Female gender, depressive symptoms, manual job, and higher physical disability predict long term low back pain persistence

ABSTRACT Background Low Back Pain (LBP) is a long-term health condition with distinct clinical courses. The characterization of these courses together with the identification of prognostic factors of a persistent disabling LBP course has the potential to enable a better identification of patients in high-risk and ultimately allow the development of personalized interventions to change their long-term prognosis. This study aimed to assess the course of chronic LBP (CLBP) over 5 years in a large population-based study, its cumulative impact on disability and health-related quality of life (HRQoL) and the indicators for persistent CLBP course. Material and methods Active CLBP participants were identified from a representative sample of 10.661 adults randomly recruited from the dwelling population of EpiDoC. Pain, disability and HRQoL were assessed at three time-points. According to their pain symptoms over time, participants were classified as having a persistent or relapsing pain course. A General Linear Model was used to compare mean differences between and within groups. The relation between baseline variables and persistent CLBP was modulated through logistic regression. Results Among the 1.201 adults with active CLBP at baseline, 634 completed the three time-points of data collection (52.8%) and 400 (63.1%) were classified as having a persistent course. Statistically significant interactions were found between the group and time on disability ( F (2.126)= 23.78, p <0.001) and HRQoL ( F (2.125)= 82.78, p <0.001). In the adjusted model, the persistent course was associated with the disability level (OR: 1.84, CI95% 1.4 to 2.4), presence of depressive symptoms (OR: 1.96, CI95% 1.2 to 3.2), female gender (OR: 1.9, CI95% 1.26-2.87), and having a manual job (OR: 1.46, CI95% 1.02 to 2.1). Conclusion In the long-term, CLBP patients have distinct clinical courses. Being female, presenting depressive symptoms, having a manual job and a higher disability at baseline predict a CLBP persistent outcome.