DRIVERS OF INTERNATIONAL VARIATION IN PREVALENCE OF DISABLING LOW BACK PAIN: FINDINGS FROM THE CULTURAL AND PSYCHOSOCIAL INFLUENCES ON DISABILITY STUDY

Review written by Dr Sandy Hilton info

BACKGROUND & OBJECTIVE

The literature supports risk factors for low back pain (LBP) of heavy lifting, somatization, low mood/stressors in the workplace, and negative beliefs about recovery. Despite the emphasis on ergonomics in the workplace, this has not reduced the amount of LBP.

The authors in this study set out to determine the reason for the wide variation in LBP internationally. The authors proposed that beliefs and expectations around LBP contribute to the continued trends in disability and that this may vary across different cultural and social backgrounds.

METHODS

Baseline information about musculoskeletal pain and risk factors was collected from 11,710 participants aged 20-59 years. Participants were from 18 different countries and 45 different occupations that fell into three categories: nurses, office workers, and those with manual tasks. Mental health, somatizing (faintness/dizziness, chest pain, nausea, shortness of breath, and temperature dysregulation), and questions of belief were assessed via a questionnaire. Negative beliefs of the ability to heal or return to work were tracked as well. Musculoskeletal (MSK) pain sites were illustrated with a body diagram and participants were asked if they had pain in any body regions in the last year that lasted longer than a day (pain propensity).

After a mean time period of 14 months, 9055 subjects were successfully followed-up. The authors used a longitudinal study to avoid risk of bias of simultaneous reporting of risk factors, and compared the amount of sites of MSK pain per person to a baseline measure. The study used multiple random intercept Poisson regression to compare the association of disabling LBP to risk factors at baseline. They also looked at group-level risk factors with a regression model.

RESULTS

The authors took their data and calculated population attributable fractions (PAF) for each of the factors. These were taken to represent the "potential importance" as a driver of LBP.

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