Return to Work as a Measure of Outcomes for Low Back PainIn this study, researchers from two large health care organizations predict prognosis for patients with acute low back pain based on return to work. This is a new way to look at recovery as most other studies use pain and function as the main measures of outcome for recovery.
Over 600 people participated in the study. Each one had an episode of acute low back pain (with or without sciatica/leg pain) in the last 30 days. They were later contacted by phone (six months later and again two years later) to ask about their experience. As part of the survey, they reported their work status (full-time, part-time, unemployed and seeking work, not seeking work, retired).
Other data collected for review and study included how long the back pain lasted, level of pain intensity, and number of days in bed and/or off work. Each individual was also asked to rate their recovery as they viewed it on a scale from much worse to fully recovered.
To give you an idea of how many people suffer an episode of back pain -- in one year's time, 42,650 people were seen at this health care facility for low back pain. The 600 patients in this study volunteered to participate and also met a series of additional requirements in order to be included. Everyone in the study was given usual care consisting of spinal manipulation, acupuncture, yoga, exercises, massage, or physical therapy.
Analysis of the data showed that prognosis when based on whether or not the person returned to work was much less favorable than when using other measures (e.g., pain, disability). Instead of the previously reported 10 per cent of patients who went from having acute low back pain to chronic pain, 13 per cent had chronic pain at six months and even more (19 per cent) had chronic low back pain at the end of two years.
Many of the remaining patients who did return to work did so with continued pain and physical limitations. Forty-one per cent (41%) reported having to change positions often just to get comfortable while 31 per cent tried to avoid bending or kneeling down. Other activities that posed problems for the group included turning over, walking quickly, getting up from a chair, or using stairs without a handrail.
In observing the results of the data, the authors make several other comments. First, there were quite a few people who were up and down with their back pain. Almost half of the group (47 per cent) had some additional recurrences of low back pain during the six months following their first episode. Second, patients with low back pain and sciatica (leg pain) were more likely to have a poor outcome. And third, results vary depending on the exact wording used to define acute and chronic low back pain.
Our knowledge of back pain, its natural consequence, and prognosis depend on research results. The authors suggest future understanding of this common problem is going to depend on finding some common ground to use when conducting studies. Right now, there is no consensus (agreement) and no consistent use of measures for outcomes, definitions of acute versus low back pain, or inclusion/exclusion criteria for patients participating in studies.
The problems of going back to work while still in pain and continuing to work despite symptoms and disability need to be addressed. The fact that people often still have back pain six months after the first episode and that increases the risk of developing chronic back pain also needs attention. Efforts are needed to find ways to prevent back pain, recurrent back pain, and chronic back pain.
Wolf E. Mehling, MD, et al. The Prognosis of Acute Low Back Pain in Primary Care in the United States. In Spine. April 15, 2012. Vol. 37. No. 8. Pp. 678-684.
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