Expectations about recovery from acute non-specific low back pain predict absence from usual work due to chronic low back pain: a systematic review.

QUESTION Do negative expectations in patients after the onset of acute low back pain increase the odds of absence from usual work due to progression to chronic low back pain? DESIGN Systematic review with meta-analysis of prospective inception cohort studies. PARTICIPANTS Adults with acute or subacute non-specific low back pain. OUTCOME MEASURE Absence from usual work at a given time point greater than 12 weeks after the onset of pain due to ongoing pain. RESULTS Ten studies involving 4683 participants were included in the review. Participants with acute or subacute pain and negative expectations about their recovery had significantly greater odds of being absent from usual work at a given time point more than 12 weeks after the onset of pain: OR 2.17 (95% CI 1.61 to 2.91). The exclusion of five studies with the greatest risk of bias showed that the result was similar when more rigorous quality criteria were applied: OR 2.52 (95% CI 1.47 to 4.31). CONCLUSION The odds that adults with acute or subacute non-specific low back pain and negative recovery expectations will remain absent from work due to progression to chronic low back pain are two times greater than for those with more positive expectations. These results were consistent across the included studies despite variations in the risk of bias.