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The aim of the study was to identify factors that predict low-back pain outcome at 12 months and thus to identify patients at risk for poor long-term outcomes. One hundred-eighty patients, all disabled by acute low-back pain, were included. Outcome (dependent) variables were Oswestry disability score, recurrences during the study year, and chronicity defined as 90 or more days off work for low-back pain during the study year, or a disease-specific sick-leave rate (a variable created by the authors) of more than 25%. Stepwise logistic regression analysis was performed. Thirty-three percent of the patients had an Oswestry score greater than 25, indicating moderate disability at the 1-year follow-up evaluation. Pain on coughing at study entry predicted a high likelihood of disability at 1 year, with a threefold risk. Many work days missed as a result of low-back pain in the past 2 years and lack of stimulating work tasks predicted recurrences during the year. A high Oswestry score assessed at study entry was the only factor that predicted chronicity. The factors revealed in the current study should help the clinician to identify patients at risk. The authors propose that the revealed predictors should be investigated extensively at the patient's first visit for acute low-back pain.

One hundred eighty patients with acute low-back pain (LBP) were compared to 608 age- and sex-matched controls with regard to somatic and personality characteristics. The low-back-pain group had a fourfold increase (median) in sick-leave episodes for reasons other than spinal morbidity during the preceding 2 years. In the same period, the median number of episodes of sick leave for LBP was 1 in the patients and 0 in the controls. The mean number of days off for other reasons was 34 (median = 20.5) in the patients compared to 9 (median = 0) in the controls, and days off for LBP were 20 (median = 5) and 5 (median = 0), respectively. Analysis of other factors than those directly related to LBP disclosed significant differences in marital status and smoking habits between patients and controls. Furthermore, LBP patients estimated their work to be physically heavier. We conclude that medical intervention should focus not only on the spine, but also on a wide range of other aspects of the patient's situation. Even in the acute phase of LBP, the previous sick-leave records should be analyzed to provide adequate measures to prevent future sick leaves. Presently, the sociomedical costs for a subset of the population who repeatedly seek help for LBP are significantly higher than those for the non-LBP population.