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Chronicity of Back Problems During Working Life

Miedema, Harald S., MD*; Chorus, Astrid M. J., MSc*; Wevers, Cees W. J., MD; van der Linden, Sjef, MD

Primary Care
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SDC

Study Design. A follow-up study of a cohort of 444 patients aged 16 to 59 years who consulted with their general practitioners(GPs) in 1987-1988 for an incident episode of back pain.

Objectives. To determine the proportion of patients with back pain in whom chronic back problems develop after a follow-up of 7 years, to compare health outcomes and labor force participation of patients with and without chronic back problems and to identify determinants of chronicity.

Summary of Background Data. The incidence and prevalence of back pain are very high. A large proportion of the costs related to medical consumption, absence from work, and disability are probably caused by chronic back problems. It is unknown what proportion of back problems become chronic, especially after a long follow-up period, and which factors can predict chronicity.

Methods. Data on the course of the symptoms and medical consumption from the period between 1987-1988 and 1991 were gathered retrospectively. Data on several health outcomes, including LFP, and data on some work characteristics were collected prospectively in 1991. A more extensive data set on health outcomes including psychologic status and working situation was collected in 1994.

Results. Chronic back problems developed in 28% of the patients. These patients reported more pain, higher levels of medical resource consumption, worse health outcomes, and lower labor force participation. Episodes of back pain before 1987-1988, severe pain in 1991, and disability score in 1991 were positively associated with chronicity in 1994, difficulties with job performance in 1991, and frequent stooping in the subgroup of patients who held a paying job in the follow-up period.

Conclusions. Even after a follow-up of 7 years, the proportion of people with chronic back problems was high. The consequences for quality of life, labor force participation, and consumption of medical resources are clear. Further research is necessary to examine determinants and ways to prevent chronicity.

From the *Division of Public Health and Prevention, TNO Prevention and Health (Netherlands Organization for Applied Scientific Research), Leiden; †NIA-TNO B.V. (Consultancy and Research on Human Resources Management), Amsterdam; and the ‡Department of Rheumatology, Academic Hospital Maastricht, The Netherlands.

The current study and the ROME study were supported by a grant from the Dutch Ministry of Public Health, Welfare, and Sports, Rijswijk, the "Loosco" Foundation, Wijhe, and the Dutch League against Rheumatism, The Hague.

Acknowledgment date: August 15, 1997.

First revision date: November 14, 1997.

Acceptance date: January 9, 1998.

Device status category: 1.

Address reprint requests to: Harald S. Miedema, MD; TNO Prevention and Health; PO Box 2215; Leiden, NL-2301 CE; The Netherlands.

© 1998 by Lippincott Williams & Wilkins