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Rheumatology Advance Access originally published online on December 23, 2005
Rheumatology 2006 45(6):718-723; doi:10.1093/rheumatology/kei231
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© The Author 2005. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Outcome of subacute low back pain: influence of patients' and rheumatologists' characteristics

S. Poiraudeau, F. Rannou, A. Le Henanff1, E. Coudeyre2, S. Rozenberg3, D. Huas4, C. Martineau5, I. Jolivet-Landreau6, M. Revel and P. Ravaud1

Service de Médecine Physique et Réadaptation, Hôpital Cochin (AP-HP), Université Paris 5, Institut Fédératif de Recherche (IFR 25) Handicap INSERM, 27 rue du Faubourg Saint-Jacques, 75679 Paris Cedex 14, 1 Département d’Epidémiologie, Biostatistique et de Recherche Clinique, Groupe Hospitalier Bichat-Claude Bernard (AP-HP), Université Paris 7, 75018 Paris, 2 Centre de Médecine Physique et Réadaptation Notre Dame, Avenue Joseph Claussat, BP 86, 63 404 Chamalières Cedex, 3 Service de Rhumatologie, Hôpital de la pitié-Salpêtrière (AP-HP), Université Paris 6, 75013 Paris, 4 Département de Médecine Générale, Université Paris 7, 75018 Paris, 5 Centre anti-douleur, Hôpital Européén Georges Pompidou (AP-HP), Université Paris 5, 75015 Paris and 6 Laboratoire Théraplix Aventis Pharma, 75012 Paris, France.

Correspondence to: S. Poiraudeau, Service de Médecine Physique et Réadaptation, Hôpital Cochin (AP-HP), Université Paris 5, 27 rue du Faubourg Saint-Jacques, 75679 Paris Cedex 14, France. E-mail: serge.poiraudeau{at}cch.ap-hop-paris.fr

Objectives. To assess the outcome of subacute low back pain, to identify the characteristics of patients and physicians which were related to outcome and to evaluate the influence of rheumatologists’ beliefs about back pain on their following the guidelines for physical and occupational activity.

Methods. Design: a longitudinal descriptive survey. Setting: a secondary care practice in France. Participants: 266 rheumatologists; 440 patients with subacute low back pain. Outcome measures: the main outcome measure was persistence of back pain 3 months after baseline evaluation. A self-administered questionnaire for physicians assessed attitudes and beliefs about back pain [Fear-Avoidance Beliefs Questionnaire (FABQ)], and one for patients assessed pain, perceived handicap and disability (Quebec Scale), anxiety and depression (Hospital Anxiety Depression Questionnaire), and beliefs about back pain (FABQ).

Results. Forty per cent of patients had persistent low back pain at 3 months; 5.5% of these had sciatica. A total of 10% of rheumatologists and 68% of patients at baseline had a high FABQ physical score (phys; >14). Determinants of outcomes were work-related back pain [odds ratio (OR) = 3.37; 95% confidence interval (CI) 1.08–5.17], anxiety (OR = 2.41; 95% CI 1.44–4.09), sex (female OR = 2.03; 95% CI 1.30–3.18) and patients’ beliefs about back pain at work (OR = 1.02; 95% CI 1.00–1.05). Physicians with high FABQ physical scores were less likely to follow guidelines on prescribing rest and occupational activity for back pain.

Conclusion. Back pain commonly persists 3 months later in patients with subacute low back pain. Patients and rheumatologists still have negative beliefs about back pain. Rheumatologists’ beliefs influence their following guidelines on physical and occupational activities. National education programmes about low back pain are needed in France.

KEY WORDS: Low back pain, Outcome, Subacute, Fears, Beliefs, Survey


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