Prognostic occupational factors for persistent low back pain in primary care
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To reduce the socio-economic burden of persistent low back pain (LBP), factors influencing the progression of acute/subacute LBP to the persistent state must be identified at an early stage.
Prospective inception cohort study of patients attending a health practitioner for their first episode of acute/subacute or recurrent LBP. Patients were assessed at baseline addressing occupational, psychological, biomedical and demographic/lifestyle factors and followed up over 6 months. Multivariate logistic regression analysis was performed separately for the variables groups of the four different domains, controlling for age, gender and body mass index. The overall predictive value was calculated for the full regression models of the different domains. Finally, all significant variables from the different domains were combined into a final predictor model.
The final four-predictor model predicted 51 % of variance of persistent LBP and included ‘resigned attitude towards the job’ (OR 1.73; 95 % CI 1.16–2.59), ‘social support at work’ (OR 0.54; 95 % CI 0.32–0.90), ‘functional limitation’ (OR 1.05; 95 % CI 1.01–1.10) and ‘duration of LBP’ (OR 1.04; 95 % CI 1.02–1.06). The accuracy of the model was 83 %, with 92 % of non-persistent and 67 % of persistent LBP patients correctly identified.
In this study of patients with acute/subacute LBP, ‘resigned attitude towards the job’ increased the likelihood of persistent LBP at 6 month. Addressing this factor with workplace interventions has the potential to modify the outcome. In patients experiencing ‘social support at work’, the development of persistent LBP was less likely and might therefore be considered as potential resource for prevention of persistent LBP.
KeywordsBack pain Prognosis Risk factors Resources Occupational Inception cohort
This research was funded by the Wishbone Trust of New Zealand, Wellington; Lottery Health Research, Wellington; the Bruce McMillan Trust, Dunedin; the Dunedin School of Medicine; realHealth International; and the University of Berne. MM was funded by a scholarship awarded by the University of Otago. We gratefully acknowledge Kirsten Stout from the Centre for Musculoskeletal Outcomes Research (CMOR) at Dunedin School of Medicine, University of Otago, for developing and maintaining the documentation and data management system.
Conflict of interest
The authors declare that they have no conflict of interest.
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