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Prognosis of Low Back Pain in General Practice

This study attempted to identify what factors determined the duration of low back pain (LBP) episodes and recurrence rate in a group of 269 general practice patients. The authors studied a number of variables in their investigation: the duration of LBP before the patient consulted a physician; the type of onset of back pain (sudden or gradual); severity of back pain at initial visit; whether or not the patient had a history of back surgery; whether the patient received physical therapy for LBP symptoms; and the degree of disability from the LBP. The patients were followed for one year after the initial assessment. The study found:

  • "The median time to recovery from the index episode was 7 weeks...70% of patients still had low back pain after 4 weeks, 48% after 8 weeks, 35% after 12 weeks, and at the end of the follow-up year 10% of the patients still had low back pain."
  • Recovery from LBP was complicated by four factors:
  1. A longer history of back pain before the initial visit to a physician.
  2. The presence of sciatica.
  3. "Maximal lumbal flexion" as determined by Schobers test.
  4. Receiving physical therapy. "The results of the present study indicate that patients receiving physical therapy during the first 5 weeks after the initial visit also will take longer to recover from low back pain than those not receiving physical therapy." The study found that "the time to recovery was approximately 4 weeks longer for patients who received physical therapy than for patients who did not receive physical therapy."

The only factor that appeared to influence the rate of relapse was disability as measured by reports of daily functioning. The researchers found that the severity of pain and psychosocial factors were not associated with the patients time to recover. However, other aspects in the patients' history—such as back surgery or chronic LBP—did emerge as risk factors for recurring LBP.

van den Hoogen HJM, Koes BW, Deville W, van Eijk JTM, Bouter LM. The prognosis of low back pain in general practice. Spine 1997;22(13):1515-1521.