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Who is Likely to Develop Persistent Low Back Pain? a Longitudinal Analysis of Prognostic Occupational Factors

Introduction Socioeconomic costs of persistent low back pain (LBP) exceed the costs of acute and subacute LBP by far. This makes the early identification of patients at risk of developing persistent LBP essential. By differentiating risk from protective factors, these factors could be addressed proactively to limit the associated socioeconomic burden. Aim of our study was to identify factors influencing the progression of acute/subacute LBP to the persistent state. Materials and Methods This is a prospective cohort study of patients attending a health practitioner for their first episode of acute/subacute LBP. Patients were assessed at baseline addressing occupational, psychological, biomedical, and demographic/lifestyle factors and followed up over 6 months according to the recommendations from the Multinational Musculoskeletal Inception Cohort Study (MMICS) Statement. Multivariate logistic regression analysis was performed separately for the variables groups of the four different domains, controlling for age, gender, and body mass index. The overall predictive value was calculated for the full regression models of the different domains. Finally, all significant variables from the different domains were combined into a final predictor model. Results The final four-predictor model predicted 51% of variance of persistent LBP and included “resigned attitude towards the job” (OR 1.73; 95% CI, 1.16–2.59), “social support at work” (OR 0.54; 95% CI, 0.32–0.90), “functional limitation” (OR 1.05; 95% CI, 1.01–1.10), and “duration of LBP” (OR 1.04; 95% CI, 1.02–1.06). The accuracy of the model was 83%, with 92% of nonpersistent and 67% of persistent LBP patients correctly identified. Conclusion In this study of patients with acute/subacute LBP, “resigned attitude towards the job” increased the likelihood of persistent LBP at 6 months. Addressing this factor with workplace interventions has the potential to modify the outcome. “Social support at work” was a protective factor meaning that development of persistent LBP was less likely. It can therefore be considered as a resource for prevention of persistent LBP. Findings from this study confirm the requirement for measurement of occupational factors in screening tools for patients at risk of developing persistent LBP. Further research is required to investigate different types of social support at work regarding their prognostic influence on the development of persistent LBP. I confirm having declared any potential conflict of interest for all authors listed on this abstract Yes Disclosure of Interest None declared