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 .
Targeted treatment in primary care for low back pain: the treatment system and clinical training programmes used in the IMPaCT Back study (ISRCTN 55174281)
Background . The IMPaCT Back study ( IMplementation to improve Patient Care through Targeted treatment for Back pain ) is a quality improvement study which aims to investigate the effects of introducing and supporting a subgrouping for targeted treatment system for patients with low back pain ( LBP ) in primary care . This paper details the subgrouping for targeted treatment system and the clinical training and mentoring programmes aim ed at equipping clinicians to deliver it . The subgrouping and targeted treatment system . This system differs from ‘ one-size fits all ’ usual practice as it suggests that first contact health care practitioners should systematic ally allocate LBP patients to one of the three subgroups according to key modifiable prognostic indicators for chronicity . Patients in each subgroup ( those at low , medium or high risk of chronicity ) are then managed according to a targeted treatment system of increasing complexity . The subgrouping tools . Subgrouping tools help guide clinical decision-making about treatment and onward referral . Two subgrouping tools have been used in the IMPaCT Back study , a 9-item version used by participating physiotherapists and a 6-item version used by GPs . The targeted treatments . The targeted treatments include a minimal intervention delivered by GPs ( for those patients at low risk of poor outcome ) or referral to primary care physiotherapists who can apply physiotherapy approaches to addressing pain and disability  ( for those at medium risk ) and additional cognitive-behavioural approaches to help address  psychological and social obstacles to recovery  ( for those at high risk ) . The training packages . Building on previous interventions for other pilot studies and r and omized trials , we have developed and delivered clinical training and support programmes for GPs and physiotherapists . Discussion . This paper describes in detail the IMPaCT Back study ’s subgrouping for targeted treatment system and the training and mentoring packages aim ed at equipping clinicians to deliver it , within the IMPaCT Back study . Study registration . IS RCT N55174281
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 .