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 .
Prediction of an unfavourable course of low back pain in general practice: comparison of four instruments.
BACKGROUND Several instruments can be used to identify patients with an unfavourable course of low back pain in general practice . However , it is unclear which instrument is the predictor of outcome . AIM To compare the predictive performance ( that is , calibration and discrimination ) of risk estimation by GPs with assessment s using the Orebro Musculoskeletal Pain Screening Question naire , the Low Back Pain Perception Scale ( LBPPS ) , and a prediction rule developed for this purpose . DESIGN OF STUDY A prospect i ve cohort study with 1-year follow-up . SETTING General practice in The Netherl and s. METHOD The outcome ' unfavourable course of low back pain ' was defined as having no clinical ly important improvement at minimally 50 % of the measurements at 6 , 13 , 26 , and 52 weeks . Logistic regression analyses were used to study associations between potential predictors and outcome . RESULTS In total , 60 GPs recruited 314 patients to the study ( 16 patients were excluded from analysis due to missing data on the course of low back pain ) . Over a third of patients ( 112/298 ) showed an unfavourable course of low back pain on follow-up . Risk estimation by GPs , the Orebro question naire , the LBPPS , and the prediction rule had discriminative ability ( area under the curve ) of 0.59 ( 95 % CI [ confidence intervals ] = 0.52 to 0.66 ) ; 0.61 ( 95 % CI = 0.54 to 0.67 ) ; 0.59 ( 95 % CI = 0.52 to 0.66 ) ; and 0.75 ( 95 % CI = 0.69 to 0.81 ) respectively . The prediction rule included history of low back pain , self-perceived risk to develop chronic low back pain , no solicitous responses of the patient 's partner ( as reported by the patient ) , frequent walking at work , and ' pain catastrophising ' . CONCLUSION Although the prediction rule performed best with regard to calibration and discrimination , it needs to be externally vali date d. Risk estimation by GPs performs as well as other instruments and , at present , seems to be the best available option
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 .