Prognosis of sciatica and back-related leg pain in primary care: the ATLAS cohort

 Low back pain (LBP) is the primary cause of musculoskeletal pain. The evidence is lacking on the prognosis and prognostic factors of back-related leg pain and sciatica in patients seeing their primary care physicians. The present study provides new evidence on the prognosis and prognostic factors of back-related leg pain and sciatica in primary care.  

Evidence related to the prognosis and prognostic factors of back-related sciatica and leg pain among the patients looking for their primary care physicians are absent, and therefore, this study was conducted to evaluate related evidence.

A total of 609 patients fulfilled the questionnaires, went through clinical assessments, magnetic resonance imaging scan and one-year follow-up. The prognostic value of six a priori defined variable sets: pain intensity, psychological factors, leg pain duration, imaging, clinical examination, and neuropathic pain variables were evaluated using the mixed-effects logistic regression. Further, the independent effects determined using a combined model, including variables from all models. No conflicts of interest were noticed during the analysis.

A total of 55% of patients improved in both the sciatica group and total sample after follow up of a year. The most active independent prognostic factors for the whole cohort that associated negatively with the improvement were patient's belief that the problem will last a long time, confidence interval, longer leg pain duration, and higher identity score. The sciatica subgroup involved patient's view that the problem will continue a long time and higher identity score which associated with improvement negatively.

The study presents new evidence regarding prognosis and prognostic factors of back-related sciatica and leg pain in primary care. At one year. Only over half of the patients exhibited an improvement. The independent prognostic factors involved the patient's hope of recovery timescale and number of other symptoms. These factors can be implemented to notify and direct decisions regarding the intensity and timing of present therapeutic choices.