PREDICTING POOR OUTCOMES FOR BACK PAIN SEEN IN PRIMARY-CARE USING PATIENTS OWN CRITERIA

Study Design. A prospective cohort study of patients seen in primary c are for low back pain. Objectives. A new measure of back pain outcomes is used to describe the status of back problems at various intervals after visits to primary care physicians and to identify subsets of pat ients with worse prognoses. Summary of Background Data. Most previous studies of the prognosis of back pain in primary care have failed to p rovide clinically useful information. Methods. Baseline data were coll ected from 219 patients making an initial visit for an episode of low back pain to a primary care clinic. A measure of how patients reported they would feel if they had their current back symptoms for the rest of their lives (''Symptom Satisfaction'') was used to distinguish good from poor outcomes. Patient outcomes were assessed 1, 3, 7, and 52 we eks after the index visit. Results. Only 67% of patients reported good outcomes after 7 weeks, and only 71% were satisfied with their condit ion 1 year later. After controlling for the effects of other variables measured during the initial physician visit, only younger age, depres sion, and pain below the knee were significant predictors of poor outc ome at 7 weeks, and only pain below the knee and depression were signi ficant predictors at 1 year. Conclusions. The proportion of primary ca re patients with back pain who have poor outcomes appears to be higher than generally recognized. Ways of improving how primary care respond s to patients with persisting pain should be investigated.