Coste J, Delecoeuillerie G, Cohen de Lara A, Le Parc J M, Paolaggi J B
INSERM Unité U 292, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.
BMJ. 1994 Feb 26;308(6928):577-80. doi: 10.1136/bmj.308.6928.577.
To describe the natural course of recent acute low back pain in terms of both morbidity (pain, disability) and absenteeism from work and to evaluate the prognostic factors for these outcomes.
Inception cohort study.
Primary care.
103 patients with acute localised non-specific back pain lasting less than 72 hours.
Complete recovery (disappearance of both pain and disability) and return to work.
90% of patients recovered within two weeks and only two developed chronic low back pain. Only 49 of 100 patients for whom data were available had bed rest and 40% of 75 employed patients lost no time from work. Proportional hazards regression analysis showed that previous chronic episodes of low back pain, initial disability level, initial pain worse when standing, initial pain worse when lying, and compensation status were significantly associated with delayed episode recovery. These factors were also related to absenteeism from work. Absenteeism from work was also influenced by job satisfaction and gender.
The recovery rate from acute low back pain was much higher than reported in other studies. Those studies, however, did not investigate groups of patients enrolled shortly after the onset of symptoms and often mixed acute low back pain patients with patients with exacerbations of chronic pain or sciatica. Several sociodemographic and clinical factors were of prognostic value in acute low back pain. Factors which influenced the outcome in terms of episode recovery (mainly physical severity factors) were only partly predictive of absenteeism from work. Time off work and return to work depended more on sociodemographic and job related influences.
从发病率（疼痛、残疾）以及工作缺勤方面描述近期急性下背痛的自然病程，并评估这些结果的预后因素。
队列起始研究。
初级保健机构。
103例急性局限性非特异性下背痛持续时间少于72小时的患者。
完全恢复（疼痛和残疾均消失）以及重返工作岗位。
90%的患者在两周内康复，仅有2例发展为慢性下背痛。在可获取数据的100例患者中，仅49例卧床休息，75例就业患者中有40%未耽误工作时间。比例风险回归分析显示，既往慢性下背痛发作史、初始残疾水平、站立时初始疼痛加重、卧位时初始疼痛加重以及赔偿状况与病情恢复延迟显著相关。这些因素也与工作缺勤有关。工作缺勤还受工作满意度和性别的影响。
急性下背痛的康复率远高于其他研究报道。然而，那些研究未调查症状发作后不久纳入的患者群体，且常将急性下背痛患者与慢性疼痛加重或坐骨神经痛患者混在一起。一些社会人口学和临床因素对急性下背痛具有预后价值。就病情恢复而言影响结果的因素（主要是身体严重程度因素）仅部分预测了工作缺勤情况。休假时间和重返工作岗位更多地取决于社会人口学和与工作相关的影响因素。
