Epidemiology and Risk of LBP Flashcards
Prevalence
percentage of people in a known population who have the problem during a particular period of time
Incidence
percentage of people in a known population who develop new problems during a particular period of time
What is the difference between LBP and disability?
LBP has pain symptoms that vary in severity, duration, and location. Disability would have restricted activity.
What are the following statistical percentages of LBP?
(1) lifetime prevalence
(2) 1-year prevalence
(3) 1-month prevalence
(4) point prevalence
(1) lifetime prevalence = 75%
(2) 1-year prevalence = 50%
(3) 1-month prevalence = 30%
(4) point prevalence = 20%
How does the prevalence of LBP vary based on race/ethnicity?
LBP is most prevalent in American Indian or Alaska Native, then White, and then Native Hawaiian Pacific Islander ethnicities. (Black and Hispanic ethnicities follow) Asian ethnicities have the lowest prevalence.
How does the prevalence of LBP vary based on education level?
Those with lower education levels have higher prevalence of LBP compared to those with higher education levels.
How does the prevalence of LBP vary based on family income?
Those with lower family income have a higher prevalence of LBP compared to those with higher family incomes.
Is the prevalence of chronic LBP increasing or decreasing?
Increasing
What are the traditional clinical classifications of back pain based on time course?
Acute = current symptoms less than 6 weeks
Subacute = current symptoms 6 weeks-3 months
Chronic = current symptoms more than 3 months
What is the strongest predictor of a new episode of LBP?
A previous episode of LBP
How should LBP be viewed opposed to the traditional clinical classification system?
As a chronic problem with a pattern of periods of relative freedom from pain interspersed with acute episodes and recurrences
What are the top 3 most common bodily symptoms reported by people?
(1) headache
(2) fatigue
(3) LBP
What other comorbidities are also associated with LBP?
Chronic pain elsewhere (67%): arthritis (51%) and migraine or other headache (15%)
Mental Health Diagnosis (35%): anxiety disorder (27%), mood disorder (18%), or substance abuse (5%)
What is the annual prevalence of work missed due to LBP?
about 12%
What is the annual cost of LBP? What accounts for the largest percentage of this cost?
The annual cost of LBP exceeds $200 billion and the small percentage of people with continuous symptoms >3 months account for the largest percentage of cost
How much evidence do the following individual factors have for risk of LBP?
- Genetics
- Gender
- Age
- Body Build (height, weight, leg length discrepancy)
- Physical fitness
- Social class, education level
- Emotional distress
- Previous history of low back pain
- Genetics - moderate evidence
- Gender - variable evidence
- Age - variable evidence
- Body Build (height, weight, leg length discrepancy) - strong evidence for no effect
- Physical fitness - moderate evidence for benefits
- Social class, education level - strong evidence that male unskilled/partly skilled laborers have greater prevalence
- Emotional distress - strong evidence of small effect
- Previous history of low back pain - strongest evidence of largest effect
How much evidence do the following environmental factors have for risk of LBP?
- Manual handling
- Bending/Twisting
- Repetitive movements
- Static sitting
- Driving/whole body vibrations
- Leisure activity and sports
- Manual handling - strong evidence for moderate effect
- Bending/Twisting - strong evidence for moderate effect
- Repetitive movements - variable evidence
- Static sitting - strong evidence small to no effect
- Driving/whole body vibrations - strong evidence for moderate effect
- Leisure activity and sports - moderate evidence for no effect
How much evidence do the following environmental (psychosocial) factors have for risk of LBP?
- Job satisfaction
- Work stress
- High job demands and pace
- Poor job content
- Low social support
- Job satisfaction - strong evidence for small effect
- Work stress - weak evidence for small effect
- High job demands and pace - variable evidence for no effect
- Poor job content - variable evidence for no effect
- Low social support - strong evidence for small effect
Which risk factors are most important on impacting the initial onset of back pain and which risk factors for the impact and consequences of back pain and for chronic pain and disability?
Physical risk factors = most important on impacting the initial onset of back pain
Psychosocial issues = most important for the impact and consequences of back pain and for chronic pain and disability
What is illness behavior?
What people say and do to express and communicate they are ill, unwell, in pain, etc.
This is reasonable and normal behavior and varies in people
What can be utilized to recognize abnormal signs and symptoms of illness behavior?
Waddell’s Signs
What are Waddell’s Symptoms/Nonorganic Symptoms?
1.
Do you get pain in your tailbone?
2.
Do you have numbness in your entire leg (front, side, and back of leg) at the same time?
3.
Do you have pain in your entire leg (front, side, and back of leg) at the same time?
4.
Does your whole leg ever give way?
5.
Have you had any time during this episode when you have had very little low back pain?
6.
Have you had to go to the emergency room because of back pain?
7.
Has all treatment for your back made your pain worse?
What are Waddell’s Signs/Nonorganic signs?
Nonorganic Sign
Description
Regional Disturbances
•Widespread region of sensory change or weakness that is divergent from accepted neuroanatomy
Superficial or non-anatomic tenderness
•Tenderness of skin to light touch (superficial) or deep tenderness felt over widespread area not localized to one structure (non-anatomic)
Simulation tests
Axial loading
Rotation
- LBP reported with pressure on pt’s head while standing
- LBP reported when shoulders/pelvis are rotated in same plane as the patient stands
Distraction tests
Straight leg raise
•Inconsistent limitation of SLR in supine and seated positions
Overreaction
•Disproportionate verbalization, facial expression, muscle tension, collapsing, sweating, etc., during examination
How do you interpret Waddell’s signs or symptoms?
3 or more are clinically meaningful
They don’t exclude organic causes of pain or indicate faking or malingering!
Instead, they are interpreted as an indication of psychosocial issues that affect prognosis of individuals with LBP
How was you treat someone that is positive for Waddell’s signs/symptoms?
You would include treatment options that address their psychosocial issues along with your treatment for their LBP.
