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Back Pain Recurrence: An Evaluation of Existing Indicators and Direction for Future Research

Wasiak, Radoslaw, PhD*†; Young, Amanda E., PhD; Dunn, Kate M., PhD§; Côté, Pierre, DC, PhD¶∥; Gross, Douglas P., PhD**; Heymans, Martijn W., PhD††; von Korff, Michael, ScD‡‡

doi: 10.1097/BRS.0b013e3181a01b63
Health Services Research

Study Design. Literature review.

Objective. To present a framework for future analyses of back pain recurrence and explore the applicability and relevance of existing recurrence indicators.

Summary of Background Data. Empirical studies of back pain have included a variety of indicators of recurrence, resulting in a range of findings about recurrence rates and associated factors. Little is known about the relationships between existing indicators.

Methods. Literature overview, expert panel, and workshop discussion at the IX International Forum on Primary Care Research on Low Back Pain.

Results. Using the International Classification of Functioning, Disability, and Health (ICF), disabling back pain was conceptualized as a health condition, i.e., back pain disorder (BPD), and BPD recurrence was conceptualized as involving a return of atypical back pain and/or back-pain-related difficulty performing tasks and actions related to the initial episode. Using the ICF, 2 types of recurrence indicators were identified: those directly describing components of BPD and those indirectly doing so (e.g., recurrence of health care utilization).

Conclusion. In light of the difficulty in measuring BPD recurrence, transparent definitions and a clear understanding of the implications of using particular indicators is required. Future research should focus: on examining the capture BPD recurrence by various research instruments, improving understanding of the relationship between indicators, and gaining insight into how individuals experiencing BPD view recurrence.

Disabling back pain was conceptualized as a health conditionback pain disorder (BPD). This allowed focusing on aspects of individuals' experience: impairment, activity limitations, and participation restrictions. Recurrence of BPD was defined as any postinitial episode. Two types of recurrence indicators were identified: describing components of BPD directly and indirectly.

From the *United BioSource Corporation, London, United Kingdom; †Department of Environmental Health, Harvard School of Public Health, Boston, MA; ‡Center for Disability Research, Liberty Mutual Research Institute for Safety, Hopkinton, MA; §Arthritis Research Campaign Primary Care Centre, Keele University, Staffordshire, UK; ¶Center for Research Excellence–Improved Disability Outcomes, Toronto Western Hospital, Toronto, Canada; ∥Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; **Department of Physical Therapy, University of Alberta, Edmonton, Canada; ††EMGO Institute, VU Medical Centre, Amsterdam, The Netherlands; and ‡‡Center for Health Studies, Group Health Cooperative, Seattle, WA.

Acknowledgment date: June 25, 2008. Revision date: October 8, 2008. Acceptance date: October 31, 2008.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Part of this work was undertaken when Radoslaw Wasiak was associated with Center for Disability Research, Liberty Mutual Research Institute for Safety, Hopkinton, MA.

Address correspondence and reprint requests to Radoslaw Wasiak, PhD, United BioSource Corporation, 20 Bloomsbury Square, London, WC1A 2NS, United Kingdom; E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.