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PubMed2003

Smoking and overweight as predictors of hospitalization for back disorders.

STUDY DESIGN: A prospective cohort study. OBJECTIVE: To study the relationship of smoking and overweight with severe back disorders leading to hospitalization. SUMMARY OF BACKGROUND DATA: Many epidemiological studies have shown an association between smoking or overweight and back pain, but the results are still equivocal. Longitudinal studies are few. METHODS: A cohort of metal industry employees (n = 902) was studied for lifestyle, work history, and health in 1973 by questionnaire and interview. The weight of the subjects was measured and body mass index (kg/m2) was calculated. Based on intensity and duration, smoking was categorized as: never smoked (reference), stopped smoking, smoked 9 pack-years. Information on hospital admissions from 1973 to 2000 from the Finnish Hospital Discharge Register was linked to the data. Seventy-five individuals had been admitted to hospital because of back disorders. Intervertebral disc disorders and other common back disorders were analyzed separately. Cox proportional hazards regression was used to estimate the time between the assessment of potential risk factors and the first hospitalization for a back disorder. RESULTS: The rate ratio of heavy smokers (>9 pack-years) for hospitalization because of intervertebral disc disorders was 3.4 (95% confidence interval 1.3-9.0) as compared with never-smokers, allowing for other risk factors. Accordingly, the rate ratio of body mass index >27.5 kg/m2 was 2.7 (1.1-6.45) as compared with people with normal weight. The results retained when patients with chronic back disease at baseline were excluded from the analyses. Other back-related diagnoses of hospitalization were not consistently associated with smoking or overweight. CONCLUSION: Heavy smoking and overweight predicted hospitalization for intervertebral disc disorders.

Aged↗
PubMed2004

Predictors of back pain in a general population cohort.

STUDY DESIGN: The study used longitudinal data from the first and second cycles (1994-1995 and 1996-1997) of the Canadian National Population Health Survey. OBJECTIVE: Our objective was to derive prediction models for back pain in the general male and female household populations. SUMMARY OF BACKGROUND DATA: Little is known about the predictors of back pain in the general population. Most previous studies focused on specific occupational groups and used a cross-sectional or case-control design. METHODS: The study cohort consisted of all respondents aged 18+ years who reported no back problems in the 1994-1995 National Population Health Survey cycle (N = 11,063). Potential predictors of chronic back pain were classified into nine groups and entered into stepwise logistic regression models. Bootstrap methods were used to derive the final models and assess their predictive power. RESULTS: The overall incidence of back pain was 44.7 per 1,000 person-years and was higher in women (47.0 per 1,000 person-years) compared with men (42.2 per 1,000 person-years). In men, significant predictors of back pain were age (peak effect in 45-64 years), height, self-rated health, usual pattern of activity (especially heavy work), yard work or gardening (negative association), and general chronic stress. In women, significant factors were self-reported restrictions in activity, being diagnosed with arthritis, personal stress, and history of psychological trauma in childhood or adolescence. CONCLUSIONS: Overall health and psychosocial factors are important predictors of back pain in both men and women. Other risk factors differ between the two sexes.

Adolescent↗
PubMed2004

Correlation between pre-employment screening X-ray finding of spondylolysis and sickness absenteeism due to low back pain among policemen of the Israeli police force.

STUDY DESIGN: A historical prospective case/control study of the significance and correlation between pre-employment findings of L5-S1 spondylolysis and sickness absenteeism due to low back pain among police officers. OBJECTIVES: Examining the importance of pre-employment lumbar spine radiographs as a prediction of work absenteeism. SUMMARY OF BACKGROUND DATA: Spondylolysis is a defect in the pars interarticularis. Its etiology remains controversial, it is a common condition among young athletes, and it carries genetic predisposition. Although described mostly as an incidental radiographic finding in the adult population, spondylolysis is implicated as a contributing factor to low back pain, although the cause-and-effect relation is not clear. METHODS: One hundred and sixty-nine police officers with L5-S1 spondylolysis were identified out of 3988 examined. Incidence density of sickness absenteeism due to low back pain was calculated for the patients and the controls. The Cox's proportional hazard model was used for comparison between the two groups, controlling for possible confounding variables. RESULTS: Similar incidence of sickness absenteeism due to low back pain was found among the patients and controls. The total duration of sickness absenteeism, however, was 2.7 times higher in the spondylolysis group than the controls. Prevalence of spondylolysis is origin specific, denoting genetic predisposition to this condition. Total sickness absenteeism not related to low back pain was not significantly different between the two study groups. CONCLUSIONS: There is low predictive value of pre-employment lumbar spine radiograph as a screening tool predicting sickness absenteeism due to low back pain. Spondylolysis, however, may increase the duration of sickness absenteeism in patients with low back pain.

Absenteeism↗
PubMed2004

The occurrence of anular tears and their relation to lifetime back pain history: a cadaveric study using barium sulfate discography.

STUDY DESIGN: The occurrence of anular tears and general disc degeneration of the lumbar spine was studied in relation to the lifetime frequency of back pain. SUMMARY OF BACKGROUND DATA: Although anular tears and ruptures are common targets for diagnostic and therapeutic approaches, the relationship between disc findings and back pain has been weak or nonexistent. METHODS: The data comprised barium sulfate discograms of lumbar spine levels from 157 male cadavers. The extent of "anular tears" and "general disc degeneration" based on posterior-anterior and side views were evaluated separately using a 4-point scale. Lifetime history of back pain occurrence and work were obtained from the families of 86 cadavers. To assess whether the risk of back pain changed with the severity of findings or the level of disc, we applied trend tests and proportional-odds logistic models for occurrence data. RESULTS: In early adulthood, the risk of anular tears was 0.6 to 0.7, whereas at retirement age, tears were practically unavoidable. The risk of full anular tears with barium sulfate leaking ("leaking" tear) was estimated to be 0.10 and 0.35 among the men in the age groups of 20 to 49 and 50 to 59 years, respectively. The risk of "leaking" tears was greatest at the L5-S1 levels. There were less severe degenerative findings associated with sedentary occupation but no differences between driving and physically light and heavy occupations. Overall, the risk of any anular tears and any general degeneration as defined was similar. The frequency of back pain had a highly significant relation to the occurrence of tears (model-based P = 0.0009). With a "leaking" tear, the model-based estimate of the risk of frequent lifetime back pain was 0.42, with an "outer" tear the risk was 0.20, and with no tears or "inner" tears the risk was 0.10 (the observed prevalence was 0). The effect of occupational loading was of borderline significance (P = 0.045). CONCLUSION: Anular degeneration of the lumbar discs appear earlier and are more clearly related to back pain than previously thought, most probably due to the better sensitivity of the BaSO4 discography method to detect tears.

Adult↗
PubMed2005

Early patterns of care for occupational back pain.

STUDY DESIGN: Cross-sectional analysis. OBJECTIVES: To describe the early health care utilization for occupational back pain. To identify factors associated with health care seeking and provider choice among persons with occupational back pain. SUMMARY OF BACKGROUND DATA: Back pain is the most prevalent work-related injury, yet little is known about patterns of care for occupational back pain. MATERIALS AND METHODS: The sample includes 1104 workers with incident episodes of low back pain. Outcomes measures include whether or not workers received care and the types of providers seen. Predictors of outcomes include demographics, injury severity, history of back pain, occupation, and employer. RESULTS: Eight percent of workers did not receive care in the first 4 to 16 weeks after filing a workers' compensation claim. Injury severity, gender, occupation, and employer were significant predictors of the decision to seek care. Almost 90% of workers who received care were treated by medical physicians, often in combination with physical therapists or chiropractors. Age, occupation, injury severity, and whether the employer or worker chose the initial health care provider were associated with the choice of provider. Employers selected providers for 78% of injured workers who received care. Medical physicians were the providers most often chosen by both employers and workers, but workers were more likely than employers to select chiropractors. CONCLUSIONS: A small but significant number of injured workers do not seek care for their back pain. Medical physicians treat all but a small fraction of the workers who receive care. The decision to seek care and the choice of providers is associated with injury severity, occupation, and employer actions.

Adult↗
PubMed2005

The role of alternative medical providers for the outpatient treatment of insured patients with back pain.

STUDY DESIGN: Analysis of health insurance claims from 2 large Washington State companies. OBJECTIVE: To evaluate the prevalence and cost of complementary and alternative medicine (CAM) provider use for back pain treatment. SUMMARY OF BACKGROUND DATA: Washington State requires all commercial insurance to cover licensed CAM providers. METHODS: Outpatient claims for the treatment of back pain were analyzed by the International Classification of Disease-9 codes and provider type. The number of visits and expenditures associated with different forms of treatments were calculated. RESULTS: Back pain accounted for 15% of all outpatient visits, and these companies spent more than $52 million on 652,593 claims submitted by 104,358 adults. Most people used only CAM (43%) or only conventional providers (45%) for back pain treatment, with merely 12% using both. Patients who saw only CAM providers had fewer comorbidities than the other 2 groups and made approximately twice as many visits as "conventional only" users (median 4 vs. 2). Average amount allowed per outpatient low back pain claim was lower for CAM visits (mean $50, SD $28) than for conventional visits (mean $128, SD $173). Total outpatient costs for the treatment of back pain were highest for the group using both CAM and conventional care (mean $1079, SD $1185), and lowest for the group using CAM only (mean $342, SD $429). CONCLUSION: Many people with back pain use only CAM for their treatment. Although less expensive, this group also appears to be less severely ill. Because of the high prevalence of this condition, cost-effectiveness studies that include CAM therapies are still warranted.

Adolescent↗
PubMed2006

Chronic back problems among persons 30 to 64 years old in France.

STUDY DESIGN: A national population-based survey focusing on disability. OBJECTIVE: To describe the frequency of chronic back conditions among those aged 30 to 64 years, the consequences on their daily lives, their employment status, and source of income. SUMMARY OF BACKGROUND DATA.: Descriptive data from community-based surveys are sparse. METHODS: In the French Handicap, Disability and Dependence survey, 1,289 subjects with chronic back problems were compared with the general population. RESULTS: The estimates for prevalence of chronic back problems were 7.9% for men (95% confidence interval, 7.2-8.5) and 7.5% for women (95% confidence interval, 7.0-8.1). Despite functional limitations, most people in France who had back problems were employed in a ordinary work: 71.5% among men (77.7% in the general population), 53.5% among women (60.2% in the general population). Among them, blue-collar workers were overrepresented. Of the subjects with back conditions, a very small proportion had a source of permanent income related to their health problems. CONCLUSIONS: The results from this national population-based survey emphasize the weight of chronic back problems in the community, in a country where the legislation offers few alternatives to ordinary work for those who suffer from chronic limitations due to low back pain.

Activities of Daily Living↗
PubMed2006

Tumor necrosis factor-immunoreactive cells and PGP 9.5-immunoreactive nerve fibers in vertebral endplates of patients with discogenic low back Pain and Modic Type 1 or Type 2 changes on MRI.

STUDY DESIGN: Immunohistochemistry for tumor necrosis factor (TNF) and protein gene product (PGP) 9.5 in vertebral endplates of patients with discogenic low back pain and Modic Type 1 or Type 2 endplate changes on MRI. OBJECTIVES: To examine whether inflammatory cytokines and nerve in-growth into the vertebral endplate are associated with discogenic low back pain. SUMMARY AND BACKGROUND DATA: Degenerated discs and endplate abnormalities can be a cause of discogenic low back pain. However, the presence of TNF-immunoreactive cells and PGP 9.5-immunoreactive nerve fibers has not been studied in patients with discogenic low back pain and endplate changes on MRI. METHODS: Eighteen endplates showing either normal intensity signals on MRI (endplate change -), Modic Type 1 signals (low intensity on T1-weighted spin-echo images), or Modic Type 2 signals (high intensity) from patients with discogenic low back pain (n = 14) or controls requiring surgery for other back problems (n = 4; scoliosis and traumatic injury of vertebra) were harvested during surgery. Endplates were immunostained using antibodies to TNF and PGP 9.5 and immunostained cells and nerve fibers in the endplates were counted. RESULTS: Vertebral endplates from patients with Modic Type 1 or Type 2 endplate changes on MRI had significantly more PGP 9.5-immunoreactive nerve fibers and TNF-immunoreactive cells in comparison with patients with normal endplates on MRI (P < 0.01). The number of TNF-immunoreactive cells in endplates exhibiting Modic Type 1 changes was significantly higher than in endplates exhibiting Modic Type 2 changes (P < 0.05). CONCLUSIONS: The results suggest that endplate abnormalities are related to inflammation and axon growth induced by TNF. TNF expression and PGP 9.5-positive nerve in-growth in abnormal endplates may be a cause of low back pain.

Adolescent↗
PubMed2006

Comorbid subjective health complaints in low back pain.

STUDY DESIGN: Cross-sectional study. OBJECTIVES: To compare subjective health complaints in subacute patients with low back pain with reference values from a Norwegian normal population. SUMMARY OF BACKGROUND DATA: Comorbidity is common with nonspecific low back pain. We wanted to investigate if these complaints were specific or part of a more general unspecific condition comparable to subjective health complaints in the normal population. MATERIALS AND METHODS: The study group consisted of 457 patients sick-listed 8 to 12 weeks for low back pain. All subjects filled out questionnaires. The subjective health complaints in the study group were compared with reference values from a Norwegian normal population using logistic regression analysis. RESULTS: Compared with the normal reference population, the patients with low back pain had significantly more low back pain, neck pain, upper back pain, pain in the feet during exercise, headache, migraine, sleep problems, flushes/heat sensations, anxiety, and sadness/depression. The prevalence of pain in arms, pain in shoulders, and tiredness was also high, but not significantly higher than in the reference population. CONCLUSIONS: Our findings indicate that patients with low back pain suffer from what may be referred to as a "syndrome," consisting of muscle pain located to the whole spine as well as to legs and head, and accompanying sleep problems, anxiety, and sadness/depression.

Adult↗
PubMed2006

Effects of a two-school-year multifactorial back education program in elementary schoolchildren.

STUDY DESIGN: A quasi-experimental pre/post design. OBJECTIVE: To investigate effects of a 2-school-year multifactorial back education program on back posture knowledge and postural behavior in elementary schoolchildren. Additionally, self-reported back or neck pain and fear-avoidance beliefs were evaluated. SUMMARY OF BACKGROUND DATA: Epidemiologic studies report mounting nonspecific back pain prevalence among youngsters, characterized by multifactorial risk factors. Study findings of school-based interventions are promising. Furthermore, biomechanical discomfort is found in the school environment. METHODS: The study sample included 193 intervention children and 172 controls (baseline, 9-to-11-year-olds). The multifactorial intervention consisted of a back education program and the stimulation of postural dynamism in the class through support and environmental changes. Evaluation consisted of a questionnaire, an observation of postural behavior in the classroom, and an observation of material handling during a movement session. RESULTS: The intervention resulted in increased back posture knowledge (P < 0.001), improved postural behavior during material handling (P < 0.001), and decreased duration of trunk flexion (P < 0.05) and neck torsion (P < 0.05) during lesson time. The intervention did not change fear-avoidance beliefs. There was a trend for decreased pain reports in boys of the intervention group (P < 0.09). CONCLUSIONS: The intervention resulted in improved postural aspects related to spinal loading. The long-term effect of improved postural behavior at young age on back pain prevalence later in life is of interest for future research.

Back↗
PubMed1995

Benefits and liabilities of hypermobility in the back pain disorders of industrial workers.

OBJECTIVES: Back pain disorders, sometimes called 'the nemesis of medicine and the albatross of industry', are ubiquitous, but have stubbornly defied diagnosis and treatment. Hypermobility syndrome, which is also very common, has been called 'an enigma of human physiology'. Both conditions have attracted wide attention and interest only recently. In an earlier study, we considered the benefits and liabilities of joint hypermobility by studying 660 musicians in the USA. In a parallel manner, the present study analysed the back pain disorders of 606 workers in a Swedish high-technology industrial plant in the context of spinal hypermobility. SUBJECTS AND METHODS: The 606 industrial workers were examined for spinal hypermobility using a standard protocol, and interviewed for work-related body-posture requirements and the low back, shoulder and neck pain disorders experienced by them. The data were analysed for associations between hypermobility and physical complaints as a whole, and by taking into account gender and body-postures at work. RESULTS: Twenty-six per cent (37) of 144 workers with hypermobility but only 14% (64) of 453 without hypermobility experienced back pain (P < 0.002). Among the 326 workers with sitting or standing jobs, 40% (29) of 71 with hypermobility had back pain, whereas only 12% (30) of the 255 without hypermobility experienced back pain (P < 0.001). The corresponding numbers with back pain for 235 in jobs with changing body-postures were 4.5% (3) of 66 with hypermobility and 14% (14) of 169 without hypermobility (P = 0.04). CONCLUSIONS: Hypermobility of the spine is an asset if the work requires change of body-posture, but a liability for those in a standing or sitting assignment. It reinforces a similar hypothesis proposed by Larsson et al.

Adolescent↗
PubMed1994

Migraine as a sequela to chronic low back pain.

The occurrence of headache as a sequela of low back pain was examined in a sample of chronic pain patients. All patients had low back pain without history of head, neck, or upper back injury or headache onset simultaneous with the low back pain. Consistent with prior research, headache was found to be a common concomitant of back pain. In many patients, headache was found to have begun or exacerbated markedly after onset of low back pain. Prevalence of migraine in female patients was significantly higher than the population prevalence for females in the United States; this was not true for male patients. Potential mechanisms for explaining the high prevalence of migraine following low back pain are discussed, including increased muscle tension, psychosocial factors, and analgesic overuse.

Female↗
PubMed2002

Effect of conformational aspects on the movement of the equine back.

The relationship between structure and function is important in the judgement of the horse. Twenty sound riding horses walked and trotted on a treadmill. The movement of the backs of each of the horses was measured using a commercially available movement analysis system. Morphometric, spatiotemporal and kinematic information were correlated to investigate the effect of conformation on movement. Taller and heavier horses seem to have longer thoracic and lumbar backs, and are wider at the pelvis. Horses with longer strides extended and flexed their backs in the caudal saddle region to a greater extent at the walk, but not the trot. Horses with greater angle of L5 tend to extend and flex this region of the back more. At the walk and trot, a long thoracic back results in greater lumbar lateral bending. A negative relationship was found between the curvature of mid-thoracic back and the amount of lateral bending of L1 and L3 and axial rotation of the pelvis at the trot. There are clear relationships between back conformation and movement that may be important to the orthopaedic health of the horse. Further understanding of the relationships between conformation, movement and injury may provide an objective basis for the evaluation of future performance and soundness.

Animals↗
PubMed2006

A clinical tool to determine the necessity of spine radiography in postmenopausal women with osteoporosis presenting with back pain.

BACKGROUND: Vertebral fractures are underdiagnosed, although the resulting mortality and morbidity in postmenopausal women with osteoporosis is now recognised. In a population of postmenopausal women with osteoporosis and back pain, symptoms may be related to vertebral fractures or degenerative changes of the spine. AIM: To evaluate a population of postmenopausal women presenting with back pain and factors associated with vertebral fractures which were assessable in a clinical setting in order to determine the necessity for spine radiography. METHODS: Patient questioning and physical examination were carried out and spinal radiographic data collected from 410 postmenopausal women with osteoporosis, with an average age of 74 years, who consulted a rheumatologist for back pain. Of these, 215 (52.4%) patients were diagnosed with at least one vertebral fracture. Logistic regression was used to identify the most relevant clinical features associated with existing vertebral fractures, and to derive a quantitative index of risk. RESULTS: The model included six parameters: age, back pain intensity, height loss, history of low trauma non-vertebral fractures, thoracic localisation of back pain and sudden occurrence of back pain. The scoring system, or the quantitative index, had a maximal score of 16. For a score >or=7, the probability of existing vertebral fracture was >or=43%. The correlation between this quantitative index and the logistic model probability was 0.98, suggesting an excellent and highly significant approximation of the original prediction equation. CONCLUSIONS: From six clinical items, an index was built to identify women with osteoporosis and back pain who should have spine radiography. This simple tool may help clinicians to optimise vertebral fracture diagnosis and to make a proper therapeutic decision.

Aged↗
PubMed2005

Biological risk indicators for recurrent non-specific low back pain in adolescents.

OBJECTIVES: A matched case-control study was carried out to evaluate biological risk indicators for recurrent non-specific low back pain in adolescents. METHODS: Adolescents with recurrent non-specific low back pain (symptomatic; n = 28; mean (SD) age 14.9 (0.7) years) and matched controls (asymptomatic; n = 28; age 14.9 (0.7) years) with no history of non-specific low back pain participated. Measures of stature, mass, sitting height, sexual maturity (Tanner self assessment), lateral flexion of the spine, lumbar sagittal plane mobility (modified Schober), hip range of motion (Leighton flexometer), back and hamstring flexibility (sit and reach), and trunk muscle endurance (number of sit ups) were performed using standardised procedures with established reliability. Backward stepwise logistic regression analysis was performed, with the presence/absence of recurrent low back pain as the dependent variable and the biological measures as the independent variables. RESULTS: Hip range of motion, trunk muscle endurance, lumbar sagittal plane mobility, and lateral flexion of the spine were identified as significant risk indicators of recurrent low back pain (p<0.05). Follow up analysis indicated that symptomatic subjects had significantly reduced lateral flexion of the spine, lumbar sagittal plane mobility, and trunk muscle endurance (p<0.05). CONCLUSIONS: Hip range of motion, abdominal muscle endurance, lumbar flexibility, and lateral flexion of the spine were risk indicators for recurrent non-specific low back pain in a group of adolescents. These risk indicators identify the potential for exercise as a primary or secondary prevention method.

Adolescent↗
PubMed1994

Clinical course and prognostic factors in acute low back pain: an inception cohort study in primary care practice.

OBJECTIVE: To describe the natural course of recent acute low back pain in terms of both morbidity (pain, disability) and absenteeism from work and to evaluate the prognostic factors for these outcomes. DESIGN: Inception cohort study. SETTING: Primary care. PATIENTS: 103 patients with acute localised non-specific back pain lasting less than 72 hours. MAIN OUTCOME MEASURES: Complete recovery (disappearance of both pain and disability) and return to work. RESULTS: 90% of patients recovered within two weeks and only two developed chronic low back pain. Only 49 of 100 patients for whom data were available had bed rest and 40% of 75 employed patients lost no time from work. Proportional hazards regression analysis showed that previous chronic episodes of low back pain, initial disability level, initial pain worse when standing, initial pain worse when lying, and compensation status were significantly associated with delayed episode recovery. These factors were also related to absenteeism from work. Absenteeism from work was also influenced by job satisfaction and gender. CONCLUSIONS: The recovery rate from acute low back pain was much higher than reported in other studies. Those studies, however, did not investigate groups of patients enrolled shortly after the onset of symptoms and often mixed acute low back pain patients with patients with exacerbations of chronic pain or sciatica. Several sociodemographic and clinical factors were of prognostic value in acute low back pain. Factors which influenced the outcome in terms of episode recovery (mainly physical severity factors) were only partly predictive of absenteeism from work. Time off work and return to work depended more on sociodemographic and job related influences.

Absenteeism↗
PubMed1998

Outcome of low back pain in general practice: a prospective study.

OBJECTIVES: To investigate the claim that 90% of episodes of low back pain that present to general practice have resolved within one month. DESIGN: Prospective study of all adults consulting in general practice because of low back pain over 12 months with follow up at 1 week, 3 months, and 12 months after consultation. SETTING: Two general practices in south Manchester. 490 subjects (203 men, 287 women) aged 18-75 years. MAIN OUTCOME MEASURES: Proportion of patients who have ceased to consult with low back pain after 3 months; proportion of patients who are free of pain and back related disability at 3 and 12 months. RESULTS: Annual cumulative consultation rate among adults in the practices was 6.4%. Of the 463 patients who consulted with a new episode of low back pain, 275 (59%) had only a single consultation, and 150 (32%) had repeat consultations confined to the 3 months after initial consultation. However, of those interviewed at 3 and 12 months follow up, only 39/188 (21%) and 42/170 (25%) respectively had completely recovered in terms of pain and disability. CONCLUSIONS: The results are consistent with the interpretation that 90% of patients with low back pain in primary care will have stopped consulting with symptoms within three months. However most will still be experiencing low back pain and related disability one year after consultation.

Adolescent↗
PubMed1999

Predicting who develops chronic low back pain in primary care: a prospective study.

OBJECTIVES: To quantify the relative contribution of premorbid and episode specific factors in determining the long term persistence of disabling symptoms of low back pain. DESIGN: Prospective cohort study. SETTING: Two general practices in the south Manchester area. PARTICIPANTS: 180 patients, who previously participated in a cross sectional population survey, who consulted because of low back pain during the study period. They were followed at 1 week and 3 and 12 months after consultation. MAIN OUTCOME MEASURE: Persistent disabling low back pain in the 12 months after the consultation. RESULTS: Disabling low back pain persisted in one third of participants after consultation and was more common with increasing age, among those with a history of low back pain, and in women. Persistence of symptoms was associated with "premorbid" factors (high levels of psychological distress (odds ratio 3.3; 95% confidence interval 1.5 to 7.2), poor self rated health (3.6; 1.9 to 6.8), low levels of physical activity (2.8; 1.4 to 5.6), smoking (2. 1; 1.0 to 4.3), dissatisfaction with employment (2.4; 1.3 to 4.5)) and factors related to the episode of low back pain (duration of symptoms, pain radiating to the leg (2.6; 1.3 to 5.1), widespread pain (6.4; 2.7 to 15), and restriction in spinal mobility). A multivariate model based on six factors identified groups whose likelihood of persistent symptoms ranged from 6% to 70%. CONCLUSIONS: The presence of persistent low back pain is determined not only by clinical factors associated with pain but also by the premorbid state.

Adolescent↗