Characteristics of Patients With Acute Low Back Pain Presenting to Primary Care in Australia
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ORIGINAL ARTICLE
Characteristics of Patients With Acute Low Back Pain
Presenting to Primary Care in Australia
Nicholas Henschke, BAppSc,* Christopher G. Maher, PhD,* Kathryn M. Refshauge, PhD,w
Robert D. Herbert, PhD,* Robert G. Cumming, PhD,z Jane Bleasel, PhD,y John York, MD,y
Anurina Das, MMedSc,w and James H. McAuley, PhD*w
Objectives: This study aimed to provide a comprehensive profile of
a representative sample of patients with acute low back pain drawn
L ow back pain is common, can be seriously disabling, and
imposes an enormous social and economic burden on
communities around the world.1 In Australia, for example,
from the primary care setting. A secondary aim was to determine it is estimated that approximately 20% of the population,
whether patient characteristics are associated with pain intensity or or 3.9 million people, have low back pain at any one time.2
disability at the initial consultation. Back complaints are the third most common condition in
Methods: A total of 1172 consecutive patients with acute low back patients consulting general practitioners in Australia, and
pain presenting to clinics of primary care practitioners (general the most common musculoskeletal condition.3 It is also the
practitioners, physiotherapists, and chiropractors) in Australia most common health problem for which an imaging test is
were recruited. Pain intensity and level of disability were measured ordered by a general practitioner.3
at the first consultation, and a range of other variables were Despite the considerable burden associated with low
measured to describe the patient’s characteristics. The character- back pain, relatively little is known about the characteristics
istics were then grouped into 7 distinct factors: demographic, of patients with acute low back pain. To improve the
social, cultural, general health, psychologic, past low back pain understanding and management of a health condition,
history, and current low back pain history. Hierarchical linear accurate information is needed regarding the patients’
regression models were used to determine each factor’s independent characteristics and their clinical presentation in a relevant
relationship with pain intensity and disability. setting.4 Previous Australian studies reporting the char-
acteristics of low back pain patients have either been
Results: The majority of patients reported having had a previous population-based surveys,2,5,6 surveys of patients present-
episode of low back pain (75.7%), and that the current episode was ing to specialists,7 or reports on the whole spectrum of
of sudden onset (76.7%). Only a small proportion (14.3%) had general practitioner activity.3 There are some data on low
compensable back pain. Pain intensity and disability were back pain patients attending primary care from North
associated with each other (PHenschke et al Clin J Pain Volume 25, Number 1, January 2009
October 2005 from the 3 main primary care professions Demographic, social, and cultural characteristics were
who manage low back pain in Australia18: general medical measured using questions taken from the 2001 Australian
practitioners, physiotherapists, and chiropractors. In Census. Data from the 2001 Australian Census was also
Australia, these professions are considered primary care used to determine the socioeconomic level of the postcode
clinicians as they provide health services to the community area in which a patient lived.26 Psychologic characteristics
without the need for prior referral. Access to primary care were assessed using questions from the Acute Low Back
clinicians is unrestricted to the public, and these clinicians Pain Screening Questionnaire,27 including items on anxiety,
serve as gatekeepers to specialist care.19 For this study, depression, and coping. Past and current low back pain
clinicians from the 3 professions were recruited from the history characteristics included questions regarding the
Sydney metropolitan area. Names and practice addresses onset of low back pain and previous episodes.
were extracted from telephone directories, professional
registry listings, and through contact with professional Data Analysis
associations of the 3 groups. Clinicians were excluded if they Descriptive statistics were used to describe the baseline
were not current primary care providers (eg, specialists or characteristics of the patients. Separate hierarchical linear
retired), were not practising within the study area, or if there regression models were used to determine the independent
were insufficient contact details available. Ethical approval relationship between pain intensity and level of interference
for this study was granted by the University of Sydney with function measured at baseline, and each of the 7
Human Research Ethics Committee. factors. Each factor, consisting of a number of variables,
was first entered as a block into the regression analysis with
Inclusion and Exclusion Criteria either pain or interference with function as the dependent
Participating clinicians were asked to screen all variable. The factors that had a statistically significant
patients with the primary symptom of low back pain who (PClin J Pain Volume 25, Number 1, January 2009 Characteristics of Acute Low Back Pain Patients
TABLE 1. Number of Ineligible Patients and Reasons for TABLE 2. Demographic, Social, Cultural, and General Health
Ineligibility Characteristics of a Primary Care Acute LBP Population
No. Patients Total
Reason for Ineligibility (%) Variable n = 1172
Not screened (practitioner forgot/too busy) 181 (9.0) Age (mean ± SD) 43.97 ± 15.1
AgedHenschke et al Clin J Pain Volume 25, Number 1, January 2009
TABLE 3. Clinical and Psychologic Characteristics of a TABLE 4. Hierarchical Regression Analyses With Pain
Primary Care Acute LBP Population Intensity as the Dependent Variable
Total Factor Being Variables Included R2 F
Variable n = 1172 Evaluated in Each Groupw Change Change bz t
Primary care clinician Demographic 0.02 14.09**
General practitioner 267 (22.8%) Sex—male 0.06 2.09*
Physiotherapist 851 (72.6%) Age 0.14 4.89**
Chiropractor 54 (4.6%) Cultural 0.03 2.01
Previous episode of LBP 888 (75.8%) Social 0.04 1.15
Previous sick leave owing to LBP 435 (37.1%) Past history 0.03 1.25
Previous back surgery 29 (2.5%) Current 0.05 9.13**
Sudden onset of LBP history
899 (76.7%)
Compensable LBP Clinician— 0.00 0.02
168 (14.3%)
Other pain sites consulted GP
Neck Clinician— 0.05 0.89
160 (13.7%)
Shoulders consulted
108 (9.2%)
Upper Back physiotherapist
99 (8.4%)
Leg Sudden onset 0.03 1.00
295 (25.2%)
Significant trauma (minor in old, major in young) Leg pain 0.02 0.52
31 (2.6%)
Currently taking medication for LBP No. pain sites 0.00 0.04
424 (36.2%)
Duration of LBP Significant trauma 0.01 0.42Clin J Pain Volume 25, Number 1, January 2009 Characteristics of Acute Low Back Pain Patients
TABLE 5. Hierarchical Regression Analyses With Interference With Function as the Dependent Variable
Factor Being Evaluated Variables Included in Each Groupw R2Change F Change bz t
Pain intensity 0.17 357.86** 0.46 18.92**
Demographic 0.00 0.55
Social 0.01 5.13**
Low socioeconomic index 0.00 0.07
Lower level of education 0.00 0.03
Compensable LBP 0.02 0.62
Working preinjury 0.04 1.41
Changed work status 0.13 4.96**
General health 0.01 4.92**
Smoker 0.08 3.26**
Exercising regularly 0.02 0.89
Self-rated health 0.03 1.35
Past history 0.00 1.42
Current history 0.01 3.78**
Clinician—consulted GP 0.05 0.97
Clinician—consulted 0.05 1.04
physiotherapist
Sudden onset 0.03 1.21
Leg pain 0.04 1.35
No. pain sites 0.04 1.30
Significant trauma 0.01 0.39
Taking medication 0.09 3.89**
Duration (wk) 0.06 2.49*
Psychologic 0.04 18.03**
Satisfaction with symptoms 0.11 4.94**
Ability to cope 0.03 1.28
Feeling tense or anxious 0.11 3.89**
Bothered by feelings of depression 0.09 3.06**
Risk of persistent pain 0.00 0.03
Change statistics represent the contribution of the factor after controlling for all other factors. Total R2 = 0.44.
*PHenschke et al Clin J Pain Volume 25, Number 1, January 2009
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