Individual Courses of Low Back Pain in Adult Danes: A Cohort Study with 4-Year and 8-Year Follow-up
SOURCE: BMC Musculoskelet Disord. 2017 (Jan 21); 18 (1): 28
Per Kjaer, Lars Korsholm, Charlotte Leboeuf-Yde, Lise Hestbaek and Tom Bendix
Department of Sports Science and Clinical Biomechanics,
University of Southern Denmark,
Campusvej 55, DK-5230,
Odense M, Denmark.
BACKGROUND: Few longitudinal studies have described the variation in LBP and its impact over time at an individual level. The aims of this study were to:
1) determine the prevalence of LBP in three surveys over a 9-year period in the Danish general population, using five different definitions of LBP,
2) study their individual long-term courses, and
3) determine the odds of reporting subsequent LBP when having reported previous LBP.
METHODS: A cohort of 625 men and women aged 40 was sampled from the general population. Questions about LBP were asked at ages 41, 45 and 49, enabling individual courses to be tracked across five different definitions of LBP. Results were reported as percentages and the prognostic influence on future LBP was reported as odds ratios (OR).
RESULTS: Questionnaires were completed by 412 (66%), 348 (56%) and 293 (47%) persons respectively at each survey. Of these, 293 (47%) completed all three surveys. The prevalence of LBP did not change significantly over time for any LBP past year: 69, 68, 70%; any LBP past month: 42, 48, 41%; >30 days LBP past year: 25, 27, 24%; seeking care for LBP past year: 28, 30, 36%; and non-trivial LBP, i.e. LBP >30 days past year including consequences: 18, 20, 20%. For LBP past year, 2/3 remained in this category, whereas four out of ten remained over the three time-points for the other definitions of LBP. Reporting LBP defined in any of these ways significantly increased the odds for the same type of LBP 4 years later. For those with the same definition of LBP at both 41 and 45 years, the risk of also reporting the same at 49 years was even higher, regardless of definition, and most strongly for seeking care and non-trivial LBP (OR 17.6 and 18.4) but less than 11% were in these groups.
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CONCLUSION: The prevalence rates of LBP, when defined in a number of ways, were constant over time at a group level, but did not necessarily involve the same individuals. Reporting more severe LBP indicated a higher risk of also reporting future LBP but less than 11% were in these categories at each survey.
KEYWORDS: Course; Epidemiology; Low back pain; Risk; Trajectories
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Background
Low back pain (LBP) is now rated as one of the most common [1], costly and disabling health conditions worldwide. [2] To date, the search for a cure has not been successful. One difficulty in the evaluation of the efficacy of treatments is that the natural course of back pain is not well understood. Another difficulty is that the identification of relevant subgroups for targeted treatment, prevention and care is still a challenge. [3] There is a view that higher priority should be given to identifying people at risk of developing chronic or recurrent disabling LBP in order to differentiate these from people with more benign LBP conditions. [4] Understanding different course trajectories of LBP may be helpful in this process.
Many studies have addressed the prevalence of LBP throughout the world and these have been summarised in reviews. [1, 5–7] The definitions of LBP and their prevalence estimates varied considerably with the heterogeneity of studies, making interpretation of the extent and, particularly, the impact, of LBP difficult. Nevertheless, chronic LBP conditions (usually defined as lasting for more than 3 months) with consequences have been reported in 6–20% of the adult population. [8, 9]
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