Prognosis in Acute Occupational Low Back Pain: Methodologic and Practical Considerations

Work-related or occupational low back pain (OLBP) is the leading cause of disability due to work-related conditions. The clinical course of this disorder is highly variable. Accurate prediction of disability outcomes in acute OLBP can lead to better selection of those likely to benefit from intensive interventions, identification of specific issues for intervention, and more efficient patient selection in clinical trials. The basis for disability prognostication has been developed through studies of outcomes in acute OLBP. These include investigations based on administrative data, workplace studies, and clinical studies in physicians' offices or workplaces. Each study design has inherent strengths and limitations that affect the accuracy of the resulting predictive models. Practical concerns for use of prognostic models in clinical settings include generalizability of results, feasibility of data collection and interpretation, acceptability to patients, cost, and linking prognosis to effective interventions. Ethical concerns include informed consent, confidentiality issues and inappropriate negative labeling. An informed choice of prognostic model and associated measures based on specific goals is needed to develop an appropriate application for a particular clinical or research situation. Future research may lead to greater use of these models, improving outcomes for workers with OLBP.