Affiliations: [a] Centre for Health Sciences, School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland | [b] Centre for Medical Research, QEII Medical Centre, University of Western Australia, Nedlands, WA, Australia | [c] Department of Work and Organizational Psychology, Institute for Psychology, University of Berne, Berne, Switzerland | [d] Department of Orthopaedic Surgery, Asklepios Klinikum Uckermark, Schwedt/Oder, Germany | [e] Institute for Evaluative Research in Orthopaedic Surgery, MEM Research Center, University of Berne, Berne, Switzerland | [f] Centre for Musculoskeletal Outcomes Research, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
Correspondence:
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Corresponding author: Markus Melloh, Centre for Health Sciences, School of Health Professions, Zurich University of Applied Sciences, Technikumstrasse 71, 8401 Winterthur, Switzerland. Tel.: +41 589344396; Fax: +41 58935 4396; E-mail: markus.melloh@zhaw.ch
Abstract: Background:Early identification of patients at risk of developing persistent low back pain (LBP) is crucial. Objective:Aim of this study was to identify in patients with a new episode of LBP the time point at which those at risk of developing persistent LBP can be best identified. Methods:Prospective cohort study of 315 patients presenting to a health practitioner with a first episode of acute LBP. Primary outcome measure was functional limitation. Patients were assessed at baseline, three, six, twelve weeks and six months looking at factors of maladaptive cognition as potential predictors. Multivariate logistic regression analysis was performed for all time points. Results:The best time point to predict the development of persistent LBP at six months was the twelve-week follow-up (sensitivity 78%; overall predictive value 90%). Cognitions assessed at first visit to a health practitioner were not predictive. Conclusions:Maladaptive cognitions at twelve weeks appear to be suitable predictors for a transition from acute to persistent LBP. Already three weeks after patients present to a health practitioner with acute LBP cognitions might influence the development of persistent LBP. Therefore, cognitive-behavioral interventions should be considered as early adjuvant LBP treatment in patients at risk of developing persistent LBP.
