The prognosis of acute low back pain in primary care in the United States: a 2-year prospective cohort study.
The prognosis of acute low back pain in primary care in the United States: a 2-year prospective cohort study.
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DOI：
10.1097/brs.0b013e318230ab20
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发表时间：
2012-04-15
期刊：
影响因子：
3
通讯作者：
Avins AL
中科院分区：
文献类型：
--
作者：
Mehling WE;Gopisetty V;Bartmess E;Acree M;Pressman A;Goldberg H;Hecht FM;Carey T;Avins AL
Prospective cohort study to assess the prognosis of patients presenting with acute low back pain (LBP) in a primary care setting in the U.S. Practice guidelines for acute LBP based on return-to-work outcomes underestimate the development of chronic pain in the primary care setting. Due to differences in inclusion criteria, chronic pain definitions and national health systems, prognostic cohort studies have reported a wide range of results limiting interpretation and generalization. Current data from carefully designed prognostic studies of acute LBP are lacking for the U.S. primary care system. Members of a large health service organization were enrolled after seeking medical care for acute LBP, with or without sciatica, of up to 30 days duration, with no prior episode in the past 12 months and no history of spine surgery. We conducted phone interviews at baseline, six months and two years. Based on receiver operating characteristic analyses, a combination of global perceived recovery with pain intensity was used as primary outcome for chronic pain. Recurrence and multiple secondary outcomes were assessed to allow for comparison with other studies. 605 patients had an average pain intensity of 5.6 (numeric rating scale 0–10) and disability of 15.8 (Roland Morris scale 0–24). Eight percent had declared sick leave between pain onset and baseline interview. 13% of 521 patients (86% follow-up) suffered from chronic pain at six months and 19% of 443 patients at 2 years. At six months, 54% had experienced at least one LBP recurrence, and 47% in the subsequent 18 months. The prognosis of strictly-defined acute LBP, with or without sciatica, is less favorable than commonly stated in practice guidelines based on failure to return to work. Broad initiatives to develop new means for the primary and secondary prevention of recurrent and chronic LBP are urgently needed.
