PubMed Health⌕ Search

Biomedical subjects

Charlotte Leboeuf-Yde

Publications and source records attributed to Charlotte Leboeuf-Yde.

At least 19 recordsLinked to original sources
PubMed2006

Modic changes and their associations with clinical findings.

It is believed that disc degeneration (DD) is, in general, only mildly associated with low back pain (LBP). MRI-identified Modic changes (MC), probably a late stage of DD, are relatively strongly associated with LBP but it is not known if people with MC also have a specific clinical profile. The purpose of this study was to investigate if the clinical findings differ in people with Modic changes (MC) as compared to those with only degenerative disc findings or none at all. In a population-based sample of 412 40-year-old Danes, information was collected independently with MRI, questionnaires and clinical examination. Three subgroups of people were created: those with both DD and MC, those with only DD, and those with neither DD nor MC. The clinical pattern was investigated for each subgroup in order to test the assumption that the clinical picture differs in the three groups. It was expected that people with both DD and MC would have a more pronounced clinical profile than those with only DD who, in turn, would differ from those with neither of these two MRI findings. Our findings were generally in concordance with our expectations. MC constitutes the crucial element in the degenerative process around the disc in relation to LBP, history, and clinical findings. People with DD and no MC only vaguely differ from those without. People with LBP and MC may deserve to be diagnosed as having specific LBP.

Activities of Daily Living↗
PubMed2006

Association between back pain and physical fitness in adolescents.

STUDY DESIGN: A cross-sectional study of 9413 adolescents. OBJECTIVES: To study the associations between back pain, physical activity, and physical fitness. SUMMARY OF BACKGROUND DATA: A high physical fitness level, and especially muscle endurance in the back muscles, is associated with lower risk of back pain, but little is known about other types of physical fitness and back pain in adolescents. METHODS: A cross-sectional study of 3956 boys and 5457 girls 17 years of age. The associations between self-reported back pain and different types of physical fitness and self-reported physical activity were analyzed in high schoolchildren in Denmark. RESULTS: Back pain was reported by 43% of the girls and 37% of the boys. Back pain was associated with low isometric muscle endurance in the back extensors, and the highest quartile had a lower risk of back pain (odds ratio = 0.71; 95% confidence interval, 0.62-0.82) within the last month. No associations were found to aerobic fitness, functional strength, flexibility, or physical activity level after adjustment for muscle endurance. More girls than boys experienced back pain, and it was more common in taller adolescents. CONCLUSION: Children with high isometric muscle endurance were less likely to report back pain. No other measures of physical fitness or level of self-reported physical activity were linked to back pain reporting.

Adolescent↗
PubMed2006

Natural course of disc morphology in patients with sciatica: an MRI study using a standardized qualitative classification system.

STUDY DESIGN: A prospective observational study of patients with sciatica. OBJECTIVES: To describe the 14-month development of disc-related MRI findings in patients with sciatica receiving active conservative treatment. SUMMARY OF BACKGROUND DATA: Previous studies of disc changes over time have reported reduction of herniations in 35% to 100% of cases. This wide range may be explained by differences in patient populations and classifications used to describe disc herniations. METHODS: Data were obtained from patients with radicular pain (n = 181) who were randomly allocated into one of two active conservative treatment regimens lasting 8 weeks. All patients were scanned at baseline and at 14 months of follow-up. Variables of interest in the present study were disc contour and nerve root compromise at the presumed symptomatic disc level. Disc contour was assessed using the recommendations from the Combined Task Forces of NASS, ASSR, and ASNR. RESULTS: In all, 154 patients were included in this study (70 women and 84 men; range, 18-65 years; mean and median age, 45 years). It was possible to identify the symptomatic disc level in 90% of patients. Extrusions or sequestrations were more common in individuals younger than 45 years and in men. Men were also more likely to have nerve root compromise. Only 3% of bulges and 38% of focal protrusions improved, whereas 75% to 100% of broad-based protrusions, extrusions, and sequestrations improved (P < 0.0001). Nerve root compromise improved in 21% to 80% depending on the disc contour. Neither type of treatment nor age had any effect on the development of MRI findings over time. However, nerve root compromise was more likely to improve in men. CONCLUSIONS: This classification system could be used to identify the majority of symptomatic disc levels. At 14 months, the MRI outcome was generally good for disc herniations and nerve root compromise. Nerve root compromise had the best MRI prognosis if the disc was extruded at baseline. There were significant differences between men and women in relation to baseline findings as well as in relation to development of MRI findings over time.

Adult↗
PubMed2006

Coping and back problems: analysis of multiple data sources on an entire cross-sectional cohort of Swedish military recruits.

BACKGROUND: As the literature now stands, a bewildering number and variety of biological, psychological and social factors are, apparently, implicated in back problems. However, if and how these have a direct influence on back problems is not clear. Obesity, for example, has in many studies been shown to be associated with back problems but there is no evidence for a causal link. This could be explained by a dearth of suitably designed studies but also because obesity may be but a proxy for some other, truly explanatory variable. Coping has been linked with, particularly, persistent back problems as well as with health in general. The question is, whether coping could be the explanatory link between, for example, these two variables. A cross-sectional study was undertaken using data from the Swedish Army, consisting of the entire cohort of males (N = 48,502) summoned in 1998 to serve in the military. The purpose of the study was to investigate the relation between five independent variables and two dependent variables ("outcome variables"). The independent variables were two anthropomorphic variables (height and body mass index), two psychological variables (intellectual capacity and coping in relation to stress), and one social variable (type of education). The two outcome variables were back problems and ill health. In particular, we wanted to determine whether controlling for coping would affect the associations between the other four independent variables and the two outcome variables. METHODS: Data for the analysis come from a battery of standardized examinations, including medical examinations, a test of intellectual capacity, and a test of coping in relation to stress. Each of these examinations was conducted independently of the others. Unadjusted and adjusted odds ratios were calculated for the outcome variables of back problems and ill health. RESULTS: The associations between height, body mass index, intellectual capacity, type of education and the two outcome variables (back problems and ill health) were weak to moderate. Additionally, there were strong associations between coping and the two outcome variables and when controlling for coping the previously noted associations diminished or disappeared, whereas none of the other variables had a large effect on the association between coping and the two outcome variables. CONCLUSION: Coping emerged as strongly associated with both back problem and ill health and coping had a leveling effect on the associations between the other independent variables and the two outcome variables. This study is noteworthy particularly because the association with coping is so robust. It is a retrospective, cross-sectional study, however, and, as such it raises questions of causality; which - if any - came first, inability to cope or back pain? The results of this study call attention to the need for a prospective study, in which coping is clearly defined. Such a study has been undertaken and will be presented separately. Index terms: back pain, coping, education, height, BMI, intellectual capacity, bio-psycho-social model, epidemiology, cohort, cross-sectional study.

Adaptation, Psychological↗
PubMed2006

Is comorbidity in adolescence a predictor for adult low back pain? A prospective study of a young population.

BACKGROUND: It has previously been shown that low back pain (LBP) often presents already in the teenage years and that previous LBP predicts future LBP. It is also well documented that there is a large degree of comorbidity associated with LBP, both in adolescents and adults. The objective of this study is to gain a deeper insight into the etiology of low back pain and to possibly develop a tool for early identification of high-risk groups. This is done by investigating whether different types of morbidity in adolescence are associated with LBP in adulthood. METHODS: Almost 10,000 Danish twins born between 1972 and 1982 were surveyed by means of postal questionnaires in 1994 and again in 2002. The questionnaires dealt with various aspects of general health, including the prevalence of LBP, classified according to number of days affected during the previous year (0, 1-7, 8-30, >30). The predictor variables used in this study were LBP, headache, asthma and atopic disease at baseline; the outcome variable was persistent LBP (>30 days during the past year) at follow-up. Associations between morbidity in 1994 and LBP in 2002 were investigated. RESULTS: LBP, headache and asthma in adolescence were positively associated with future LBP. There was no association between atopic disease and future LBP. Individuals with persistent LBP at baseline had an odds ratio of 3.5 (2.8-4.5) for future LBP, while the odds ratio for those with persistent LBP, persistent headache and asthma was 4.5 (2.5-8.1). There was a large degree of clustering of these disorders, but atopic disease was not part of this pattern. CONCLUSION: Young people from 12 to 22 years of age with persistent LBP during the previous year have an odds ratio of 3.5 persistent LBP eight years later. Both headache and asthma are also positively associated with future LBP and there is a large clustering of LBP, headache and asthma in adolescence.

Adolescent↗
PubMed2006

Are lifestyle-factors in adolescence predictors for adult low back pain? A cross-sectional and prospective study of young twins.

INTRODUCTION: With more than half of the population experiencing low back pain (LBP) before the age of 20, research must focus on young populations. Lifestyle-factors might be important elements of prevention, since they are modifiable in nature. Therefore, the objective of the present study is to investigate the association between smoking, alcohol consumption and overweight in adolescence and 1) present LBP (cross-sectionally) and 2) the risk of future LBP (longitudinally). METHODS: Data from 9,600 twins, aged 12-22, were analysed cross-sectionally with respect to associations between the above-mentioned lifestyle-factors and LBP. Eight years later, a follow-up survey (n = 6,554) was conducted and LBP at follow-up was correlated to the lifestyle-factors at baseline. Finally, the associations found to be significant were tested in a twin-control study design. RESULTS: Our cross-sectional study demonstrated small, but statistically significant, positive associations between all three investigated life-style factors and LBP. In the longitudinal study, smoking at baseline showed a monotonic dose-response relationship with LBP at follow-up (OR up to 4.0 for those smoking >20 cig./day). There was also evidence of temporality (smoking preceding LBP). Adult LBP was negatively associated with adolescent alcohol consumption. We found no evidence of a dose-response relationship or temporality. There were no associations detected between adolescent overweight and adult LBP. In the twin-control study, the directions of associations were the same, but none of these associations attained statistical significance. CONCLUSION: Several of the Bradford Hill criteria for causality were fulfilled for smoking whereas the crucial aspect of temporality was missing for alcohol consumption and overweight. The twin-control study failed to confirm a statistically significant link between smoking and LBP.

Adolescent↗
PubMed2006

The course of low back pain from adolescence to adulthood: eight-year follow-up of 9600 twins.

STUDY DESIGN: Prospective study with 8-year follow-up. OBJECTIVE: To describe the evolution of low back pain from adolescence into adulthood. SUMMARY OF BACKGROUND DATA: High prevalence rates of low back pain among children and adolescents have been demonstrated in several studies, and it has been theorized that low back pain in childhood may have important consequences for future low back pain. It is important to understand the nature of such a link if effective preventive programs are to be established. METHODS: Almost 10,000 Danish twins born between 1972 and 1982 were surveyed by means of postal questionnaires in 1994 and again in 2002. The questionnaires dealt with various aspects of general health, including the prevalence of low back pain, classified according to number of days affected (0, 1-7, 8-30, >30). RESULTS: Low back pain in adolescence was found to be a significant risk factor for low back pain in adulthood with odds ratios as high as four. We also demonstrated a dose-response association: the more days with low back pain at baseline, the higher the risk of future low back pain. Twenty-six percent of those with low back pain for more than 30 days during the baseline year also had more than 30 days with low back pain during the follow-up year. This was true for only 9% of the rest of the sample. CONCLUSIONS: Our study clearly demonstrates correlations between low back pain in childhood/adolescence and low back pain in adulthood. This should lead to a change in focus from the adult to the young population in relation to research, prevention, and treatment.

Adolescent↗
PubMed2006

Coping and back problems: a prospective observational study of Danish military recruits.

OBJECTIVE: The aim of this study was to investigate if Antonovsky's coping questionnaire ("sense of coherence" [SOC]-13) can be used to predict self-reported low back pain (LBP) and associated leg pain in young men subjected to the first 3 months of military service and to challenge such a link with a number of biosocial variables. METHODS: A prospective observational study of a fixed cohort consisting of 357 military conscripts was completed. Data were collected at baseline and after 3 months of military service. The outcome variables were self-reported LBP and leg pain at any time during those 3 months. The main independent (predictor) variable was coping. Covariables were biological (age, height, weight, fitness, strength, and a history of previous problems) and social (type of work, years of education, and social support). The clinical usefulness was shown for the best model, with each outcome variable in relation to sensitivity/specificity, positive/negative predictive value, numbers correctly classified, and the area under the receiver operating characteristics curve. RESULTS: The SOC-13 questionnaire could successfully predict leg pain (odds ratio [OR], 3.3), but only 1 of its 13 items predicted LBP (OR 2.0). For leg pain, the strongest predictor was age (OR, 4.5), and for LBP, the strongest predictor was previous LBP (OR, 6.7). The receiver operating characteristics curves of the final models were 0.85 and 0.79, respectively. CONCLUSIONS: In these young Danish conscripts, coping or elements of coping (as defined with the help of the SOC-13 questionnaire) could predict LBP and leg pain occurring during a 3-month period. Biological and psychological variables dominated the final models, but none of the social variables could significantly predict LBP or leg pain.

Adaptation, Psychological↗
PubMed2005

Back pain reporting in young girls appears to be puberty-related.

BACKGROUND: There is a large increase in back pain reporting in the early teens. In no previous study has the prevalence of low back pain been investigated in relation to the onset of puberty. The objective of this study was to establish whether the onset of puberty is associated with back pain reporting in young girls. METHODS: A subsample of 254 girls aged 8-10 years and 165 girls aged 14-16 years from a cross-sectional survey of 481 children aged 8-10 years and 325 adolescents aged 14-16 years of both sexes. Main outcome measures were back pain defined as low back pain, mid back pain, and/or neck pain in the past month. Other variables of interest were Puberty (five different stages), age, body mass index, and smoking. Independent information on onset of puberty was obtained through a physical examination and on back pain through an individual structured interview. The association was studied between onset of puberty and the outcome variable (the one month period prevalence of back pain), controlling for overweight, and smoking. Odds ratios with 95% confidence intervals were used to describe bivariate associations, logistic regression with robust standard errors was used for multivariate analyses. RESULTS: There is a highly significant trend for increased back pain reporting with increasing level of puberty until maturity is reached. The biggest leap appears between the second level (beginning of puberty) and the third level (mid puberty) and the findings remain after controlling for the covariates. These results emanate from the low back, whereas pain in the mid back and neck do not seem to be linked with pubertal stage. CONCLUSION: In girls, the reporting of low back pain increases in frequency during puberty until maturity, regardless of age. Why some girls are susceptible to back pain in the early stage of puberty is unknown.

Adolescent↗
PubMed2005

Low back pain in military recruits in relation to social background and previous low back pain. A cross-sectional and prospective observational survey.

BACKGROUND: Traditionally, studies on the etiology of low back pain have been carried out in adult populations. However, since low back pain often appears early in life, more research on young populations is needed. This study focuses on the importance of social background factors and previous low back pain in the development of low back pain in military recruits. METHODS: During a three-month period, Danish military recruits with different social backgrounds live and work under the same conditions. Thus, there is an opportunity to investigate the influence of social background on the development of low back pain, when persons are removed from their usual environment and submitted to a number of new stressors. In addition, the importance of the recruits' previous low back pain history in relation to low back pain during military service was studied. This was done by means of questionnaires to 1,711 recruits before and after this three-month period. RESULTS: Sedentary occupation was negatively associated with long-lasting low back pain (>30 days during the past year) at baseline with an odds ratios of 0.55 (95% CI: 0.33-0.90). This effect vanished during service. Having parents with higher education increased the risk of low back pain during service (OR: 1.9;1.2-3.0, for the highest educated group), but not of the consequences (leg pain and exemption from duty), whereas high IQ decreased the risk of these consequences (odds ratios as low as 0.2;0.1-0.8 for exemption from duty in the group with highest IQ). Long-lasting low back pain prior to service increased the risk of long-lasting low back pain (OR: 4.8;2.1-10.8), leg pain (OR: 3.3;1.3-8.3) and exemption from duty during service (OR: 5.9;2.4-14.8). CONCLUSION: Sedentary occupation is negatively associated with low back pain at baseline. This protective effect disappears, when the person becomes physically active. For predicting trouble related to the low back during service, the duration of low back pain prior to service and IQ-level are the most important factors.

Adult↗
PubMed2005

Magnetic resonance imaging and low back pain in adults: a diagnostic imaging study of 40-year-old men and women.

STUDY DESIGN: Cross-sectional cohort study of a general population. OBJECTIVE: To investigate "abnormal" lumbar spine magnetic resonance imaging (MRI) findings, and their prevalence and associations with low back pain (LBP). SUMMARY OF BACKGROUND DATA: The clinical relevance of various "abnormal" findings in the lumbar spine is unclear. Distinguishing between inevitable age-related findings and degenerative findings with deleterious consequences is a challenge. METHODS: Lumbar spine MRI was obtained in 412, 40-year-old individuals. Predefined "abnormal" MRI findings were interpreted without any knowledge of patient symptoms. Associations between MRI abnormalities and LBP were calculated using odds ratios. The "overall picture" of each MRI finding was established on the basis of the frequencies, diagnostic values, and the strength and consistency of associations. RESULTS: Most "abnormal" MRI findings were found at the lowest lumbar levels. Irregular nucleus shape and reduced disc height were common (>50% of individuals). Relatively common (25% to 50%) were hypointense disc signal, anular tears, high intensity zones, disc protrusions, endplate changes, zygapophyseal joint degeneration, asymmetry, and foraminal stenosis. Nerve root compromise, Modic changes, central spinal stenosis, and anterolisthesis/retrolisthesis were rare (<25%). Most strongly associated with LBP were Modic changes and anterolisthesis (odds ratios >4). Significantly positive associations with all LBP variables were seen for hypointense disc signals, reduced disc height, and Modic changes. All disc "abnormalities" except protrusion were moderately associated with LBP during the past year. CONCLUSION: Most degenerative disc "abnormalities" were moderately associated with LBP. The strongest associations were noted for Modic changes and anterolisthesis. Further studies are needed to define clinical relevance.

Adult↗
PubMed2005

An epidemiologic study of MRI and low back pain in 13-year-old children.

STUDY DESIGN: Cross-sectional cohort study of a general population. OBJECTIVE: To describe associations between "abnormal" lumbar magnetic resonance imaging (MRI) findings and low back pain (LBP) in 13-year old children. SUMMARY AND BACKGROUND DATA: Very little is known about the distribution of lumbar MRI findings and how they are associated with LBP in youngsters. METHODS: Disc abnormalities, as well as nerve root compromise, endplate changes, and anterolisthesis were identified from MRI studies of 439 children. LBP was identified from structured interviews. Associations are presented as odds ratios (OR). RESULTS: Signs of disc degeneration were noted in approximately 1/3 of the subjects. Reduced signal intensity and irregular nucleus shape in the upper 3 lumbar discs were significantly associated with LBP within the last month (OR, 2.5-3.6), whereas reduced signal intensity and disc protrusion at L5-NS1 were associated with seeking care (OR, 2.8 and 7.7, respectively). Endplate changes in relation to the L3 discs were associated with LBP month and seeking care (OR, between 9.7 and 22.2). Anterolisthesis at L5 was associated with seeking care (OR, 4.3). There were obvious differences between genders: degenerative disc changes in the upper lumbar spine were more strongly associated with LBP in boys, while disc abnormalities in the lower lumbar spine were more strongly associated with seeking care in girls. CONCLUSIONS: In children, degenerative disc findings are relatively common, and some are associated with LBP. There appears to be a gender difference. Disc protrusions, endplate changes, and anterolisthesis in the lumbar spine were strongly associated with seeking care for LBP.

Adolescent↗
PubMed2005

The Nordic back pain subpopulation program: a 1-year prospective multicenter study of outcomes of persistent low-back pain in chiropractic patients.

OBJECTIVES: The aims of the study are to describe the low-back pain and disability status at baseline, the fourth visit, and at 3 and 12 months in Norwegian patients treated by chiropractors for persistent low back pain (LBP) and to describe movements between various subgroups over time. DESIGN: Prospective uncontrolled multicenter study. METHODS: Self-reported pain was measured with a 0-10 box scale and disability with the revised Oswestry LBP questionnaire. The main outcome measures were mean pain or disability values and numbers of LBP-free patients. LBP status was assessed through patient questionnaires at baseline, the fourth visit, and after 3 and 12 months. STUDY SUBJECTS AND SETTING: Of 205 invited chiropractors, 115 Norwegian chiropractors were each willing to recruit 10 consecutive patients who had LBP for at least 2 weeks at the time of consultation and a minimum of 30 days altogether within the preceding year. The numbers of participants were 875 (baseline), 799 (fourth visit), 598 (3 months), and 512 (12 months). RESULTS: Considerable improvement was noted between baseline and the fourth visit both for mean values and in numbers of LBP-free patients. There was virtually no further mean improvement up to the third month, whereas the number of LBP-free individuals doubled. At 12 months, no additional improvement was noted, and 80% reported that they had experienced recurrent problems. Less than 1% reported considerable worsening. Severity of symptoms at baseline determined the subsequent outcome, mild symptoms tending to worsen, and severe symptoms tending to improve. CONCLUSION: The outcome pattern is similar to that found in other clinical studies. Treatment outcome should be measured early with follow-up at 3 rather than at 12 months, because patients will improve or recover quickly but may experience recurring problems. Numbers "cured" appear to be a feasible outcome variable in this type of study population.

Adult↗
PubMed2005

The Bournemouth Questionnaire: can it be used to monitor and predict treatment outcome in chiropractic patients with persistent low back pain?

OBJECTIVE: To investigate the Bournemouth Questionnaire (BQ) as a baseline, monitoring of progress, and prognostic instrument in chiropractic patients with persistent low back pain (LBP). STUDY DESIGN: Predictive and concurrent validation study. STUDY PARTICIPANTS AND SETTING: One hundred fifteen Norwegian chiropractors collected prospective data on 875 patients with persistent LBP, defined as LBP for at least 2 weeks at baseline and a minimum of 30 days totaling within the preceding year. METHODS: Data collection took place at first consultation, fourth visit, and 3 months using the BQ, the revised Oswestry questionnaire, and a 10-point pain box scale. Follow-up at 12 months included the BQ, Oswestry questionnaire, and additional questions on the number of days with LBP and the number of days off work in the past year. DATA ANALYSIS: Frequency of reporting of each 7 items in the BQ at baseline was identified as median value with 10th and 90th percentiles. Concurrent analyses of the 2 questionnaires were made at the 4 points in time with calculation of mean differences with limits of agreement together with Bland-Altman plots. Logistic regression was used to identify and compare the predictive values of the questionnaires and to test the relevance of each individual item in the BQ. RESULTS: The median baseline values of the 7 items in the BQ ranged from 2 to 5. The 2 questionnaires did not agree on patients' status, and mean differences between the Oswestry questionnaire and the BQ were largest when patients reported higher scores. The predictive values for the 2 questionnaires were low, with no significant difference between the 2. The predictive value of the BQ could be improved by removing most of the 7 items. Certain items can predict specific outcomes. CONCLUSIONS: The BQ is not a useful instrument to identify baseline status, monitor progress, or predict the 1-year progress in chiropractic patients having persistent LBP. However, certain individual items are useful to predict specific outcomes.

Absenteeism↗
PubMed2005

Self-reported nonmusculoskeletal responses to chiropractic intervention: a multination survey.

OBJECTIVE: To replicate a previous study of nonmusculoskeletal responses to chiropractic intervention and to establish whether such responses are influenced by the country of study, chiropractors' attitudes, and information to patients, patients' demographic profiles, and treatment regimens. METHODS: Information obtained through questionnaires by chiropractors and patients on return visit within 2 weeks of previous treatment from chiropractic practices in Canada, United States, Mexico, Hong-Kong, Japan, Australia, and South Africa. In all, 385 chiropractors collected valid data on 5607 patients. Spinal manipulation with or without additional therapy was the intervention provided by chiropractors. Outcome measures included self-reported improved nonmusculoskeletal reactions (allergy, asthma, breathing, circulation, digestion, hearing, heart function, ringing in the ears, sinus problems, urination, and others). RESULTS: The results from the previous study were largely reproduced. Positive reactions were reported by 2% to 10% of all patients and by 3% to 27% of those who reported to have such problems. Most common were improved breathing (27%), digestion (26%), and circulation (21%). Some variables were identified that somewhat influenced the outcome: patients informed that such reactions may occur (odds ratio [OR] 1.5), treatment to the upper cervical spine (OR 1.4), treatment to lower thoracic spine (OR 1.3), and female sex (OR 1.3). However, these had a very small "explanatory" value (pseudo R2 3%). CONCLUSION: A minority of patients with self-reported nonmusculoskeletal symptoms report definite improvement after chiropractic care, and very few report definite worsening. Future studies should use stringent criteria to investigate a possible treatment effect and concentrate on specific diagnostic subgroups such as digestive problems and tinnitus.

Adult↗
PubMed2005

The Nordic back pain subpopulation program: the long-term outcome pattern in patients with low back pain treated by chiropractors in Sweden.

OBJECTIVES: (1) To describe the low back pain (LBP) pattern at baseline; (2) to describe the long-term outcome pattern; (3) to investigate the presence of distinct subgroups in relation to outcome; (4) to establish whether short-term outcome is a predictor of long-term outcome. METHODS: A 3- to 6- and 12- to 18-month, multicenter practice-based, prospective descriptive study was performed in private chiropractic practices in Sweden. Fifty-eight of 64 previously compliant chiropractors each recruited a maximum of 30 consecutive patients with LBP. Complete baseline clinical information was provided on 1054 patients, of which 93% were interviewed approximately 3 months later, and 57% responded to a questionnaire at approximately 12 months. Chiropractic treatment was decided by the treating chiropractor. Twelve descriptive subgroups were created based on (1) duration of LBP at baseline, (2) duration of LBP in the past year, and (3) LBP pattern in the past year. The predictive value was tested for outcome status at the fourth visit. Information on self-reported LBP status and improvement over the past months were collected. RESULTS: Patients were spread in a U-shaped fashion from benign to severe with the 2 extreme groups being most prevalent. About half the participants reported "no LBP in the past week" at 3 months and somewhat fewer at 12 months. Almost 75% claimed to be definitely better at 3 months, and approximately 50% at 12 months. Specific predictive subgroups can be identified, mainly in relation to the past-year history of LBP. Improvement at the fourth visit is a predictor of long-term outcome. CONCLUSION: Knowledge of specific subgroups may improve the quality of care and the selection of homogeneous study populations in clinical trials.

Adult↗
PubMed2004

Comorbidity with low back pain: a cross-sectional population-based survey of 12- to 22-year-olds.

STUDY DESIGN: Cross-sectional, population-based survey. OBJECTIVES: To investigate the pattern of comorbidity with low back pain in adolescents. SUMMARY OF BACKGROUND DATA: Low back pain is usually dealt with as a specific and independent entity. However, the existing literature shows comorbidity to be common with low back pain, suggesting that low back pain may be part of a broader pattern of general health. The present knowledge is based on studies of adult populations; therefore, associations could be explained by work and lifestyle factors. Information in this area is lacking regarding subjects still unaffected by such factors. METHODS: A questionnaire-survey about general health, including low back pain, was carried out among twins registered in the population-based Danish Twin Registry. Associations between disorders were calculated and patterns of comorbidity investigated, by means of logistic regression and a finite mixture model. Finally a twin-control study was conducted. RESULTS: A total of 9,567 individuals, 12 to 22 years of age, responded to the questionnaire. Positive associations between low back pain and asthma and headache/migraine were demonstrated, mainly because of study participants with several disorders. No association between low back pain and atopic dermatitis/hay fever was found. The presence of two other disorders increased the probability of low back pain considerably more than the presence of only one other disorder. The finite mixture model indicated that the probability of belonging to a frail subgroup decreased from 60% at age 13 to 25% at age 21, and in the frail subgroups nearly all report low back pain and headache in the older ages. Furthermore, increasing duration of low back pain increased the likelihood of having other disorders. Results from the twin-control study were similar. CONCLUSION: Young people are more likely to suffer from asthma and headache, but not from atopic dermatitis/hay fever, if they have low back pain. All of the investigated disorders cluster in some individuals. A model of common origin for these seemingly independent disorders should be considered.

Adolescent↗