Intended for healthcare professionals


Prognosis in patients with recent onset low back pain in Australian primary care: inception cohort study

BMJ 2008; 337 doi: (Published 07 July 2008) Cite this as: BMJ 2008;337:a171
  1. Nicholas Henschke, postdoctoral fellow12,
  2. Christopher G Maher, director of division12,
  3. Kathryn M Refshauge, professor2,
  4. Robert D Herbert, associate professor12,
  5. Robert G Cumming, professor3,
  6. Jane Bleasel, rheumatologist4,
  7. John York, rheumatologist4,
  8. Anurina Das, research officer2,
  9. James H McAuley, research manager12
  1. 1Musculoskeletal Division, The George Institute for International Health, Sydney, Australia
  2. 2Back Pain Research Group, Faculty of Health Sciences, University of Sydney
  3. 3School of Public Health, University of Sydney
  4. 4Department of Rheumatology, Royal Prince Alfred Hospital, Sydney
  1. Correspondence to: C G Maher, PO Box M201, Camperdown NSW 2050, Australia cmaher{at}
  • Accepted 25 April 2008


Objective To estimate the one year prognosis and identify prognostic factors in cases of recent onset low back pain managed in primary care.

Design Cohort study with one year follow-up.

Setting Primary care clinics in Sydney, Australia.

Participants An inception cohort of 973 consecutive primary care patients (mean age 43.3, 54.8% men) with non-specific low back pain of less than two weeks’ duration recruited from the clinics of 170 general practitioners, physiotherapists, and chiropractors.

Main outcome measures Participants completed a baseline questionnaire and were contacted six weeks, three months, and 12 months after the initial consultation. Recovery was assessed in terms of return to work, return to function, and resolution of pain. The association between potential prognostic factors and time to recovery was modelled with Cox regression.

Results The follow-up rate over the 12 months was more than 97%. Half of those who reduced their work status at baseline had returned to previous work status within 14 days (95% confidence interval 11 to 17 days) and 83% had returned to previous work status by three months. Disability (median recovery time 31 days, 25 to 37 days) and pain (median 58 days, 52 to 63 days) took much longer to resolve. Only 72% of participants had completely recovered 12 months after the baseline consultation. Older age, compensation cases, higher pain intensity, longer duration of low back pain before consultation, more days of reduced activity because of lower back pain before consultation, feelings of depression, and a perceived risk of persistence were each associated with a longer time to recovery.

Conclusions In this cohort of patients with acute low back pain in primary care, prognosis was not as favourable as claimed in clinical practice guidelines. Recovery was slow for most patients. Nearly a third of patients did not recover from the presenting episode within a year.


  • Contributors: CGM, KMR, RDH, RGC, and JB were the chief investigators on the NHMRC project grant that funded the study. All authors contributed to the design of the study. NH, AD, JHMc, CGM, KMR, JB, and JY trained the recruiting clinicians. NH, AD, and JHMc conducted the follow-up assessments and entered and double checked the data. All authors contributed to the analysis and interpretation of the data and reviewed and approved the final version of the manuscript. CGM is guarantor.

  • Funding: National Health and Medical Research Council of Australia.

  • Competing interests: None declared.

  • Ethical approval: University of Sydney human research ethics committee.

  • Provenance and peer review: Not commissioned; externally peer reviewed.

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