• M Melloh, A Elfering, C Egli Presland, C Röder, P Hendrick, B Darlow, and J-C Theis.
• Department of Orthopaedic Surgery, Dunedin School of Medicine, University of Otago, Private Bag 1921, Dunedin 9054, New Zealand.
• Occup Med (Lond). 2011 Mar 1;61(2):127-31.

BackgroundMost people experience low back pain (LBP) at least once in their lifetime. Only a minority of them go on to develop persistent LBP. However, the socioeconomic costs of persistent LBP significantly exceed the costs of the initial acute LBP episode.AimsTo identify factors that influence the progression of acute LBP to the persistent state at an early stage.MethodsProspective inception cohort study of patients attending a health practitioner for their first episode of acute LBP or recurrent LBP after a pain free period of at least 6 months. Patients were assessed at baseline addressing occupational and psychological factors as well as pain, disability, quality of life and physical activity and followed up at 3, 6, 12 weeks and 6 months. Variables were combined to the three indices 'working condition', 'depression and maladaptive cognitions' and 'pain and quality of life'.ResultsThe index 'depression and maladaptive cognitions' was found to be a significant baseline predictor for persistent LBP up to 6 months (OR 5.1; 95% CI: 1.04-25.1). Overall predictive accuracy of the model was 81%.ConclusionsIn this study of patients with acute LBP in a primary care setting psychological factors at baseline correlated with a progression to persistent LBP up to 6 months. The benefit of including factors such as 'depression and maladaptive cognition' in screening tools is that these factors can be addressed in primary and secondary prevention.

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