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 .
Prevalence of and screening for serious spinal pathology in patients presenting to primary care settings with acute low back pain.
OBJECTIVE To determine the prevalence of serious pathology in patients presenting to primary care setting s with acute low back pain , and to evaluate the diagnostic accuracy of recommended " red flag " screening questions . METHODS An inception cohort of 1,172 consecutive patients receiving primary care for acute low back pain was recruited from primary care clinics in Sydney , Australia . At the initial consultation , clinicians recorded responses to 25 red flag questions and then provided an initial diagnosis . The reference st and ard was a 12-month followup supplemented with a specialist review of a r and om sub sample of participants . RESULTS There were 11 cases ( 0.9 % ) of serious pathology , including 8 cases of fracture . Despite the low prevalence of serious pathology , most patients ( 80.4 % ) had at least 1 red flag ( median 2 , interquartile range 1 - 3 ) . Only 3 of the red flags for fracture recommended for use in clinical guidelines were informative : prolonged use of corticosteroids , age > 70 years , and significant trauma . Clinicians identified 5 of the 11 cases of serious pathology at the initial consultation and made 6 false-positive diagnoses . The status of a diagnostic prediction rule containing 4 features ( female sex , age > 70 years , significant trauma , and prolonged use of corticosteroids ) was moderately associated with the presence of fracture ( the area under the curve for the rule score was 0.834 [ 95 % confidence interval 0.654 - 1.014 ] ; P = 0.001 ) . CONCLUSION In patients presenting to a primary care provider with back pain , previously undiagnosed serious pathology is rare . The most common serious pathology observed was vertebral fracture . Approximately half of the cases of serious pathology were identified at the initial consultation . Some red flags have very high false-positive rates , indicating that , when used in isolation , they have little diagnostic value in the primary care setting
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 .