indices ‘working condition', ‘depression and maladaptive cognitions' and ‘pain and quality of life'. Results The index ‘depression and maladaptive cognitions' was found to be a significant baseline predictor for persistent LBP up to 6 months (OR 5.1; 95% CI: 1.04-25.1). Overall predictive accuracy of the model was 81%. Conclusions In this study of patients with acute LBP in a primary care setting psychological factors at baseline correlated with a progression to persistent LBP up to 6 months. The benefit of including factors such as ‘depression and maladaptive cognition' in screening tools is that these factors can be addressed in primary and secondary prevention