Cited by 701Musculoskeletal pain and rehabilitationSpine and Intervertebral Disc PathologyMedical Practices and Rehabilitation

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Will This Patient Develop Persistent Disabling Low Back Pain?

Chou, Roger·2010·JAMA

DOI 10.1001/jama.2010.344

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Abstract

CONTEXT: Low back pain is extremely common. Early identification of patients more likely to develop persistent disabling symptoms could help guide decisions regarding follow-up and management. OBJECTIVE: To systematically review the usefulness of individual risk factors or risk prediction instruments for identifying patients more likely to develop persistent disabling low back pain. DATA SOURCES: Electronic searches of MEDLINE (1966-January 2010) and EMBASE (1974-February 2010) and review of the bibliographies of retrieved articles. STUDY SELECTION: Prospective studies of patients with fewer than 8 weeks of low back pain from which likelihood ratios (LRs) were calculated for prediction of persistent disabling low back pain for findings attainable during the clinical evaluation. DATA EXTRACTION: Two authors independently assessed studies and extracted data to estimate LRs. DATA SYNTHESIS: A total of 20 studies evaluating 10,842 patients were identified. Presence of nonorganic signs (median [range] LR, 3.0 [1.7-4.6]), high levels of maladaptive pain coping behaviors (median [range] LR, 2.5 [2.2-2.8]), high baseline functional impairment (median [range] LR, 2.1 [1.2-2.7]), presence of psychiatric comorbidities (median [range] LR, 2.2 [1.9-2.3]), and low general health status (median [range] LR, 1.8 [1.1-2.0]) were the most useful predictors of worse outcomes at 1 year. Low levels of fear avoidance (median [range] LR, 0.39 [0.38-0.40]) and low baseline functional impairment (median [range] LR, 0.40 [0.10-0.52]) were the most useful items for predicting recovery at 1 year. Results were similar for outcomes at 3 to 6 months. Variables related to the work environment, baseline pain, and presence of radiculopathy were less useful for predicting worse outcomes (median LRs approximately 1.5), and a history of prior low back pain episodes and demographic variables were not useful (median LRs approximately 1.0). Several risk prediction instruments were useful for predicting outcomes, but none were extensively validated, and some validation studies showed LRs similar to estimates for individual risk factors. CONCLUSION: The most helpful components for predicting persistent disabling low back pain were maladaptive pain coping behaviors, nonorganic signs, functional impairment, general health status, and presence of psychiatric comorbidities.

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Authors: Chou, R.
Affiliations: Oregon Health & Science University (US)
Corresponding author: Chou, Roger
ORCID: Chou, Roger
Venue: JAMA
Publisher: American Medical Association (AMA)
Published: 2010-04-07
Volume: 303
Issue: 13
Pages: 1295
ISSN: 0002-9955 (ISSN-L)
0098-7484
DOI: 10.1001/jama.2010.344
OpenAlex: W2089574135
Cited by: 701
References: 50
Citations by year: 2026: 17 · 2025: 35 · 2024: 49 · 2023: 38 · 2022: 57 · 2021: 42 · 2020: 44 · 2019: 35 · 2018: 43 · 2017: 40 · 2016: 51 · 2015: 53 · 2014: 54 · 2013: 43 · 2012: 43
FWCI: 33.33
Type: journal article
Language: en
Open access: closed
Locations: JAMA (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Orthopedics and Sports Medicine › Spine and Intervertebral Disc Pathology
Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
Keywords: risk prediction, risk factors, likelihood ratios, functional disability, health status, psychiatric comorbidity, fear avoidance, recovery prediction, radiculopathy, work environment, pain catastrophizing, pain-related worry, pain-related hopelessness
MeSH terms: Adaptation, Psychological, Adult, Aged, Mental Disorders, Chronic Disease, Female, Health Status, Humans, Male, Middle Aged, Prognosis, Prospective Studies, Risk Factors, Comorbidity, Low Back Pain

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Will This Patient Develop Persistent Disabling Low Back Pain?

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