Prognosis and Course of Disability in Patients With Chronic Nonspecific Low Back Pain

Very little data is available on the course of and predictors for disability in patients with chronic non-specific low back pain (CNSLBP). The authors conducted this study to describe the course and identify clinically important prognostic factors of low-back-pain-specific disability in CNSLBP patients participating in multidisciplinary therapy. A total of 1760 patients with CNSLBP who received multidisciplinary therapy were evaluated for their course and prognostic factors at baseline and at 2, 5 and 12-months follow-up. Recovery was defined as a 30% improvement in low-back-pain-specific disability at follow-up compared to baseline, and an absolute recovery if the score on the Quebec Back Pain Disability Scale (QBPDS) was ≤ 20 points at follow-up. Potential prognostic factors were identified using multivariable logistic regression analysis. Patient-reported disability scores ranged from 51.7 (SD 15.6) at baseline to 31.7 (SD 15.2), 31.1 (SD 18.2) and 29.1 (SD 20.0) on the QBPDS at 2, 5 and 12 months, respectively. The prognostic factors identified for recovery at 5 and 12 months were younger age, high scores on disability, and on the SF-36 (physical and mental component scales) at baseline. In addition, at 5-months follow-up a shorter duration of complaints was a positive predictor, while having no co-morbidity and less pain at baseline were additional predictors at 12-months follow-up. Missing values at 5 and 12-months follow-up were 11.1% and 45.2%, respectively.

They found that following multidisciplinary treatment, the course of disability in patients with CNSPBP continues to decline over a 12-month period. At 5 and 12-months follow-up prognostic factors were identified for a clinically relevant decrease in disability scores on the QBPDS.