Cited by 702Musculoskeletal pain and rehabilitationSpine and Intervertebral Disc PathologyMedical Practices and Rehabilitation

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Psychosocial Predictors of Outcome in Acute and Subchronic Low Back Trouble

Burton, A. Kim, Tillotson, K. Malcolm, Main, Chris J., Hollis, Sally·1995·Spine

DOI 10.1097/00007632-199503150-00014

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Abstract

STUDY DESIGN: A prospective survey of patients seeking primary care for low back pain. Clinical and psychosocial data, available at presentation, were explored for predictors of outcome at 1 year. OBJECTIVES: To determine the relative value of clinical and psychosocial variables for early identification of patients with a poor prognosis. SUMMARY OF BACKGROUND DATA: Current treatment strategies for low back pain have failed to stem the rising levels of disability. Psychosocial factors have been shown to be important determinants of response to therapy in chronic patients, but the contribution from similar data in acute or subchronic patients has not been comprehensively investigated. METHODS: Two hundred fifty-two patients with low back pain, presenting to primary care, underwent a structured clinical interview and completed a battery of psychosocial instruments. Follow-up was done by mail at 1 year; outcome was measured using a back pain disability questionnaire. Predictive relationships were sought between the data at presentation and disability at follow-up. RESULTS: Most patients showed improved disability and pain scores, although more than half had persisting symptoms. Eighteen percent showed significant psychological distress at presentation. Multiple regression analysis showed the level of persisting disability to depend principally on measures in the psychosocial domain; for acute cases outcome is also dependent on the absence or presence of a previous history of low back trouble. Discriminant models successfully allocated typically 76% of cases to recovered/not-recovered groups, largely on the basis of psychosocial factors evident at presentation. CONCLUSIONS: Early identification of psychosocial problems is important in understanding, and hopefully preventing, the progression to chronicity in low back trouble.

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Is the self-reported history accurate in patients with persistent axial pain after a motor vehicle accident?
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“When will I recover?” A national survey on patients’ and physicians’ expectations concerning the recovery time for acute back pain
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Acute Low Back Pain and Primary Care
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“Patients developing chronic low back pain are more affected by psychosocial factors, especially coping strategies than other patients with low back pain [6].”
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Implicit attitude towards pictures of back‐stressing activities in pain‐free subjects and patients with low back pain: an affective priming study
Goubert, L., Crombez, G., Hermans, D., & Vanderstraeten, G. (2003) · European Journal of Pain · doi:10.1016/s1090-3801(02)00054-x · Cited by 30
“Depression has been shown to predict disability better than pain intensity and duration (Rudy et al., 1988), and has also been found to predict disability one year after a new occurrence of low back pain (Burton et al., 1995).”
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The INTERMED questionnaire for predicting return to work after a multidisciplinary rehabilitation program for chronic low back pain
Scerri, M., de Goumoëns, P., Fritsch, C., et al. (2006) · Joint Bone Spine · doi:10.1016/j.jbspin.2005.12.012 · Cited by 30
RESEARCH IN PHYSICAL EDUCATION, SPORT AND HEALTH
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The Relationship between Chronic Pain, Immune Function, Depression, and Health Behaviors
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Employer Attitudes, Training, and Return-to-Work Outcomes: A Pilot Study
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1 Health care providers should use a common language in relation to low back pain patients
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“Although this questionnaire was designed for chronic populations, it has been used to predict the development of chronic pain in patients similar to ours [27].”
Method
Structure-oriented beliefs and disability due to back pain
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Brain Imaging in Fibromyalgia
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“There is some evidence [46, 49] that catastrophizing exerts greater influence on the progression of pain in the acute stage than on treatment outcome in a chronic pain cohort.”
Background
Exercise therapy for chronic low back pain
Hayden, J. A., Cartwright, J., van Tulder, M. W., & Malmivaara, A. V. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009790 · Cited by 33
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A Narrative Review of the Assessment of Depression in Chronic Pain
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BackgroundInfluential
Differences in symptoms, functioning, and quality of life between women on long-term sick-leave with musculoskeletal pain with and without concomitant depression
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“Previous studies on acute or subchronic patients with LBP in primary care have found several factors associated with persistence of symptoms and the progression to chronicity in LBP: high levels of psychological distress (1, 2); dissatisfaction with employment (1, 3); longer duration of symptoms (1, 4); a previous his…”
Background
‘Functional overlay’, and illness behaviour in chronic pain: Distress or malingering? Conceptual difficulties in medico-legal assessment of personal injury claims
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Differences in treatment outcome between subgroups of patients with chronic low back pain using lumbar dynamometry and psychological aspects
Hutten, M. M. R., Hermens, H. J., & Zilvold, G. (2001) · Clinical Rehabilitation · doi:10.1191/026921501680425207 · Cited by 27
Assessment of Psychosocial Factors in Functional Capacity Evaluation of Clients with Chronic Back Pain
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Prevalence of lower back pain and its associations with lifestyle behaviors among college students in Saudi Arabia
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Psychosocial Factors Related to Lower Back Problems in a South African Manganese Industry
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“A positive relationship between fear-avoidance beliefs, cognitive behavioral coping strategies for pain, and chronic pain has been reported in the literature (3,5,18,32,33).”
Background
The Reliability of the Clinical Tests and Questions Recommended in International Guidelines for Low Back Pain
McCarthy, C. J., Gittins, M., Roberts, C., et al. (2007) · Spine · doi:10.1097/01.brs.0000259864.21869.26 · Cited by 26
“These clinicians generally demonstrated fair agreement when testing features of the “nerve root,” “yellow” and “red flag” presentations recommended in international guidelines for the management of LBP and nonspecific LBP.”
BackgroundInfluential
NHG-Standaard Aspecifieke lagerugpijn
Chavannes, A. W., Mens, J. M. A., Koes, B. W., Lubbers, W. J., Ostelo, R., Spinnewijn, W., & Kolnaar, B. G. M. (2009) · Bohn Stafleu van Loghum eBooks · doi:10.1007/978-90-313-6614-9_72 · Cited by 25
Physical Symptoms and Signs and Chronic Pain
Hunter, J. P. (2001) · Clinical Journal of Pain · doi:10.1097/00002508-200112001-00008 · Cited by 25
Risk factors for low back pain outcome: Does it matter when they are measured?
Klyne, D. M., Hall, L., Nicholas, M. K., & Hodges, P. W. (2022) · European Journal of Pain · doi:10.1002/ejp.1911 · Cited by 24
“A diverse range of factors have been studied across sociodemographic (e.g., age, sex, education and employment status) (Burton et al., 1995; Campbell et al., 2013; Pincus et al., 2008), psychological (depression, pain catastrophizing and self- efficacy) (George & Beneciuk, 2015; Jegan et al., 2017;…”
Background
Is the psychosocial profile of people with low back pain seeking care in Danish primary care different from those in secondary care?
Morsø, L., Kent, P. M., Albert, H., & Manniche, C. (2012) · Manual Therapy · doi:10.1016/j.math.2012.07.002 · Cited by 24
“Guidelines also recommend assessment of the psychosocial characteristics of individual LBP patients, as these have been shown to be risk factors for poor outcome regardless of treatment type (Burton et al., 1995; Linton et al., 2000; Vlaeyen and Linton, 2000; van Tulder et al., 2006; Chou et al., 2007; Krismer and van…”
Background
Gender Differences in the Association of Brain Gray Matter and Pain-Related Psychosocial Characteristic
Malfliet, A. (2019) · Pain Physician · doi:10.36076/ppj/2019.22.e191 · Cited by 27
Early maladaptive schemas in Finnish adult chronic male and female pain patients
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Psychological Distress Among Patients With Musculoskeletal Illness in General Practice
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Psychological Distress in Acute Low Back Pain: A Review of Measurement Scales and Levels of Distress Reported in the First 2 Months After Pain Onset
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Patient-Reported Outcomes and Fibromyalgia
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Anxiety and Fear Avoidance Beliefs and Behavior May Be Significant Risk Factors for Chronic Opioid Analgesic Therapy Reliance for Patients with Chronic Pain—Results from a Preliminary Study
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Personality Characteristics of Women with Fibromyalgia and of Women with Chronic Neck, Shoulder, or Low Back Complaints in Terms of Minnesota Multiphasic Personality Inventory and Defense Mechanism Technique Modified
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Lumbar Discography
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Are childhood adversities relevant in patients with chronic low back pain?
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Authors: Burton, A. K., Tillotson, K. M., Main, C. J., & Hollis, S.
Affiliations: University of Huddersfield (GB)
Salford Royal NHS Foundation Trust (GB)
Corresponding author: Tillotson, K. Malcolm
ORCID: Main, Chris J.
Venue: Spine
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 1995-03
Volume: 20
Issue: 6
Pages: 722-728
ISSN: 0362-2436 (ISSN-L)
DOI: 10.1097/00007632-199503150-00014
OpenAlex: W1970664734
Cited by: 700
References: 0
Citations by year: 2026: 4 · 2025: 2 · 2024: 11 · 2023: 9 · 2022: 9 · 2021: 18 · 2020: 13 · 2019: 14 · 2018: 19 · 2017: 13 · 2016: 19 · 2015: 15 · 2014: 22 · 2013: 22 · 2012: 29
FWCI: 15.04
Type: journal article
Language: en
Open access: closed
Locations: Spine (publishedVersion)
PubMed (publishedVersion)
University of Huddersfield Repository (University of Huddersfield) (submittedVersion)
Lancaster EPrints (Lancaster University) (submittedVersion)
Research Explorer (The University of Manchester) (submittedVersion)
Huddersfield Research Portal (University of Huddersfield) (submittedVersion)
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: low back pain, psychosocial factors, prognosis, disability, psychological distress, acute low back pain, outcome prediction, primary care
MeSH terms: Acute Disease, Adult, Chronic Disease, Disability Evaluation, Female, Follow-Up Studies, Humans, Male, Pain Measurement, Prospective Studies, Discriminant Analysis, Low Back Pain

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Psychosocial Predictors of Outcome in Acute and Subchronic Low Back Trouble

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