Subakuter und chronischer Rückenschmerz in der hausärztlichen Versorgung: Eine systematische Übersichtsarbeit symptomevaluierender Studien

Background: Subacute and chronic back pain is a frequently seen symptom in the general practice. Reasons for encounter in general practice are usually symptoms. Therefore symptom based studies, which are subject of this review, evaluate important characteristics of the primary care setting: Prognosis, prevalence and etiology are the most interesting outcomes. Objective: This systematic review analyses the literature from the past 50 years assessing the results of symptom based studies about prognosis, prevalence and etiology of subacute and chronic back pain in a primary care setting in order to show the current state of knowledge. Methods: Studies were identified through systematic search of abstracts in Pubmed and through identification of relevant related publications in the literature list of the respective studies, until 2015. The identified abstracts were independently rated by two reviewers according to the following predefined criteria: qualitative design of included studies, primary care setting, symptom based study design, and subacute or chronic back pain with a minimum duration of 6 weeks and prognostic/prevalence/etiologic outcome. Bibliographic data, methodological items and outcome data from full text manuscripts of the eligible studies were extracted. A standardized outcome tool was applied to enable quality assessment. To ensure comparability of different outcomes, questionnaires percentage outcome measurements were used: percentage baseline value, percentage outcome value and a percentage change. Results: 3794 abstracts were identified that lead to a total of 885 publications. Finally 26 publications from 15 studies were included, matching the topic of this review. Due to the heterogeneity of the included studies a meta-analysis could not be performed and thus a descriptive analysis was used instead. The vast majority of the studies obtained good to average quality results and no study had to be excluded for quality reasons. Only one study provided aetiological data in which the authors found a prevalence of 23.6 % (CI: 19.4-28.3) for axial spondyloarthritis, 22 % of those showed results of a spondylitis ankylosans. Two studies reported results on the prevalence of chronic back pain. The first one found 1.3 % of the practice visits to be caused by chronic back pain patients. The second one declared that 5.95 % of chronically ill patients received an ICPC code for chronic back pain (L84, L86). Most of the results referred to prognostic outcomes. The key outcomes were quality of life, pain, disability, work-related aspects and mental health. Average percentage change (PC) over 6 months for quality of life ranged from -2.9 to 23.6 % with great variance for each subscale. With regard to pain the results ranged from -2.1 to 11 % (PC), and the vast majority of studies showed an improvement with time. The disability outcome ranged from +5.8 to +6.8 % (PC). 48 % to 58 % of those back pain patients, who were initially on sick-leave, returned to work after 1 year. The category of mental outcomes included many different questionnaires about diverse aspects of mental health and again the data showed improvement over time. Conclusion: This systematic review of symptom evaluating studies overall showed an improvement of prognostic outcomes for subacute and chronic back pain. There is scarce literature on prevalence and etiology in primary care.