Abstract
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 concentrated on back pain prognosis studies with epidemiologically sound designs focusing on work-disability outcomes and utilizing survival analytic methods. Nine papers were reviewed. There were few well-designed studies that achieved good scientific quality with minimal flaws. The outcomes were well defined in each paper. The age and sex characteristics of the cohorts were described in six papers and an adequate description of the study site occurred in five papers. All papers employed suitable mathematical/statistical techniques, but only one paper discussed accuracy and predictive value. No paper addressed the issue of reproducibility of the predictor variables or the final model. Most papers derived models that were clinically sensible, and the ease of use for clinicians was high. A recommended course of action for use by future patients/therapists in prognostication was rarely documented. To date, prognosis has been an inadequately studied aspect of the continuum from back injury to recovery. Researchers and clinicians interested in prognosis research need to overcome the limitations of past designs and address the methodological guidelines outlined to improve the quality of future prognosis studies.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
McIntosh G, Frank JW, Hogg-Johnson S, Bombardier C, Hall H. Prognostic factors for time receivingworkers' compensation benefits in a cohort of patients with low-back pain. Spine 2000; 25(2): 147–157.
Frank JW, Brooker AS, Demaio S, Kerr MS, Maetzel A, Shannon HS, Sullivan TJ, Norman RW, Wells RP. Disability resulting from occupational low-back pain. Part II: What do we know about secondary prevention? A review of the scientific evidence on prevention after disability begins. Spine 1996; 21(24): 2918–2929.
Frank JW, Pulcins IR, Kerr MS, Shannon HS, Stansfeld SA. Occupational back pain-an unhelpful polemic. Scand J Work Environ Health 1995; 21: 3–14.
How to read clinical journals: III. To learn the clinical course and prognosis of disease. Can Med Assoc J 1981; 124: 869–872.
Pulcins IR, Goel V, Cohen JE, Frank JW. A structured critical review of acute back pain prognosis studies. Working Paper No. 21-R1, Institute for Work & Health, 1995, unpublished.
Baldwin ML, Johnson WG, Butler RJ. The error of using returns-to-work to measure the outcomes of health care. Am J Industr Med 1996; 29: 632–641.
Allison PD. Survival analysis using the SAS system: A practical guide. SAS Institute, Inc., Cary, NC, 1995.
Haidar H. Expressing effect estimates of predictors of return to work. MS Thesis in Epidemiology. Toronto: University of Toronto Press, 1997.
Hogg-Johnson S, Cole DC. Early prognostic factors for duration on benefits amongworkers with compensated occupational soft tissue injuries. Working Paper No. 64, Institute For Work & Health, 1998, unpublished.
Hogg-Johnson SA, Frank JW, Rael E. Prognostic risk factor models for low-back pain: Why they have failed and a new hypothesis. Working Paper, No. 19, Institute for Work & Health, 1994, unpublished.
Mau W, Bornmann M, Weber H, Weidemann HF, Hecker H, Raspe HH. Prediction of permanent work disability in a follow-up study of early rheumatoid arthritis: Results of a tree structured analysis using RECPAM. Br J Rheumatol 1996; 35(7): 652–659.
Nishimura A, Sakata S, Iida K, Iwasaki Y, Takeshima T, Todoroki T, Ohara K, Hata K, Miyoshi M, Seo Y. Evaluation of intraoperative radiotherapy for carcinoma of the pancreas: Prognostic factors and survival analyses. Radiation Med 1988; 6(2): 85–91.
Ridder GJ. Klempnauer J. Back pain in patients with ductal pancreatic cancer. Its impact on resectability and prognosis after resection. Scand J Gastroenterology 1995; 30(12): 1216–1220.
Albert SM, Marder K, Dooneief G, Bell K, Sano M, Todak G, Stern Y. Neuropsychologic impairment in early HIV infection. A risk factor for work disability. Arch Neurol 1995; 52(5): 525–530.
van den Hoogen HJM, Koes BW, Deville W, van Eijk JTM, Bouter LM. The prognosis of low-back pain in general practice. Spine 1997; 22(13): 1515–1521.
Indahl A, Velund L, Reikeraas O. Good prognosis for low-back pain when left untampered. A randomized clinical trial. Spine 1995; 20(4): 473–477.
Burdorf A, Naaktgeboren B, Post W. Prognostic factors for musculoskeletal sickness absence and return to work among welders and metal workers. Occup Environ Med 1998; 55(7): 490–495.
Infante-Rivard C, Lortie M. Relapse and short sickness absence for back pain in the six months after return to work. Occup Environ Med 1997; 54(5): 328–334.
Infante-Rivard C, Lortie M. Prognostic factors for return to work after a first compensated episode of back pain. Occup Environ Med 1996; 53(7): 488–494.
Oleinick A, Gluck JV, Guire KE. Factors affecting first return to work following a compensable occupational back injury. Am J Industr Med 1996; 30: 540–555.
Cheadle A, Franklin G, Wolfhagen C, Savarino J, Liu PY, Salley C, Weaver M. Factors influencing the duration of work-related disability: A population based study of washington state workers' compensation. Am J Public Health 1994; 84: 190–196.
Coste J, Delecoeuillerie G, Cohen De Lara A, Le Parc JM, Paolaggi J. Clinical course and prognostic factors in acute low-back pain: An inception cohort study in primary care practice. Br Med J 1994; 308: 577–580.
Sinclair S, Hogg-Johnson SA, Mondloch MV, Shields SA. The effectiveness of an early active intervention program for workers with soft-tissue injuries: Early claimant cohort study. Spine 1997; 22(24): 2219–2231.
Singer J, Gilbert J, Hutton T, Taylor D. Predicting outcome in acute low-back pain. Can Fam Physician 1987; 33: 655–659.
Reid S, Haugh LD, Hazard RG, Tripathi M. Occupational low-back pain: Recovery curves and factors associated with disability. J Occup Rehabil 1997; 7(1): 1–14.
Johnson W, Ondrich J. The duration of post injury absences from work. November 1989, unpublished.
Johnson W, Butler R, Baldwin M. First spells of work absences among Ontario workers. March 1993, unpublished.
Lynch M. The duration of invalidity benefits claims: A proportional hazard model. Applied Econom 1991; 23: 1043–1052.
McIntosh G. Back pain prognostic factors: A cohort study of 1,752 patients of a national rehabilitation clinic system. MS Thesis in Epidemiology. Toronto: University of Toronto Press, 1999.
Wasson JH, Sox HC, Neff RK, Goldman L. Clinical prediction rules: Application and methodological standards. N Engl J Med 1985; 313: 793–799.
Laupacis A, Sekar N, Stiell IG. Clinical prediction rules: A review and suggested modifications of methodological standards. JAMA 1997; 277(6): 488–494.
Greenough CG, Fraser RD. The effects of compensation on recovery from low back injury. Spine 1989; 14(9): 947–955.
Spitzer WO, Leblanc FE, Dupuis M. Scientific approach to the assessment and management of activity-related spinal disorders: A monograph for clinicians. Report of the Quebec task force on spinal disorders. Spine 1987; 12(7S): 1–59.
The Cochrane Collaboration Handbook–version 3.0.2. Institute for Work & Health 1998.
Last JM. A dictionary of epidemiology. New York: Oxford University Press, 1995.
Kleinbaum DG. Survival analysis: A self learning text. New York: Springer-Verlag, 1996.
Cantor AB. Extending SAS survival analysis techniques for medical research. SAS Institute, Inc., Cary, NC, 1997.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
McIntosh, G., Frank, J., Hogg-Johnson, S. et al. Low Back Pain Prognosis: Structured Review of the Literature. J Occup Rehabil 10, 101–115 (2000). https://doi.org/10.1023/A:1009450102876
Issue Date:
DOI: https://doi.org/10.1023/A:1009450102876