Estimates of risk of recurrence of low back pain are much higher than previously reported

This post was originally written for the Body in Mind website, however with BiM’s retirement we were asked if it might find a place on NOIjam. Of course, we’re delighted to provide a home for Tatiane’s piece, below.

 

Previous studies demonstrated that the majority of patients with acute LBP will recover from the episode within 12 weeks.1,2 However, some of them may experience a recurrence of low back pain.3,4 Our research group conducted a recent systematic review5 that investigated the risk of recurrence of low back pain in patients who recovered from a previous episode within a year. The results showed that reliable estimates of the risk of a recurrence of low back pain recurrence were not yet available due to the heterogeneity and poor methodological quality of the included studies.5 The review also found little evidence on prognostic factors for recurrence of low back pain.5

Most previous studies6-9 investigating recurrences of low back pain included people who have recovered from an episode of low back pain at different times in the past, and may have recovered for long and varied periods. This may influence recurrence estimates as the clinical course of people who have had a condition for a long time is probably different from those who have recently developed the condition. Previous studies also used different definitions of recurrence or did not report a clear definition,6-8,10,11 and this may have influenced the estimates. In addition, most previous studies did not clearly describe the definition of a previous episode,6-9,12,13 which raises the question whether the participants had actually recovered and were truly at risk for a recurrence.

We decided to conduct a study14 to provide more reliable estimates of the risk of recurrences of low back pain within one year of recovery from a previous episode of low back pain; and to identify prognostic factors for a recurrence of low back pain. This is a prospective cohort study with a total of 250 patients who recovered from an episode of low back pain in the last month. The primary outcome was days to recurrence of an episode of low back pain. Secondary outcomes were: days to recurrence of low back pain severe enough to limit activity moderately, and days to recurrence of low back pain for which healthcare was sought.

The results showed that the estimated risk of a recurrence of low back pain was much higher than previously reported. Within one year, 69% of participants had recurrence of an episode of low back pain, 40% had a recurrence of low back pain severe enough to limit activity moderately and 41% had a recurrence of low back pain for which healthcare was sought. We also found that frequent exposure to awkward postures, longer time sitting (0.5 hours per day), and more than two previous episodes were predictive of recurrence of an episode of low back pain within one year.

The results of this study indicate that after recovery from an episode of low back pain, about 70% of people will experience another low back pain episode within one year. However, many of these episodes appear to be relatively minor as only about 40% of participants reported limiting daily activities or seeking health care.

These results are important for clinicians, to provide better information about the likely risk of recurrences of low back pain. The results also demonstrate the need for effective strategies to prevent low back pain recurrences. The prognostic factors that we have found related to frequent exposure to awkward postures and long sitting periods may be considered potential targets for the development of more effective prevention strategies.

– Tatiane Da Silva

Reference of the study

Recurrence of low back pain is common: a prospective inception cohort study.

da Silva T, Mills K, Brown BT, Pocovi N, de Campos T, Maher C, Hancock MJ.

J Physiother. 2019 Jun 14. pii: S1836-9553(19)30059-1. doi: 10.1016/j.jphys.2019.04.010. [Epub ahead of print]

(Available at Tatiane’s Research Gate page here)

 

About Tati da Silva

Tati is currently a post doctorate student at the Univercidade Cidade de São Paulo, under supervision of prof Leo Costa. Tati has recently completed her PhD on the topic of predicting recovery for acute LBP, and risk of recurrences of LBP. Her PhD was completed at Macquarie University, under supervision of Prof Mark Hancock, with a scholarship from Brazil’s government. Her research interests include prediction of recovery of acute low back pain, understanding the risk of recurrences of LBP, effectiveness of interventions for LBP, and investigating the use of evidence-based practice by clinicians.  Tati will continue her work as a post-doctoral researcher at Universidade Cidade de Sao Paulo (UNICID), Brazil.

 

References

  1. da Cunha Menezes Costa L, Maher CG, Hancock MJ, McAuley JH, Herbert RD, Costa LO. The prognosis of acute and persistent low-back pain: a meta-analysis. CMAJ. 2012;184(11):E613-624.
  2. Henschke N, Maher CG, Refshauge KM, et al. Prognosis in patients with recent onset low back pain in Australian primary care: inception cohort study. BMJ. 2008;337:a171.
  3. Hoy D, Brooks P, Blyth F, Buchbinder R. The Epidemiology of low back pain. Best Pract Res Clin Rheumatol. 2010;24(6):769-781.
  4. Refshauge KM, Maher CG. Low back pain investigations and prognosis: a review. Br J Sports Med. 2006;40(6):494-498.
  5. da Silva T, Mills K, Brown BT, Herbert RD, Maher CG, Hancock MJ. Risk of Recurrence of Low Back Pain: A Systematic Review. J Orthop Sports Phys Ther. 2017;47(5):305-313.
  6. Biering-Sorensen F. A prospective study of low back pain in a general population. I. Occurrence, recurrence and aetiology. Scand J Rehabil Med. 1983;15(2):71-79.
  7. Carey TS, Garrett JM, Jackman A, Hadler N. Recurrence and care seeking after acute back pain: results of a long-term follow-up study. North Carolina Back Pain Project. Med Care. 1999;37(2):157-164.
  8. Cassidy JD, Cote P, Carroll LJ, Kristman V. Incidence and course of low back pain episodes in the general population. Spine (Phila Pa 1976). 2005;30(24):2817-2823.
  9. Stevenson JM, Weber CL, Smith JT, Dumas GA, Albert WJ. A longitudinal study of the development of low back pain in an industrial population. Spine (Phila Pa 1976). 2001;26(12):1370-1377.
  10. Hancock MJ, Maher CM, Petocz P, et al. Risk factors for a recurrence of low back pain. Spine J. 2015;15(11):2360-2368.
  11. Stanton TR, Henschke N, Maher CG, Refshauge KM, Latimer J, McAuley JH. After an episode of acute low back pain, recurrence is unpredictable and not as common as previously thought. Spine (Phila Pa 1976). 2008;33(26):2923-2928.
  12. Soukup MG, Glomsrod B, Lonn JH, Bo K, Larsen S. The effect of a Mensendieck exercise program as secondary prophylaxis for recurrent low back pain. A randomized, controlled trial with 12-month follow-up. Spine (Phila Pa 1976). 1999;24(15):1585-1591; discussion 1592.
  13. Soukup MG, Lonn J, Glomsrod B, Bo K, Larsen S. Exercises and education as secondary prevention for recurrent low back pain. Physiother Res Int. 2001;6(1):27-39.
  14. da Silva T, Mills K, Brown BT, et al. Recurrence of low back pain is common: a prospective inception cohort study. J Physiother. 2019.

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