Individual recovery expectations and prognosis of outcomes in non specific low back pain: prognostic factor review

Low back pain is the most common pain in the general population and the leading cause of disability, globally causing a high socioeconomic impact. Most people who experience low back pain have a “non-specific” pain, meaning the pain cannot be attributed to a specific pathology, such as a fracture or rheumatoid arthritis. Between 60% and 80% of people with low back pain who have consulted a practitioner will continue to have pain after one year.
Research has not yet found a specific cause for most cases of low back pain, but studies have found several factors associated with poor outcomes including older age, poor general health, baseline disability, increased stress, negative cognitive characteristics, heavy physical demands in the workplace, and receipt of compensation. Patients’ expectations of treatment and recovery have been shown to be related to outcomes. Considering that this is a potentially modifiable prognostic factor, attention is now focused on it.
The aim of this review was to find out if positive recovery expectations may influence future pain, return to activities, and return to work in people suffering from low back pain. Sixty studies met the inclusion criteria. Fifty studies provided data for narrative syntheses, and 24 provided results from meta‐analyses. Information regarding a total of 30,530 people was included.
Moderate-quality evidence that positive expectations were strongly associated with better work participation was found. Functional limitations and pain intensity outcomes were less certain to be associated with prognosis (moderate observed association). Expectations may be associated with clinically important recovery outcomes (low-quality evidence). Future studies are needed to assess psychometric properties of measures of expectations.

Comment by Sara Laxe