Prognosis in patients with recent onset low back pain in Australian primary care: inception cohort study

doi:10.1136/bmj.a171

Published 7 July 2008, doi:10.1136/bmj.a171
Cite this as: BMJ 2008;337:a171

Research

Prognosis in patients with recent onset low back pain in Australian primary care: inception cohort study

Nicholas Henschke, postdoctoral fellow¹^,2, Christopher G Maher, director of division¹^,2, Kathryn M Refshauge, professor², Robert D Herbert, associate professor¹^,2, Robert G Cumming, professor³, Jane Bleasel, rheumatologist⁴, John York, rheumatologist⁴, Anurina Das, research officer², James H McAuley, research manager¹^,2

¹ Musculoskeletal Division, The George Institute for International Health, Sydney, Australia, ² Back Pain Research Group, Faculty of Health Sciences, University of Sydney, ³ School of Public Health, University of Sydney, ⁴ Department of Rheumatology, Royal Prince Alfred Hospital, Sydney

Correspondence to: C G Maher, PO Box M201, Camperdown NSW 2050, Australia cmaher{at}george.org.au

Objective To estimate the one year prognosis and identify prognosticfactors in cases of recent onset low back pain managed in primarycare.

Design Cohort study with one year follow-up.

Setting Primary care clinics in Sydney, Australia.

Participants An inception cohort of 973 consecutive primarycare patients (mean age 43.3, 54.8% men) with non-specific lowback pain of less than two weeks’ duration recruited fromthe clinics of 170 general practitioners, physiotherapists,and chiropractors.

Main outcome measures Participants completed a baseline questionnaireand were contacted six weeks, three months, and 12 months afterthe initial consultation. Recovery was assessed in terms ofreturn to work, return to function, and resolution of pain.The association between potential prognostic factors and timeto recovery was modelled with Cox regression.

Results The follow-up rate over the 12 months was more than97%. Half of those who reduced their work status at baselinehad returned to previous work status within 14 days (95% confidenceinterval 11 to 17 days) and 83% had returned to previous workstatus by three months. Disability (median recovery time 31days, 25 to 37 days) and pain (median 58 days, 52 to 63 days)took much longer to resolve. Only 72% of participants had completelyrecovered 12 months after the baseline consultation. Older age,compensation cases, higher pain intensity, longer duration oflow back pain before consultation, more days of reduced activitybecause of lower back pain before consultation, feelings ofdepression, and a perceived risk of persistence were each associatedwith a longer time to recovery.

Conclusions In this cohort of patients with acute low back painin primary care, prognosis was not as favourable as claimedin clinical practice guidelines. Recovery was slow for mostpatients. Nearly a third of patients did not recover from thepresenting episode within a year.

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