Spine. 2009 Apr 20; 34(9): 970-977Wasiak R, Young AE, Dunn KM, Côté P, Gross DP, Heymans MW, von Korff MSTUDY 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.
