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Chapter 2

Evidence Review

Diagnostic Triage

Initial Assessment Methods
(Adapted from AHCPR 1994)

X-Rays

Psychosocial Factors

Risk factors for chronicity

Management

Information to Patients

Information to Patients

Appropriate information and advice can reduce anxiety and improve patient satisfaction with care.

Deyo & Diehl 1986, Jones et al 1988, Roland & Dixon 1989, AHCPR 1994

Evidence exists in support of the following statements:

Most severe back pain and severe activity limitation improves considerably in a few days or at most a few weeks, but milder symptoms may persist longer, often for a few months.
Most patients will have some recurrences of back pain from time to time.
( Recurrences are normal and do not mean that you have re-injured your back or that your condition is getting worse.)
About 10% of patients will have some persisting symptoms a year later, but most of them can manage to continue with most normal activities. Patients who return to normal activities feel healthier, use less analgesics and are less distressed than those who limit their activities.

Pedersen 1981, Troup et al 1981 and Lloyd & Troup 1983 (same study), Roland & Morris 1983 and Roland et al 1983 (same study), Chavannes et al 1986, Coste et al 1994, Von Korff et al 1993, Von Korff & Saunders 1996

The longer someone is off work with back pain, the lower their chance of returning to work.

McGill 1968, Abenhaim et al 1985, Waddell 1987.

Back pain does not usually increase with age, but becomes (slightly) less common after age 50-60.
However, older patients who do continue to have back pain may have more persistent symptoms and more activity limitation.

CSAG 1994b

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