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 .
Independent effect of depression and anxiety on chronic obstructive pulmonary disease exacerbations and hospitalizations.
RATIONALE Depression and anxiety are significant comorbid and potentially modifiable conditions in chronic obstructive pulmonary disease ( COPD ) , but their effects on exacerbations are not clear . OBJECTIVES To investigate the independent effect of depression and anxiety on the risk of COPD exacerbations and hospitalizations . METHODS A multicenter prospect i ve cohort study in 491 patients with stable COPD in China . Multivariate Poisson and linear regression analyses were used , respectively , to estimate adjusted incidence rate ratios ( IRRs ) and adjusted effects on duration of events . MEASUREMENTS AND MAIN RESULTS  Depression and anxiety  were measured using the  Hospital Anxiety and Depression Scale ( HADS ) at baseline . Other measurements included sociodemographic , clinical , psychosocial , and treatment characteristics . Patients were then monitored monthly for 12 months to document the occurrence and characteristics of COPD exacerbations and hospitalizations . Exacerbation was determined using both symptom-based ( worsening of > or = 1 key symptom ) and event-based definitions ( > or = 1 symptom worsening plus > or = 1 change in regular medications ) . A total of 876 symptom-based and 450 event-based exacerbations were recorded , among which 183 led to hospitalization . Probable depression ( HADS depression score > or = 11 ) was associated with an increased risk of symptom-based exacerbations ( adjusted IRR , 1.51 ; 95 % confidence interval [ CI ] , 1.01 - 2.24 ) , event-based exacerbations ( adjusted IRR , 1.56 ; 95 % CI , 1.02 - 2.40 ) , and hospitalization ( adjusted IRR , 1.72 ; 95 % CI , 1.04 - 2.85 ) compared with nondepression ( score < or = 7 ) . The duration of event-based exacerbations was 1.92 ( 1.04 - 3.54 ) times longer for patients with probable anxiety ( HADS anxiety score > or = 11 ) than those with no anxiety ( score < or = 7 ) . CONCLUSIONS This study suggests a possible causal effect of depression on COPD exacerbations and hospitalizations . Further studies are warranted to confirm this finding and to test the effectiveness of antidepressants and psychotherapies on reducing exacerbations and improving health re source utilizations
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 .