Advertisement

European Spine Journal

, Volume 23, Issue 1, pp 113–119 | Cite as

Prognosis of chronic low back pain in patients presenting to a private community-based group exercise program

  • Daniel SteffensEmail author
  • Mark J. Hancock
  • Chris G. Maher
  • Jane Latimer
  • Robert Satchell
  • Manuela Ferreira
  • Paulo H. Ferreira
  • Melissa Partington
  • Anna-Louise Bouvier
Original Article

Abstract

Purpose

To examine the prognosis and prognostic factors for patients with chronic low back pain presenting to a private, community-based, group exercise program.

Methods

A total of 118 consecutive patients with chronic LBP were recruited. Baseline assessments included socio-demographic characteristics, back pain history and clinical examination findings. Primary outcome measures were pain intensity and disability at 3, 6 and 12 months. Potential prognostic factors to predict pain intensity and disability at 12 months were assessed using a multivariate regression model.

Results

112 (95 %) participants were followed up at 12 months. The majority of participants were female (73 %), had high educational levels (82 %) and resided in suburbs with a high socio-economic status (99 %). Pain intensity improved markedly during the first 6 months (35 %) with further minimal reductions up to 12 months (39 %). Interestingly, disability improved to a greater degree than pain (48 % improvement at 6 months) and continued to improve throughout the 12 months (60 %). Baseline pain intensity accounted for 10 % of the variance in the 1 year pain outcomes. Duration of current episode, baseline disability and educational level accounted for 15 % of the variation in disability at 12 months.

Conclusions

During a period of 12 months, patients with chronic LBP presenting to a private, community-based, group exercise program improved markedly, with greater improvements in disability than pain. The predictors investigated accounted for only 10 and 15 % of pain and disability outcomes, respectively.

Keywords

Chronic low back pain Prognosis Disability Outcomes 

Notes

Acknowledgments

We thank all staff at the Willoughby and Stadium Physiocise clinics for their valuable assistance and support of this study.

Conflict of interest

None.

References

  1. 1.
    Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, Mannion AF, Reis S, Staal JB, Ursin H, Zanoli G (2006) European guidelines for the management of chronic nonspecific low back pain. Eur Spine J 15:192–300CrossRefGoogle Scholar
  2. 2.
    LdCM Costa, Maher CG, Hancock MJ, McAuley JH, Hebert RD, Costa LOP (2012) The prognosis of acute and persistent low-back pain: a meta-analysis. CMAJ 184(11):E613–E624CrossRefGoogle Scholar
  3. 3.
    Burton AK, McClune TD, Clarke RD, Main CJ (2004) Long-term follow-up of patients with low back pain attending for manipulative care: outcomes and predictors. Man Ther 9(1):30–35PubMedCrossRefGoogle Scholar
  4. 4.
    de Vet HCW, Heymans MW, Dunn KM, Pope DP, van der Beek AJ, Macfarlane GJ, Bouter LM, Croft OR (2002) Episodes of low back pain: a proposal for uniform definitions to be used in research. Spine 27:2409–2416PubMedCrossRefGoogle Scholar
  5. 5.
    Grotle M, Foster NE, Dunn KM, Croft P (2010) Are prognostic indicators for poor outcome different for acute and chronic low back pain consulters in primary care? Pain 151:790–797PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Hayden JA, Dunn KM, van der Windt DA, Shaw WS (2010) What is the prognosis of back pain? Best Pract Res Clin Rheumatol 24(2):167–179PubMedCrossRefGoogle Scholar
  7. 7.
    Hayden JA, Chou R, Hogg-Johnson S, Bombardier C (2009) Systematic reviews of low back pain prognosis had variable methods and results: guidance for future prognosis reviews. J Clin Epidemiol 62:781–796PubMedCrossRefGoogle Scholar
  8. 8.
    Costa Lda C, Maher CG, McAuley JH, Hancock MJ, Herbert RD, Refshauge KM, Henschke N (2009) Prognosis for patients with chronic low back pain: inception cohort study. BMJ 339:b3829PubMedCrossRefGoogle Scholar
  9. 9.
    Melzack R (2001) Pain and the Neuromatrix in the Brain. J Dent Educ 65(12):1378–1382PubMedGoogle Scholar
  10. 10.
    Bouvier AL (2008) Physiocise moviment for life: Backs, brains, breathing. Physiocise, AustraliaGoogle Scholar
  11. 11.
    Bouvier AL, Fleming J (2010) The feel good body: 7 steps to easing aches and looking great. Harper Collins, AustraliaGoogle Scholar
  12. 12.
    Pengel LHM, Refshauge KM, Maher CG (2004) Responsiveness of pain, disability, and physical impairment outcomes in patients with low back pain. Spine 29(8):879–883PubMedCrossRefGoogle Scholar
  13. 13.
    Roland M, Morris R (1983) A study of the natural history of back pain. Part I: development of a reliable and sensitive measure of disability in low-back pain. Spine 8(2):141–144PubMedCrossRefGoogle Scholar
  14. 14.
    Scrimshaw SV, Maher CG (2001) Responsiveness of Visual Analogue and McGill Pain Scale Measures. J Manipulative Physiol Ther 24(8):501–504PubMedCrossRefGoogle Scholar
  15. 15.
    Deyo RA, Battie M, Beurskens AJ, Bombardier C, Croft P, Koes B, Malmivaara A, Roland M, Von Korff M, Waddell G (1998) Outcome measures for low back pain research. A proposal for standardized use. Spine 23(18):2003–2012PubMedCrossRefGoogle Scholar
  16. 16.
    Westaway MD, Stratford PW, Binkley JM (1998) The patient-specific functional scale: validation of lts use in persons with neck dysfunction. J Orthop Sports Phys Ther 27(5):331–338PubMedCrossRefGoogle Scholar
  17. 17.
    Miller RP, Kori S, Todd D (1991) The Tampa Scale: a measure of kinesiophobia. Clin J Pain 7(1):51–52CrossRefGoogle Scholar
  18. 18.
    Harrell FE, Lee KL (1984) Regression modelling strategies for improved prognostic prediction. Stat Med 3:143–152PubMedCrossRefGoogle Scholar
  19. 19.
    van Tulder MW, Koes BW, Metsemakers JFM, Bouter LM (1998) Chronic low back pain in primary care: a prospective study on the management and course. Fam Pract 15:126–132PubMedCrossRefGoogle Scholar
  20. 20.
    Lambeek LC, van Mechelen W, Knol DL, Loisel P, Anema JR (2010) Randomised controlled trial of integrated care to reduce disability from chronic low back pain in working and private life. BMJ 340:c1035PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Guzman J, Esmail R, Karjalainen K, Malmivaara A, Irvin E, Bombardier C (2001) Multidisciplinary rehabilitation for chronic low back pain: systematic review. BMJ 322:1511–1516PubMedCrossRefGoogle Scholar
  22. 22.
    Bekkering GE, Hendriks HJM, van Tulder MW, Knol LD, Simmonds MJ, Oostendorp RAB, Bouter LM (2005) Prognostic factors for low back pain in patients referred for physiotherapy: comparing outcomes and varying modeling techniques. Spine 30:1881–1886PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Daniel Steffens
    • 1
    Email author
  • Mark J. Hancock
    • 2
  • Chris G. Maher
    • 1
  • Jane Latimer
    • 1
  • Robert Satchell
    • 5
  • Manuela Ferreira
    • 1
  • Paulo H. Ferreira
    • 3
  • Melissa Partington
    • 4
  • Anna-Louise Bouvier
    • 4
  1. 1.Musculoskeletal Division, The George Institute for Global HealthUniversity of SydneySydneyAustralia
  2. 2.Discipline of Physiotherapy, Faculty of Human SciencesMacquarie UniversitySydneyAustralia
  3. 3.Discipline of Physiotherapy, Faculty of Health SciencesThe University of SydneySydneyAustralia
  4. 4.Physiocise, Movement for LifeSydneyAustralia
  5. 5.Coast Allied HealthCulburra BeachAustralia

Personalised recommendations