The Prediction of Chronicity in Patients With Acute and Subacute Nonspecific Low Back Pain and Associated Risk Factors: A Case-Control Study

Published:February 14, 2022DOI:



      Chronic low back pain is one of the most common musculoskeletal disorders in different countries.


      This study aimed to predict the chronicity of nonspecific acute and nonspecific low back pain (LBP) and related risk factors among cases referred to physiotherapy clinics.


      A case-control and cross-sectional study.


      Two physiotherapy centers in Tehran, Iran.


      This study included 502 patients with acute, subacute and chronic LBP.


      This study included 502 patients with acute, subacute and chronic LBP. Data were obtained using the Fear-Avoidance Beliefs Questionnaire, Patient Health Questionnaire, Pain Catastrophic Scale, Tampa Scale for Kinesiophobia, Pittsburgh Sleep Quality Index, Walker's Health-Promoting Lifestyle Questionnaire, Roland Morris Disability Questionnaire, and Numerical Pain Rating Scale. Data analysis was performed by applying independent sample t test, χ2, and multiple logistic regression in SPSS software version 25. IBM Amos version 22 was used for path analysis.


      It was found that some demographic parameters (i.e., weight, BMI, job, type of occupational task performance, history of low back pain, work shift, underlying diseases and income), some cognitive parameters (i.e., fear-avoidance beliefs, kinesiophobia, catastrophic pain, and depression), some lifestyle parameters (i.e., health responsibility, physical activity, and interpersonal relationships), sleep quality and pain related disability were among the most critical risk factors in the chronicity of acute and subacute LBP (p < .05).


      Personal, psychological, and psychosocial parameters can be among the most critical predictors in the chronicity of acute and subacute nonspecific LBP. Hence, paying attention to all the mentioned factors at the beginning of patients' treatment to create a targeted treatment algorithm and prevent the conversion of acute and subacute into chronic LBP has particular importance.
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        • Ahmadi H.
        • Farshad A.
        • Motamedzadeh M.
        • Mahjob H.
        Epidemiology of low-back pain and its association with occupational and personal factors among employees of Hamadan province industries.
        Journal of Health. 2014; 5: 59-66
        • Akbari H.
        • Akbari H.
        • Bagheri Hossein Abadi M.
        • Gholami Fesharaki M.
        • Ghasemi M.
        Assessing the risk of manual handling of patients and its relationship with the prevalence of musculoskeletal disorders among nursing staff: Performance evaluation of the MAPO and PTAI methods.
        Iranian Red Crescent Medical Journal. 2017; 19
        • Alhowimel A.
        • AlOtaibi M.
        • Radford K.
        • Coulson N.
        Psychosocial factors associated with change in pain and disability outcomes in chronic low back pain patients treated by physiotherapist: A systematic review.
        SAGE Open Medicine. 2018; 62050312118757387
        • Asghari M.
        • Golak N.
        The roles of pain coping strategies in adjustment to chronic pain.
        Clinical Psychology and Personality. 2005; 3: 1-23
        • Balagué F.
        • Mannion A.F.
        • Pellisé F.
        • Cedraschi C.
        Nonspecific low back pain.
        The Lancet. 2012; 379: 482-491
        • Bogduk N.
        Psychology and low back pain.
        International Journal of Osteopathic Medicine. 2006; 9: 49-53
        • Boissoneault J.
        • Mundt J.
        • Robinson M.
        • George S.Z.
        Predicting low back pain outcomes: Suggestions for future directions.
        Journal of Orthopaedic & Sports Physical Therapy. 2017; 47: 588-592
        • Brox J.I.
        • Storheim K.
        • Holm I.
        • Friis A.
        • Reikeras O.
        Disability, pain, psychological factors and physical performance in healthy controls, patients with sub-acute and chronic low back pain: A case-control study.
        Journal of Rehabilitation Medicine. 2005; 37: 95-99
        • Childs J.D.
        • Piva S.R.
        • Fritz J.M.
        Responsiveness of the numeric pain rating scale in patients with low back pain.
        Spine. 2005; 30: 1331-1334
        • Chung E.J.
        • Hur Y.-G.
        • Lee B.-H.
        A study of the relationship among fear-avoidance beliefs, pain and disability index in patients with low back pain.
        Journal of Exercise Rehabilitation. 2013; 9: 532
        • Cougot B.
        • Petit A.
        • Paget C.
        • Roedlich C.
        • Fleury-Bahi G.
        • Fouquet M.
        • Roquelaure Y.
        Chronic low back pain among French healthcare workers and prognostic factors of return to work (RTW): A non-randomized controlled trial.
        Journal of Occupational Medicine and Toxicology. 2015; 10: 1-15
        • Dadfar M.
        • Kalibatseva Z.
        • Lester D.
        Reliability and validity of the Farsi version of the Patient Health Questionnaire-9 (PHQ-9) with Iranian psychiatric outpatients.
        Trends in Psychiatry and Psychotherapy. 2018; 40: 144-151
        • Ghasemi M.
        • Khoshakhlagh A.H.
        • Ghanjal A.
        • Yazdanirad S.
        • Laal F.
        The impacts of rest breaks and stretching exercises on lower back pain among commercial truck drivers in Iran.
        International Journal of Occupational Safety and Ergonomics. 2020; 26: 662-669
        • Gheldof E.L.
        • Vinck J.
        • Vlaeyen J.W.
        • Hidding A.
        • Crombez G.
        Development of and recovery from short-and long-term low back pain in occupational settings: A prospective cohort study.
        European Journal of Pain. 2007; 11: 841-854
        • Goodyear M.D.
        • Krleza-Jeric K.
        • Lemmens T.
        The declaration of Helsinki.
        British Medical Journal Publishing Group. 2007;
      1. Gordon, R., & Bloxham, S. (2016). A systematic review of the effects of exercise and physical activity on nonspecific chronic low back pain.Paper presented at the Healthcare.

        • Hartvigsen J.
        • Hancock M.J.
        • Kongsted A.
        • Louw Q.
        • Ferreira M.L.
        • Genevay S.
        • Sieper J.
        What low back pain is and why we need to pay attention.
        The Lancet. 2018; 391: 2356-2367
        • Hooper D.
        • Coughlan J.
        • Mullen M.
        • Hooper D.
        Structural equation modelling: Guidelines for determining model fit.
        Electronic Journal of Business Research Methods. 2008; 6: 53-60
        • Hoy D.G.
        • Smith E.
        • Cross M.
        • Sanchez-Riera L.
        • Blyth F.M.
        • Buchbinder R.
        • March L.M.
        Reflecting on the global burden of musculoskeletal conditions: lessons learnt from the global burden of disease 2010 study and the next steps forward.
        Annals of the Rheumatic Diseases. 2015; 74: 4-7
        • Jafari H.
        • Ebrahimi I.
        • Salavati M.
        • Kamali M.
        • Fata L.
        Psychometric properties of Iranian version of Tampa Scale for Kinesiophobia in low back pain patients.
        Archives of Rehabilitation. 2010; : 11
        • Löwe B.
        • Kroenke K.
        • Herzog W.
        • Gräfe K.
        Measuring depression outcome with a brief self-report instrument: sensitivity to change of the Patient Health Questionnaire (PHQ-9).
        Journal of Affective Disorders. 2004; 81: 61-66
        • Malliou P.
        • Gioftsidou A.
        • Beneka A.
        • Godolias G.
        Measurements and evaluations in low back pain patients.
        Scandinavian Journal of Medicine & Science in Sports. 2006; 16: 219-230
        • Manchikanti L.
        • Singh V.
        • Datta S.
        • Cohen S.P.
        • Hirsch J.A.
        Comprehensive review of epidemiology, scope, and impact of spinal pain.
        Pain Physician. 2009; 12: E35-E70
        • Mansouri A.
        • Mokhayeri Y.
        • Mohammadi Farrokhran E.
        • Tavakkol Z.
        • Fotouhi A.
        Sleep quality of students living in dormitories in Tehran University of Medical Sciences (TUMS) in 2011.
        Iranian Journal of Epidemiology. 2012; 8
        • Mehling W.
        • Avins A.
        • Acree M.
        • Carey T.
        • Hecht F.
        Can a back pain screening tool help classify patients with acute pain into risk levels for chronic pain?.
        European Journal of Pain. 2015; 19: 439-446
        • Moghaddam J.F.
        • Nakhaee N.
        • Sheibani V.
        • Garrusi B.
        • Amirkafi A.
        Reliability and validity of the Persian version of the Pittsburgh Sleep Quality Index (PSQI-P).
        Sleep and Breathing. 2012; 16: 79-82
        • Mohamadi S.
        • Dehghani M.
        • Heidari M.
        • Sedaghat M.
        • Khatibi A.
        The evaluation of pain-related psychological similarities among patients with musculoskeletal chronic pain and their spouses.
        International Journal of Behavioral Sciences. 2013; 7: 57-66
        • Mohammadi Zeidi I.
        • Pakpour Hajiagha A.
        • Mohammadi Zeidi B.
        Reliability and validity of Persian version of the health-promoting lifestyle profile.
        Journal of Mazandaran University of Medical Sciences. 2012; 21: 102-113
        • Morris P.
        • Ali K.
        • Merritt M.
        • Pelletier J.
        • Macedo L.G.
        A systematic review of the role of inflammatory biomarkers in acute, subacute and chronic nonspecific low back pain.
        BMC Musculoskeletal Disorders. 2020; 21: 1-12
        • Mousavi S.J.
        • Akbari M.E.
        • Mehdian H.
        • Mobini B.
        • Montazeri A.
        • Akbarnia B.
        • Parnianpour M.
        Low back pain in Iran: A growing need to adapt and implement evidence-based practice in developing countries.
        Spine. 2011; 36: E638-E646
        • Nakhostin Ansari N.
        • Naghdi S.
        • Habibzadeh F.
        • Salsabili N.
        • Ebadi S.
        Persian translation and validation of the Back Pain Functional Scale.
        Physiotherapy Theory and Practice. 2018; 34: 223-230
        • Pinheiro M.B.
        • Ferreira M.L.
        • Refshauge K.
        • Maher C.G.
        • Ordoñana J.R.
        • Andrade T.B.
        • Ferreira P.H.
        Symptoms of depression as a prognostic factor for low back pain: A systematic review.
        The Spine Journal. 2016; 16: 105-116
        • Ramezani M.
        • Taghizade G.
        • Abdolvahab M.
        • Lajavardi L.
        • Saeidi Brojeni M.
        Investigating of risk factors related to chronic nonspecific low back pain in military men.
        Journal of Modern Rehabilitation. 2015; 9: 54-63
        • Roland M.
        • Fairbank J.
        The Roland-Morris disability questionnaire and the Oswestry disability questionnaire.
        Spine. 2000; 25: 3115-3124
        • Rostami M.
        • Noorian N.
        • Mansournia M.A.
        • Sharafi E.
        • Babaki A.E.S.
        • Kordi R.
        Validation of the Persian version of the fear avoidance belief questionnaire in patients with low back pain.
        Journal of Back and Musculoskeletal Rehabilitation. 2014; 27: 213-221
        • Sadeghi Yarandi M.
        • Ghasemi M.
        • Ghanjal A.
        The relationship between individual, physical and psychosocial risk factors with musculoskeletal disorders and related disabilities in flight security personnel.
        International Journal of Occupational Safety and Ergonomics. 2020; : 1-11
        • Shmagel A.
        • Foley R.
        • Ibrahim H.
        Epidemiology of chronic low back pain in US adults: Data from the 2009–2010 National Health and Nutrition Examination Survey.
        Arthritis Care & Research. 2016; 68: 1688-1694
        • Silver A.
        • Haeney M.
        • Vijayadurai P.
        • Wilks D.
        • Pattrick M.
        • Main C.
        The role of fear of physical movement and activity in chronic fatigue syndrome.
        Journal of Psychosomatic Research. 2002; 52: 485-493
        • Sullivan M.J.
        • Bishop S.R.
        • Pivik J.
        The pain catastrophizing scale: Development and validation.
        Psychological Assessment. 1995; 7: 524
        • Waddell G.
        • Newton M.
        • Henderson I.
        • Somerville D.
        • Main C.J.
        A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability.
        Pain. 1993; 52: 157-168
        • Wertli M.M.
        • Rasmussen-Barr E.
        • Held U.
        • Weiser S.
        • Bachmann L.M.
        • Brunner F.
        Fear-avoidance beliefs—a moderator of treatment efficacy in patients with low back pain: A systematic review.
        The Spine Journal. 2014; 14: 2658-2678
        • Woby S.R.
        • Urmston M.
        • Watson P.J.
        Self-efficacy mediates the relation between pain-related fear and outcome in chronic low back pain patients.
        European Journal of Pain. 2007; 11: 711-718
        • Woby S.R.
        • Watson P.J.
        • Roach N.K.
        • Urmston M.
        Adjustment to chronic low back pain: The relative influence of fear-avoidance beliefs, catastrophizing, and appraisals of control.
        Behaviour Research and Therapy. 2004; 42: 761-774
        • Yadollahpour N.
        • Zahednejad S.
        • Yazdi M.J.S.
        • Esfandiarpour F.
        The Discriminant ability of physical and psychological factors in stratification of patients with low back pain based on start back screening tool.
        Journal of Biochemistry Techniques. 2019; : 168-174