The Study: Course and prognosis of older back pain patients in general practice: a prospective cohort study
The Facts:
a. The authors sought to identify the prognostic factors that would cause older patients with back pain not to have recovered after 3 months.
b. This was a prospective study of patients over 55 who saw a general practitioner in the Netherlands.
c. The patients were suffering from a new episode of back pain.
d. At the 3 month point 61% still had not recovered, but importantly only 26% had revisited their provider.
e. There were a number of factors that were prognostic of longer recovery times: a greater duration of the back pain, the severity of the patient’s back pain, a history of back pain, number of comorbidities, the patient’s expectation of non-recovery and a longer time to complete the Up and Go test.
f. “Furthermore, the presence of radiating pain in the leg below the knee was not statistically significant associated with non-recovery in the bivariate regression analysis. But in the multiple regression analysis the absence of radiating pain in the leg below the knee was associated with non-recovery.”
Take Home:
Patients don’t necessarily return to the GP and tell them that they still have back pain so the GP often doesn’t know how well patients are responding. There are a number of factors you should look for which may indicate the patient will not respond quickly.
Reviewer’s Comments:
First, I was somewhat surprised about the information contained in section f above. I quoted it so you could read exactly what the authors had to say. Secondly, for those of you who aren’t familiar with the Up and Go test, it is the time required for the subject to get up from a chair, walk three meters, turn around, walk back and sit down in the chair. On a final note, I do resent the fact that patients over 55 were considered to be “older patients”!
Reviewer: Roger Coleman DC
Reference: Scheele J, Enthoven WT, Bierma-Zeinstra SM, Peul WC, van Tulder MW, Bohnen AM, Berger MY,Koes BW, Luijsterburg PA. Course and prognosis of older back pain patients in general practice: a prospective cohort study. Pain. 2013 Jun;154(6):951-7
Link to Abstract: