• Petrozzi MJ
• Rubinstein SM
• Ferreira PH
• Leaver A
• Mackey MG

• Affiliation / University of Sydney. School of Health Sciences. Faculty of Medicine and Health
• Affiliation / Vrije Universiteit Amsterdam. Department of Health Sciences
• Affiliation(G) / Australia / New South Wales / Sydney
• Affiliation(G) / Netherlands / Amsterdam
• Chiropractic / Australia
• Low Back Pain
• Manipulation, Spinal
• Mobilization
• Open Access Document
• Physical Therapy Modalities
• Prognosis

Background: Predicting ongoing disability for chronic non-specific low back pain (LBP) is important to avoid prolonged disability.

Objective: Determine predictors of disability at 6 month follow-up in patients with LBP at medium risk of ongoing disability.

Methods: Baseline data was collected from 108 patients with medium-risk chronic non-specific LBP (mean age 50.4 years, SD 13.6) from six private chiropractic and physiotherapy clinics in Australia who took part in a randomised control trial. All patients received a pragmatic course of multimodal physical treatments [e.g., manual therapy (spinal manipulation or mobilization and/or soft tissue massage)] combined with advice, education and exercise. Baseline prognostic variables included sociodemographic, physical and psychological characteristics. Primary outcome was disability (Roland Morris Disability) at 6 month follow-up. Multivariable linear regression analysis was conducted.

Results: Variables remaining in the final multivariable model: lower work ability (β = − 1.05, 95% CI − 1.40 to − 0.70; p < 0.0001) and consultation with a medical specialist for back pain in the preceding 3 months (β = 3.35, 95% CI 1.14 to 5.55; p < 0.003), which significantly predicted higher disability at 6 months (unadjusted R 2 = 0.31). Those with a lower work ability (scale 1 to 10) and who had seen a medical specialist for their back pain were more likely to report greater LBP-related disability at 6 months.

Conclusion: Patients with chronic LBP presenting to primary care with lower work ability and recent consultation with a medical specialist for LBP are more likely to have a worse prognosis; these are indicators to clinicians that standard conservative care may not adequately manage the patients’ needs.

Author keywords: Chronic non-specific LBP —  Predictors —  Prognosis —   Physical therapy  —  Chiropractic

Author affiliations: MJP, PHF, AL, MGM: Faculty of Medicine and Health, University of Sydney, Sydney School of Health Sciences, Sydney, Australia; SMR: Department of Health Sciences, Vrije Universiteit, Amsterdam, The Netherlands 

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