A review and proposal for a core set of factors for prospective cohorts in low back pain: a consensus statement. The impact of specialist care for low back pain on health service utilization in primary care patients: A prospective cohort study Discographic, MRI and psychosocial determinants of low back pain disability and remission: a prospective study in subjects with benign persistent back pain. Low back pain in general practice: cost-effectiveness of a minimal psychosocial intervention versus usual care Low back pain in Australian adults. health provider utilization and care seeking. How does the self-reported clinical management of patients with low back pain relate to the attitudes and beliefs of health care practitioners? A survey of UK general practitioners and physiotherapists Psychosocial, musculoskeletal and somatoform comorbidity in patients with chronic low back pain: original results from the Dutch Transition Project. Prevention of Low Back Pain in Female Eldercare Workers: Randomized Controlled Work Site Trial Biomechanical constraints remain major risk factors for low back pain. Results from a prospective cohort study in French male employees. Stay@Work: Participatory Ergonomics to prevent low back and neck pain among workers: design of a randomised controlled trial to evaluate the (cost-)effectiveness Potential Risk Factors of Persistent Low Back Pain Developing from Mild Low Back Pain in Urban Japanese Workers A 2-year prospective longitudinal study on low back pain in primary school children Assessment of psychosocial risk factors for the development of non-specific chronic disabling low back pain in Japanese workers—findings from the Japan Epidemiological Research of Occupation-related Back Pain (JOB) study Predictors of Outcome in Patients With (Sub)Acute Low Back Pain Differ Across Treatment Groups Cost-effectiveness of a multifaceted implementation strategy for the Dutch multidisciplinary guideline for nonspecific low back pain: design of a stepped-wedge cluster randomised controlled trial Effect of a multidisciplinary program for the prevention of low back pain in hospital employees: a randomized controlled trial. Effect of Low Back Pain Risk-Stratification Strategy on Patient Outcomes and Care Processes: the MATCH Randomized Trial in Primary Care Occupational, Personal and Psychosocial Resources for Preventing Persistent Low Back Pain Why is a treatment aimed at psychosocial factors not effective in patients with (sub)acute low back pain? Is chronic non-specific low back pain chronic? Definitions of a problem and problems of a definition. Beliefs About Low Back Pain in the Norwegian General Population: Are They Related to Pain Experiences and Health Professionals? Pain location matters: the impact of leg pain on health care use, work disability and quality of life in patients with low back pain Individualized chiropractic and integrative care for low back pain: the design of a randomized clinical trial using a mixed-methods approach
Introduction The Multinational Musculoskeletal Inception Cohort Study ( MMICS ) Statement is a consensus statement aim ed at improving the quality of prospect i ve investigations into the transition from early stages of low back pain ( LBP ) to persistent problems . The statement aims to help improve the quality of such studies by recommending an agreed minimal list of measures for inclusion in baseline data collection . The MMICS Statement is primarily aim ed at research ers who want to investigate prognosis in LBP , and this will allow data from cohorts to be pooled and will facilitate comparisons between different health care systems . One approach to preventing acute new episodes of LBP ( up to 3 weeks from onset ) from developing into persistent disabling pain is to identify those individuals with LBP who are most likely to progress to chronic disability . Targeting interventions at those at highest risk could reduce the population burden of chronic LBP . A wide range of baseline parameters have been associated with poor outcome in inception cohort studies ( 1–6 ) . Few existing studies have been of sufficient size and method ologic rigor to produce conclusive findings . Even in method ologically robust studies , baseline factors only account for a small proportion of the variance in outcome ( 7 ) , typically around 30 % . Systematic review s of the literature could not pool data because studies used different measurements ( 1–3 ) . Despite some information on physical , psychosocial , and work-related risk factors , it has not been possible to adequately estimate the comparative impact of individual psychosocial and societal factors on the transition from acute to persistent disabling LBP . How to address this problem was one focus of the VI International Forum for Primary Care Research in Low Back Pain held in April 2003 . A steering group for the collaboration was appointed , and 8 national team leaders volunteered to recruit teams of national experts . Three additional team leaders were recruited by the steering group ( Australia , France , and Germany ) . Independent experts were invited to advise on the quality of the MMICS process . The MMICS steering group , located in the UK , met regularly and included expert research ers in clinical and outcome factors in back pain ( AB ) , work-related issues in back pain ( AKB ) , psychosocial aspects of back pain ( TP and RS ) , and general practice aspects of back pain ( MU ) . The MMICS Statement set out to include 1 ) a minimal but comprehensive number of predictor factors based on current evidence and theory ; 2 ) appropriate measurement instruments for agreed predictor factors based on their clinometric properties , availability , and practical characteristics ; and 3 ) a minimum set of followup measures , including recommendations about measurement and timing Guidelines portray low back pain ( LBP ) as a benign self‐limiting disease which should be managed mainly by primary care physicians . For the German health care system we analyze which factors are associated with receiving specialist care and how this affects treatment . This is a longitudinal prospect i ve cohort study . General practitioners recruited consecutive adult patients presenting with LBP .  Data on physical function , on depression , and on utilization of health services were collected at the first consultation and at follow‐up telephone interviews for a period of 12 months .  Logistic regression models  were calculated to investigate predictors for specialist consultations and use of specific health care services . Large proportions ( 57 % ) of the 1342 patients were seeking additional specialist care . Although patients receiving specialist care had more often chronic LBP and a positive depression score , the association was weak . A total of 623 ( 46 % ) patients received some form of imaging  , 654 ( 49 % ) physiotherapy and 417 ( 31 % ) massage . Consulting a specialist remained the strongest predictor for imaging and therapeutic interventions  while disease‐related and socio‐demographic factors were less important . Our results suggest that the high use of specialist care in Germany is due to the absence of a functioning primary care gate keeping system for patient selection . The high dependence of health care service utilization on providers rather than clinical factors indicates an un systematic and probably inadequate management of LBP BACKGROUND CONTEXT A range of morphologic and psychosocial variables has been suggested as risk factors for serious low back pain ( LBP ) illness . Although the relative contributions of structural and psychosocial variables are intensely debated , the validity of differing hypotheses has proven difficult to test because the incidence of serious disabling LBP illness is low in healthy subjects . These factors dictate the requirement for large sample sizes , extensive structural imaging and extended longitudinal study . Previous studies included either small cohorts with intensive imaging testing or large population studies that do not establish a detailed morphologic baseline . PURPOSE To establish , using a strict patient sample design , the relative contribution of structural and psychosocial determinants of serious LBP illness among subjects with no previous LBP disability or clinical LBP illness . STUDY DESIGN / SETTING A prospect i ve , longitudinal study of subjects with high risk factors for serious LBP as determined by structural and psychosocial characteristics . PATIENT SAMPLE One hundred subjects with known mild persistent low back pain and a 2:1 ratio of chronic ( non-lumbar ) pain syndrome were recruited from a study population with a predisposition to disc degenerative disease , to undergo baseline examination , testing and 5-year follow-up . OUTCOME MEASURES Observations were made at 6-month intervals over 4 to 6 years ( mean , 5.3 ) for the after primary outcomes measures : episodes of serious back pain ( visual analogue scale [ VAS ] > or = 6 ) , episodes of occupational disability less than 1 week , episodes of occupational disability for 1 week , remission episodes of all back pain symptoms at least 6 months and medical visits primarily for LBP evaluation and treatment . METHODS Lumbar magnetic resonance imaging ( MRI ) , lumbar provocative discography ( in psychometrically normal subjects ) , physical examinations , medical and work histories and psychometric testing were performed at baseline . Imaging and psychometric testing were grade d by blinded examiners . A scripted interview was conducted every 6 months during follow-up by independent research assistants who also were blinded to patient baseline data . The interview covered interval medical , occupational and accident or injury histories . RESULTS Psychosocial variables strongly predicted both long- and short-term disability events , duration and health-care visits for LBP problems ( p<0.0001 - 0.004 ) . The likelihood of a sustained remission from the baseline persistent ( sub clinical ) LBP appeared to be linked to occupation factors ( leaving a heavy labor occupation ; p=0.0001 ) , neurophysiologic variables ( chronic nonlumbar pain ; p=0.0002 ) and psychometric profiles at baseline ( DRAM and FABQ-PA ; p=0.003 - 0.002 ) . Of the structural findings measured only moderate or severe Modic changes of the vertebral end plate were weakly associated with an adverse outcome . A positive provocative discogram at baseline did not predict any future adverse event . CONCLUSION The development of serious LBP disability in a cohort of subjects with both structural and psychosocial risk factors was strongly predicted by baseline psychosocial variables . Structural variables on both MRI and discography testing at baseline had only weak association with back pain episodes and no association with disability or future medical care An intervention that can prevent low back pain ( LBP ) becoming chronic , may not only prevent great discomfort for patients , but also save substantial costs for the society . Psychosocial factors appear to be of importance in the transition of acute to chronic LBP . The aim of this study was to compare the cost-effectiveness of an intervention aim ed at psychosocial factors to usual care in patients with (sub)acute LBP . The study design was an economic evaluation alongside a cluster-r and omized controlled trial , conducted from a societal perspective with a follow-up of 1 year . Sixty general practitioners in 41 general practice s recruited 314 patients with non-specific LBP of less than 12 weeks ’ duration . General practitioners in the minimal intervention strategy ( MIS ) group explored and discussed psychosocial prognostic factors . Usual care ( UC ) was not protocol ized . Clinical outcomes were functional disability ( Rol and –Morris Disability Question naire ) , perceived recovery and health-related quality of life ( EuroQol ) . Cost data consisted of direct and indirect costs and were measured by patient cost diaries and general practitioner registration forms . Complete cost data were available for 80 % of the patients . Differences in clinical outcomes between both the groups were small and not statistically significant . Differences in cost data were in favor of MIS . However , the complete case analysis and the sensitivity analyses with imputed cost data were inconsistent with regard to the statistical significance of this difference in cost data . This study presents conflicting points of view regarding the cost-effectiveness of MIS . We conclude that ( Dutch ) general practitioners , as yet , should not replace their usual care by this new intervention OBJECTIVE To determine the characteristics of Australian adults who seek care for low back pain ( LBP ) , including the type of care they choose and any factors associated with making those choices . DESIGN A population -based mailed survey . SUBJECTS An age , gender , and state stratified r and om sample of 2768 Australian adults selected from the Electoral Roll . METHODS A self-administered , fully structured question naire included a series of questions relating to care seeking for LBP , choice of provider , and types of treatment received . In addition , a series of questions were asked relating to demographic characteristics , socioeconomic variables , severity of LBP , cigarette smoking , anthropometric variables , perceived cause of LBP , lifetime emotional distress , job satisfaction , lifetime physical fitness , past 5-year health status , and fear of LBP causing future impairment . RESULTS The response rate was 69.1 % . The sample proved to be similar to the Australian adult population . The majority of respondents with LBP in the past 6 months did not seek care for it ( 55.5 % ) . Factors that increased care seeking were higher grade s of pain and disability severity , fear of the impact of pain on future work and life , and female sex . Factors decreasing the likelihood for seeking care were identified as the cause of pain being an accident at home and also never being married . General medical practitioners and chiropractors are the most popular providers of care . CONCLUSION This study shows that a majority of people did not seek care for their LBP . The reasons for care seeking proved to be independent of social or economic status & NA ; Guidelines for the management of low back pain ( LBP ) have existed for many years , but adherence to these by health care practitioners ( HCPs ) remains suboptimal . The aim of this study was to measure the attitudes , beliefs and reported clinical behaviour of UK physiotherapists ( PTs ) and general practitioners ( GPs ) about LBP and to explore the associations between these . A cross‐sectional postal survey of GPs ( n = 2000 ) and PTs ( n = 2000 ) was conducted that included the  Pain Attitudes and Beliefs Scale ( PABT.PT )  , and a vignette of a  patient with non‐specific LBP ( NSLBP )  with questions asking about recommendations for work , activity and bedrest . Data from 1022 respondents ( 442 GPs and 580 PTs ) who had recently treated patients with LBP were analysed . Although the majority of HCPs reported providing advice for the vignette patient that was broadly in line with guideline recommendations , 28 % reported they would advise this patient to remain off work . Work advice was significantly related to the PABS.PT scores with higher biomedical ( F1,986 = 77.5 , p < 0.0001 ) and lower behavioural ( F1,981 = 31.9 , p < 0.001 ) scores associated with advice to remain off work . We have demonstrated that the attitudes and reported practice behaviour of UK GPs and PTs for patients with NSLBP are diverse . Many HCPs held the belief that LBP necessitates some avoidance of activities and work . The attitudes and beliefs of these HCPs were associated with their self‐reported clinical behaviour regarding advice about work . Future studies need to investigate whether approaches aim ed at modifying these HCP factors can lead to improved patient outcomes BACKGROUND Better insight into frequent comorbidities in patients with chronic ( ≥ 3 months ) low back pain ( LBP ) may help general practitioners when planning comprehensive care for these patients . OBJECTIVE To prospect ively study the prevalence of psychological , social , musculoskeletal and somatoform disorders in patients presenting with chronic non-specific LBP to general practitioners , in comparison to a contrast group of patients consulting in the same setting . METHODS This case-control study is embedded in a historical cohort , based on a primary care practice -based research network . All the health problems presented by the patients were prospect ively coded according to the international classification of primary care between 1996 and 2013 . The prevalence of psychological , social , musculoskeletal and somatoform disorders presented by the adult patients from 1 year before the onset of chronic LBP to 2 years after onset was compared to that of matched patients consulting without LBP , using conditional logistic regressions . RESULTS The 1511 patients with chronic LBP more often presented musculoskeletal disorders than the contrast group during the year before the onset of LBP and during the second year after it , with odds ratios ( 95%confidence intervals ) of 1.39 ( 1.20 - 1.61 ) and 1.56 ( 1.35 - 1.81 ) , respectively . They did not more often present psychological , social or non-musculoskeletal somatoform disorders . CONCLUSIONS General practitioners should consider all the musculoskeletal symptoms when caring for patients with chronic LBP . Rather than systematic ally screening for specific psychological , social or somatoform disorders , they should consider with the patient how LBP and any type of potential comorbidity interfere with his/her daily functioning Study Design . R and omized controlled trial . Objective . To evaluate the effectiveness of an ergonomic and psychosocial intervention in reducing  low back pain ( LBP ) among health care workers . Summary of Background Data . LBP and injuries are reported frequently among health care workers worldwide . Improvement of person-transfer techniques is the preferred tool in the prevention of both . Although popular , to our knowledge , any effect has not been documented in controlled trials . Methods . Study participants were eldercare workers from 19 eldercare groups r and omly assigned to the transfer technique , stress management , or reference arm . A total of 163 individuals ( 79 % of the source population ) participated in both baseline and follow-up after 2 years . Outcome was intra-individual change in rating of LBP during the past 3 and 12 months . Results . We found no difference in LBP in any of the intervention arms over the study period . Conclusion . The study showed no effect of a transfer technique or stress management program targeting LBP . Thus , there is a need for discussing other priorities in the prevention of LBP among health care workers BACKGROUND CONTEXT Low back pain ( LBP ) is a major public health problem , with a considerable impact on workers . PURPOSE To model the risk of LBP in the male general working population . STUDY DESIGN / SETTING Repeated cross-sectional surveys in a wide occupational setting . PATIENT SAMPLE A r and om sample of 2,161 men working in various occupations in a French region participated in a first survey in 2002 , and 1,313 of these ( 60.8 % ) participated in a second survey in 2007 . OUTCOME MEASURE The self-reported prevalence of LBP during the previous week in the second survey . METHODS Twenty-one biomechanical , organizational , psychosocial , and individual factors were assessed in the first survey . The association between these potential risk factors and the prevalence of later LBP ( in the second survey ) was studied , using multistep logistic regression models . RESULTS Three hundred ninety-four men reported LBP in the second survey ( prevalence 30.0 % ) . The final multivariate model highlighted four risk factors : frequent bending ( odds ratio [ OR ] , 1.45 , 95 % confidence interval [ CI ] , 1.07 - 1.97 for bending forward only ; and OR , 2.13 , 95 % CI , 1.52 - 3.00 for bending both forward and sideways ) , driving industrial vehicles ( OR , 1.35 ; 95 % CI , 1.00 - 1.81 ) , working more hours than officially planned ( OR , 1.38 ; 95 % CI , 1.05 - 1.81 ) , and reported low support from supervisors ( OR , 1.35 ; 95 % CI , 1.02 - 1.79 ) . CONCLUSIONS These results emphasize that biomechanical factors remain worth considering , even when psychosocial factors are taken into account , and provide a significant contribution to preventive strategies Background Low back pain ( LBP ) and neck pain ( NP ) are a major public health problem with considerable costs for individuals , companies and society . Therefore , prevention is imperative . The Stay@Work study investigates the (cost-)effectiveness of Participatory Ergonomics ( PE ) to prevent LBP and NP among workers . Methods In a r and omised controlled trial ( RCT ) , a total of 5,759 workers working at 36 departments of four companies is expected to participate in the study at baseline . The departments consisting of about 150 workers are pre-stratified and r and omised . The control departments receive usual practice and the intervention departments receive PE . Within each intervention department a working group is formed including eight workers , a representative of the management , and an occupational health and safety coordinator . During a one day meeting , the working group follows the steps of PE in which the most important risk factors for LBP and NP , and the most adequate ergonomic measures are identified on the basis of group consensus . The implementation of ergonomic measures at the department is performed by the working group . To improve the implementation process , so-called ' ergocoaches ' are trained . The primary outcome measure is an episode of LBP and NP . Secondary outcome measures are actual use of ergonomic measures , physical workload , psychosocial workload , intensity of pain , general health status , sick leave , and work productivity . The cost-effectiveness analysis is performed from the societal and company perspective . Outcome measures are assessed using question naires at baseline and after 6 and 12 months . Data on the primary outcome as well as on intensity of pain , sick leave , work productivity , and health care costs are collected every 3 months . Discussion Prevention of LBP and NP is beneficial for workers , employers , and society . If the intervention is proven (cost-)effective , the intervention can have a major impact on LBP and NP prevention and , thereby , on work disability prevention . Results are expected in 2010.Trial registration IS RCT Study Design Two-year , prospect i ve cohort data from the Japan epidemiological research of occupation-related back pain study in urban setting s were used for this analysis . Objective To examine the association between aggravated low back pain and psychosocial factors among Japanese workers with mild low back pain . Summary of Background Data Although psychosocial factors are strongly indicated as yellow flags of low back pain ( LBP ) leading to disability , the association between aggravated LBP and psychosocial factors has not been well assessed in Japanese workers . Methods At baseline , 5,310 participants responded to a self-administered question naire including questions about individual characteristics , ergonomic work dem and s , and work-related psychosocial factors ( response rate : 86.5 % ) , with 3,811 respondents completing the 1-year follow-up question naire . The target outcome was aggravation of mild LBP into persistent LBP during the follow-up period . Incidence was calculated for the participants with mild LBP during the past year at baseline . Logistic regression was used to explore risk factors associated with persistent LBP . Results Of 1,675 participants who had mild LBP during the preceding year , 43 ( 2.6 % ) developed persistent LBP during the follow-up year . Multivariate analyses adjusted for individual factors and an ergonomic factor found statistically significant or almost significant associations of the following psychosocial factors with persistent LBP : interpersonal stress at work [ adjusted odds ratio ( OR ) : 1.96 and 95 % confidence interval ( 95%CI ) : 1.00–3.82 ] , job satisfaction ( OR : 2.34 , 95%CI : 1.21–4.54 ) , depression ( OR : 1.92 , 95%CI : 1.00–3.69 ) , somatic symptoms ( OR : 2.78 , 95%CI : 1.44–5.40 ) , support from supervisors ( OR : 2.01 , 95%CI : 1.05–3.85 ) , previous sick-leave due to LBP ( OR : 1.94 , 95%CI : 0.98–3.86 ) and family history of LBP with disability ( OR : 1.98 , 95%CI : 1.04–3.78 ) . Conclusions Psychosocial factors are important risk factors for persistent LBP in urban Japanese workers . It may be necessary to take psychosocial factors into account , along with physical work dem and s , to reduce LBP related disability Abstract . There is increasing evidence that non-specific low back pain ( LBP ) is common among children and adolescents , but there are few longitudinal studies on this subject . This is a longitudinal prospect i ve study aim ed at finding factors associated with the prediction of low back pain in schoolchildren aged 9–12 years , which is a younger age group than has previously been studied . This study was performed on school children in the city of Antwerp , Belgium . A total of 287 children filled out a question naire  and were examined at the beginning of the study ( T1 ) and 2 years later ( T2 ) . The question naire asked about back pain , general health , health perceptions , quality of life perceptions , sports , leisure , daily life , school life ( weight of satchel ... ) and some issues related to parents ( smoking , LBP ) . The question naire reliability was tested . Logistic regression was used to analyse the data . No predictors for LBP in children could be identified . Using logistic regression techniques , we analysed the children who reported no lifetime episode of LBP at both T1 and T2 , the children who did report a lifetime episode at both T1 and T2 and also those who reported a history of LBP at T2 only ( New LBP ) . At T2 there were 51 children ( 17.8 % ) reporting suffering at least one lifetime episode of LBP who had not reported such an episode at T1 . Only one parameter showed a statistical difference : New LBP was observed significantly more frequently in children who do not walk to school ( P<0.0001 ) . An interesting point of this study is that a number of children who had reported a history of LBP at T1 did not do so at T2 . It may be that LBP in children is so benign and its natural history so favourable that the memory of the episode fades away . It is extremely interesting to note that among the few significant variables , those related to general well-being and self-perception of health , are prominent . It appears , therefore , that psychological factors play a role in the experience of LBP in a similar way to what has been reported in adults . Poor self-perception of health ( health belief ) could be a factor behind the reporting of LBP . Some variables linked to consequences of LBP ( absence from school or from gym and visit to a doctor ) play a significant role in reporting LBP , which suggests that those " health care " factors may reinforce a feeling of disease severity To investigate the associations between psychosocial factors and the development of  chronic disabling low back pain ( LBP ) in Japanese workers . A 1 yr prospect i ve cohort of the Japan Epidemiological Research of Occupation-related Back Pain ( JOB ) study was used . The participants were office workers , nurses , sales/marketing personnel , and manufacturing engineers . Self-administered question naires were distributed twice : at baseline and 1 yr after baseline . The outcome of interest was the development of chronic disabling LBP during the 1 yr follow-up period . Incidence was calculated for the participants who experienced disabling LBP during the month prior to baseline . Logistic regression was used to assess risk factors for chronic disabling LBP . Of 5,310 participants responding at baseline ( response rate : 86.5 % ) , 3,811 completed the question naire at follow-up . Among 171 eligible participants who experienced disabling back pain during the month prior to baseline , 29 ( 17.0 % ) developed chronic disabling LBP during the follow-up period . Multivariate logistic regression analysis implied reward to work ( not feeling rewarded , OR : 3.62 , 95%CI : 1.17–11.19 ) , anxiety ( anxious , OR : 2.89 , 95%CI : 0.97–8.57 ) , and daily-life satisfaction ( not satisfied , ORs : 4.14 , 95%CI : 1.18–14.58 ) were significant . Psychosocial factors are key to the development of chronic disabling LBP in Japanese workers .  Psychosocial interventions may reduce the impact of LBP in the workplace Study Design . Prospect i ve study with 6 weeks of follow-up . Objective . To examine the predictors of outcome for patients with (sub)acute low back pain ( LBP ) receiving usual care ( UC ) or a minimal intervention strategy ( MIS )  aim ed at psychosocial factors . Summary of Background Data . A r and omized controlled trial in general practice showed no differences in average effect between UC and MIS . Methods . Socio-demographic variables , characteristics of LBP , and psychosocial factors were included as potential predictors of outcome . The outcome clinical ly important improvement was defined as a reduction of at least 30 % on functional disability plus patient perceived recovery . Logistic regression analyses were used to study the associations between predictors and outcome at 6 weeks follow-up . Results . In the  UC group ( n = 163 ) , the multivariable model included a shorter duration of the LBP episode , few previous episodes , less pain catastrophizing , and good perceived general health . The area under the curve ( AUC ) of the model was 0.77 ( 95 % confidence interval , 0.70–0.85 ) . In the  MIS group ( n = 142 ) , the multivariable model included less somatizing symptoms , more solicitous responses by an important other , lower perceived risk for chronic LBP , more fear avoidance beliefs , higher level of education , and shorter duration of the LBP episode . This AUC was 0.78 ( 95 % confidence interval , 0.71–0.86 ) . Conclusions . As we found two different profiles , our approach may contribute to the important question : what intervention works for whom Background Low back pain ( LBP ) is one of the most prevalent and expensive health care problems in industrialised countries . LBP leads to high health care utility and productivity losses ; leaving the individual , the employer , and society with substantial costs . To improve the care for LBP patients and reduce the high societal and financial burden of LBP , in 2010 the ‘ Multidisciplinary care guideline for nonspecific low back pain ’ was developed in the Netherl and s. The current paper describes the design of a study aim ing to evaluate the ( cost- ) effectiveness of a multifaceted strategy to implement this guideline . Methods In a cluster-r and omised controlled trial , the ( cost- ) effectiveness of a multifaceted implementation strategy will be compared to passive guideline dissemination . Using a stepped-wedge approach , participating general practitioners , physiotherapists , and occupational physicians are allocated into clusters and will attend a multidisciplinary continuing medical education training session . The timing these clusters receive the training is the unit of r and omisation . LBP patients visiting the participating health care providers are invited to participate in the trial and will receive access to a multimedia intervention aim ed at improving beliefs , cognitions , and self-management . The primary outcome measure of this study is patient back beliefs . Secondary outcome measures on patient level include pain , functional status , quality of life , health care utility , and productivity losses . Outcome measures on professional level include knowledge and attitude towards the guideline , and guideline adherence . A process evaluation for the implementation strategy will be performed among the health care providers and the patients . Furthermore , a qualitative subgroup analysis among patients with various ethnic background s will be performed . Discussion This study will give insight into the ( cost- ) effectiveness of a multifaceted implementation strategy for the Dutch multidisciplinary guideline for non-specific back pain to improve outcomes on patient and professional level . The valuable information gained with this study may prove useful for policy-makers , health care providers , and research ers who are in the process of reducing the burden of back pain on individuals and society . Trial Registration Netherl and s Trial Register ( NTR ) : NTR4329 . Registered December 20th , 2013 BACKGROUND Hospital workers with physically dem and ing jobs are at risk for developing recurrent LBP . There is a lack of studies evaluating multidisciplinary prevention of  low back pain ( LBP ) in hospital workers . OBJECTIVE This r and omized controlled trial evaluates the effect of a multidisciplinary prevention program , focusing on a client-centred approach , on hospital workers at risk for developing LBP . METHODS Caregiving hospital workers were allocated to an experimental ( 12-week lasting multidisciplinary prevention program ) or control group ( no intervention ) . They were evaluated prior to the intervention and after a 6 months follow-up period . Primary outcome measures included incidence of LBP , work absenteeism and general health . Secondary outcomes included daily physical activity , job satisfaction and coping strategies . RESULTS A significant improvement was seen for passive coping after 6 months follow-up , but no significant differences were observed between groups in primary or other secondary outcome measures ( p > 0.05 ) . CONCLUSIONS A multidisciplinary prevention program fitting into a bio-psychosocial context may not have been intensive enough to promote a change in daily habitudes , and had no effect on work absenteeism , incidence of LBP or general health . Further research should determine whether prevention of LBP is possible in caregiving personnel Background The STarT Back strategy for categorizing and treating patients with low back pain ( LBP ) improved patients ’ function while reducing costs in Engl and . Objective This trial evaluated the effect of implementing an adaptation of this approach in a US setting . Design The Matching Appropriate Treatments to Consumer Healthcare needs ( MATCH ) trial was a pragmatic cluster r and omized trial with a pre-intervention baseline period . Six primary care clinics were pair r and omized , three to training in the STarT Back strategy  and three to serve as  controls . Participants Adults receiving primary care for non-specific LBP were invited to provide data 2 weeks after their primary care visit and follow-up data 2 and 6 months ( primary endpoint ) later . Interventions The STarT Back risk-stratification strategy matches treatments for LBP to physical and psychosocial obstacles to recovery using patient-reported data ( the STarT Back Tool ) to categorize patients ’ risk of persistent disabling pain . Primary care clinicians in the intervention clinics attended six didactic sessions to improve their underst and ing LBP management and received in-person training in the use of the tool that had been incorporated into the electronic health record ( EHR ) . Physical therapists received 5 days of intensive training . Control clinics received no training . Main measures Primary outcomes were back-related physical function and pain severity . Intervention effects were estimated by comparing mean changes in patient outcomes after 2 and 6 months between intervention and control clinics . Differences in change scores by trial arm and time period were estimated using linear mixed effect models . Secondary outcomes included healthcare utilization . Key Results Although clinicians used the tool for about half of their patients , they did not change the treatments they recommended . The intervention had no significant effect on patient outcomes or healthcare use . Conclusions A re source -intensive intervention to support stratified care for LBP in a US healthcare setting had no effect on patient outcomes or healthcare use . Trial Registration National Clinical Trial Number NCT02286141 The aim of this prospect i ve cohort study was to identify modifiable protective factors of the progression of acute/subacute low back pain ( LBP ) to the persistent state at an early stage to reduce the socioeconomic burden of persistent LBP .  Patients attending a health practitioner for acute/subacute LBP were assessed at baseline addressing occupational , personal and psychosocial factors , and followed up over 12 weeks . Pearson correlations were calculated between these baseline factors and the presence of nonpersistent LBP at 12-week follow-up . For those factors found to be significant , multivariate logistic regression analyses were performed . The final 3-predictor model included job satisfaction , mental health and social support . The accuracy of the model was 72 % , with 81 % of nonpersistent and 60 % of persistent LBP patients correctly identified . Further research is necessary to confirm the role of different types of social support regarding their prognostic influence on the development of persistent LBP & NA ; Psychosocial factors have been shown to play an important role in the development of chronic low back pain ( LBP ) . In our recently completed cluster‐r and omized trial we found , however , no evidence of an effect of our minimal intervention strategy ( MIS ) aim ed at psychosocial factors , over usual care ( UC ) in patients with (sub)acute LBP . To explore the reasons why , this paper presents an evaluation of the processes presumably underlying the effectiveness of MIS . General practitioner ( GP ) attitude was evaluated by the Pain Attitudes and Beliefs Scale and two additional questions . GP behaviour was evaluated by analysing treatment registration forms and patients ' responses to items regarding treatment content . Patients also scored items on satisfaction and compliance . Modification of psychosocial measures was evaluated by analysing changes after 6 and 52 weeks on the Fear Avoidance and Beliefs Question naire , the Coping Strategies Question naire and the 4‐Dimensional Symptom Question naire . A total of 60 GPs and 314 patients participated in the study . GPs in the MIS‐group adopted a less biomedical orientated attitude than in the UC‐group , but were only moderately successful in identification of psychosocial factors . Treatment contents as perceived by the patient and patient satisfaction differed significantly between both groups . Changes on psychosocial measures , however , did not differ between groups . The suboptimal identification of psychosocial factors in the MIS‐group and the absence of a relevant impact on psychosocial factors may explain why MIS was not more effective than UC BACKGROUND Chronic low back pain ( LBP ) accounts for the majority of the disability and costs for LBP . However , the definition of chronicity is unclear . AIM To elicit practitioners ' definitions of chronic LBP patients , both in general and in the patients they were treating ; to assess the most common characteristics of these practitioners ' chronic LBP patients ; and to assess the stability of chronicity in a sample of the general population . METHOD Semi-structured interviews were conducted with 33 practitioners working in private practice , 71 LBP patients and their therapists , and 252 employees of a chain store who were assessed yearly in a prospect i ve study . RESULTS The therapists ' definitions of chronic LBP patients generally included psychosocial aspects . Only physical symptoms and signs were stressed in the patients they were treating . These patients displayed common characteristics with reference to pain , functional problems , and contact with health care services . Duration of symptoms was not sufficient to define chronicity . In the employee population , chronicity defined according to pain duration was unstable . However , the same was true when chronicity was measured according to the criteria defined in the patient population . CONCLUSION There is a discrepancy between theory and practice regarding the definition of chronic LBP . This discrepancy concerns not only the literature but also clinical practice itself . The term ' chronic ' LBP as currently used is therefore equivocal Study Design . A baseline study of the general population and the health care providers in 3 Norwegian counties . Objective . To investigate if beliefs about low back pain ( LBP ) are related to personal experiences and profession sought for care . Summary of Background Data . Myths about LBP that are ab and oned by health professionals are still alive in the public . Such myths represent pain avoidance beliefs and passive coping strategies that may hinder normal spontaneous recovery from an episode of LBP . Methods . A sample of 1502 r and omly selected people was interviewed  by telephone , and all the 1105 physicians , physiotherapists , and chiropractors in the area were sent a question naire in April 2002 . All respondents gave their responses in terms of degree of agreement to 6 statements reflecting beliefs about LBP . Results . Personal back pain experiences were important for beliefs about LBP . People with a history of previous back pain had more faith in the 2 statements “ Back pain recovers best by itself ” ( 52.2 % ) and “ In most cases back pain recovers by itself in a couple of weeks ” ( 32.5 % ) than those with current pain ( 36.9 % and 20.9 % , respectively , P < 0.000 ) . There were significant differences in beliefs between physicians and the chiropractors concerning the same 2 statements , and these differences were also reflected in the beliefs of patients treated by the different professional groups . Conclusions . Belief in spontaneous recovery from LBP seems to be positively correlated to previous experience with LBP without current pain . Patients of the various health care providers seem to have a faith in spontaneous recovery similar to that of their health care provider . These differences may frustrate the public and patients who visit more than one provider , and hinder collaboration among professional groups Purpose In low back pain ( LBP ) patients , those with radiating leg pain or sciatica have poorer pain and disability outcomes . Few studies have assessed the effect of leg pain on health care use and quality of life . Methods Prospect i ve cohort study of 1,581 UK LBP primary care consulters .  Back pain , employment , health care utilisation , and quality of life ( EQ-5D ) data were collected at baseline , 6 and 12 months . At baseline , patients were classified as reporting ( 1 ) LBP only , ( 2 ) LBP and leg pain above the knee only ( LBP + AK ) or ( 3 ) LBP and leg pain extending below the knee ( LBP + BK ) . Results Self-reported leg pain was common ; at baseline 645 ( 41 % ) reported LBP only , 392 ( 25 % ) reported LBP + AK and 544 ( 34 % ) reported LBP + BK . Patients with LBP + BK , compared to those with LBP only , were significantly more likely to be unemployed , take time off work , consult their family doctor , receive physical therapy , or be referred to other health care practitioners . There were statistically significant decrements in EQ-5D scores for LBP + AK compared to LBP only , and for LBP + BK compared to LBP + AK ( p ≤ 0.05 for all comparisons ) . Conclusions Patients with self-reported leg pain below the knee utilise more health care are more likely to be unemployed and have poorer quality of life than those with LBP only 12 months following primary care consultation . The presence of leg pain warrants early identification in primary care to explore if targeted interventions can reduce the impact and consequences of leg pain Background Low back pain ( LBP ) is a prevalent and costly condition in the United States . Evidence suggests there is no one treatment which is best for all patients , but instead several viable treatment options . Additionally , multidisciplinary management of LBP may be more effective than monodisciplinary care . An integrative model that includes both complementary and alternative medicine ( CAM ) and conventional therapies , while also incorporating patient choice , has yet to be tested for chronic LBP.The primary aim of this study is to determine the relative clinical effectiveness of 1 ) monodisciplinary chiropractic care and 2 ) multidisciplinary integrative care in 200 adults with non-acute LBP , in both the short-term ( after 12 weeks ) and long-term ( after 52 weeks ) . The primary outcome measure is patient-rated back pain . Secondary aims compare the treatment approaches in terms of frequency of symptoms , low back disability , fear avoidance , self-efficacy , general health status , improvement , satisfaction , work loss , medication use , lumbar dynamic motion , and torso muscle endurance . Patients ' and providers ' perceptions of treatment will be described using qualitative methods , and cost-effectiveness and cost utility will be assessed . Methods and Design This paper describes the design of a r and omized clinical trial ( RCT ) , with cost-effectiveness and qualitative studies conducted alongside the RCT . Two hundred participants ages 18 and older are being recruited and r and omized to one of two 12-week treatment interventions .  Patient-rated outcome measures are collected via self-report question naires at baseline , and at 4 , 12 , 26 , and 52 weeks post-r and omization . Objective outcome measures are assessed at baseline and 12 weeks by examiners blinded to treatment assignment . Health care cost data is collected by self-report question naires and treatment records during the intervention phase and by monthly phone interviews thereafter . Qualitative interviews , using a semi-structured format , are conducted with patients at the end of the 12-week treatment period and also with providers at the end of the trial . Discussion This mixed- methods r and omized clinical trial assesses clinical effectiveness , cost-effectiveness , and patients ' and providers ' perceptions of care , in treating non-acute LBP through evidence -based individualized care delivered by monodisciplinary or multidisciplinary care teams . Trial registration Clinical Trials.gov
In the first systematic review , the patients ' or HCPs ' overall judgment about the likely evolution of LBP was the factor most strongly linked to poor outcome , with predictive validity similar to that of multidimensional scales .
This result may be explained by the implicit aggregation of many prognostic factors underlying this judgment and suggests the relevance of considering the patients from biopsychosocial and longitudinal points of view .
It is unlikely that any intervention focusing on a single factor would ever fit the needs of most patients ; interventions targeting determinants from several fields ( mainly psychosocial , biomechanical , and occupational ) may be more relevant .
Finally , in the third study , the prevalence of psychosocial comorbidity in chronic LBP patients was not found to be significantly higher than in other patients consulting in primary care .
Rather than specifically screening for psychosocial conditions , this suggests taking into account any potential comorbidity in patients with chronic LBP , as in other patients .
As this condition is illustrative of many situations encountered in primary care , the strategies proposed here may benefit most patients consulting in this setting
Non-specific low back pain ( LBP ) affects many people and has major socio-economic consequences .
Traditional therapeutic strategies , mainly focused on biomechanical factors , have had moderate and short-term impact .
Certain psychosocial factors have been linked to poor prognosis of LBP and they are increasingly considered as promising targets for management of LBP .
Primary health care providers ( HCPs ) are involved in most of the management of people with LBP and they are skilled in providing comprehensive care , including consideration of psychosocial dimensions .
This review aims to discuss three pieces of recent research focusing on psychosocial issues in LBP patients in primary care .