Low back pain prognosis: Structured review of the literature

The purpose of this paper was To review and appraise pertinent articles to gain a better understanding of critical methodological issues necessary to properly design a high-quality back pain prognosis study. The review concen trated on back pain prognosis studies with epidemiologically sound designs focusing on work-disability outcomes and utilizing survival analytic method s. Nine papers were reviewed. There were few well-designed studies that ach ieved good scientific quality with minimal flaws. The outcomes were well de fined in each paper The age and sex characteristics of the cohorts were des cribed in six papers and an adequate description of the study site occurred in five papers. AIL papers employed suitable mathematical statistical tech niques, bur only one paper discussed accuracy and predictive value. No pape r addressed the issue of reproducibility of the predictor variables or thee final model. Most papers derived models that were clinically sensible, and the ease of use for clinicians was high. A recommended course of action fo r use by future patients/therapists in prognostication was rarely documente d To date, prognosis has been an inadequately studied aspect of the continu um from back injury to recovery Researchers and clinicians interested in pr ognosis research need to overcome the limitations of past designs and addre ss the methodological guidelines outlined to improve the quality of future prognosis studies.