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Chiropractic Research Review

Identifying Acute-Chronic LBP Progression

Evidence suggests that 10% of occupational low back pain (LBP) cases account for 80% of the costs for the condition, yet most research is devoted to identifying risk factors for acute, not chronic, LBP.

It is known that risk factors for chronic LBP are different than those for acute LBP; chronic cases involve more individual, psychosocial, and workplace variables. Is it possible to identify which acute LBP cases will progress into costly chronic cases?

The authors of this study examined workers' compensation claimants identified from an insurance company in New Zealand to determine if a variety of factors reported by LBP patients at their initial time of injury claim could distinguish those at high risk for future chronic LBP. Three high-risk groups were assessed: nurses and nurses' aides, manual workers, and drivers. All subjects completed a number of self-administered questionnaires, such as a LBP history and the Oswestry Disability Index. The questionnaires provided information regarding physical function; general health; mental health; perception of support from other workers; overall job satisfaction; stressful life events occurring near the time of claim; and locus of control of behavior.

Twenty-four percent of the claimants (204 of 854 who completed the questionnaire) were still receiving monetary compensation three months after the initial claim. Job dissatisfaction and poor workplace relations were not linked to chronic LBP. Factors associated with progression from acute to chronic LBP are presented below, with corresponding odds ratios (OR) for increased likelihood of chronicity:

* Oswestry Disability score indicating at least moderate disability (OR, 3.1-4.0);
* severe radiating leg pain (OR, 1.9);
* high General Health Quality-28 score (OR, 1.9);
* obesity (OR, 1.7); and
* no "light" duties available on return to work (OR, 1.7).

The authors conclude, "Simple self-report measures of individual, psychosocial, and workplace factors at the time the initial earnings-related compensation claim is made for back pain can identify individuals with increased odds for development of chronic occupational disability."

Fransen M, Woodward M, Norton R, et al. Risk factors associated with the transition from acute to chronic occupational back pain. Spine 2002:27(1), pp. 92-98.

Chiropractic Research Review

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