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Primary Care

Acute low back pain: systematic review of its prognosis

BMJ 2003; 327 doi: (Published 07 August 2003) Cite this as: BMJ 2003;327:323
  1. Liset H M Pengel, PhD student1,
  2. Robert D Herbert, senior lecturer (R.Herbert{at},
  3. Chris G Maher, associate professor1,
  4. Kathryn M Refshauge, associate professor1
  1. 1School of Physiotherapy, University of Sydney, PO Box 170, Lidcombe NSW 1825, Australia
  1. Correspondence to: R D Herbert
  • Accepted 4 June 2003


Objectives To describe the course of acute low back pain and sciatica and to identify clinically important prognostic factors for these conditions.

Design Systematic review.

Data sources Searches of Medline, Embase, Cinahl, and Science Citation Index and iterative searches of bibliographies.

Main outcome measures Pain, disability, and return to work.

Results 15 studies of variable methodological quality were included. Rapid improvements in pain (mean reduction 58% of initial scores), disability (58%), and return to work (82% of those initially off work) occurred in one month. Further improvement was apparent until about three months. Thereafter levels for pain, disability, and return to work remained almost constant. 73% of patients had at least one recurrence within 12 months.

Conclusions People with acute low back pain and associated disability usually improve rapidly within weeks. None the less, pain and disability are typically ongoing, and recurrences are common.


  • Contributors LHMP designed the study protocol, located and selected studies, extracted and interpreted the data, wrote the paper, and approved the final manuscript. RDH designed the study protocol, extracted and interpreted the data, advised on the statistical analysis, and revised and approved the final manuscript. CGM and KMR designed the study protocol, assessed the quality of the trials, interpreted the data, and revised and approved the final manuscript. LHMP will act as guarantor for the paper

  • Funding LHMP's scholarship was funded by the National Health and Medical Research Council and the Australasian Physiotherapy Low Back Pain Trial Consortium. The guarantor accepts full responsibility for the conduct of the study, had access to the data, and controlled the decision to publish.

  • Competing interests None declared

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