Epidemiology and Risk of LBP

Question 1

Prevalence

Answer 1

percentage of people in a known population who have the problem during a particular period of time

Question 2

Incidence

Answer 2

percentage of people in a known population who develop new problems during a particular period of time

Question 3

What is the difference between LBP and disability?

Answer 3

LBP has pain symptoms that vary in severity, duration, and location. Disability would have restricted activity.

Question 4

What are the following statistical percentages of LBP?

(1) lifetime prevalence
(2) 1-year prevalence
(3) 1-month prevalence
(4) point prevalence

Answer 4

(1) lifetime prevalence = 75%
(2) 1-year prevalence = 50%
(3) 1-month prevalence = 30%
(4) point prevalence = 20%

Question 5

How does the prevalence of LBP vary based on race/ethnicity?

Answer 5

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.

Question 6

How does the prevalence of LBP vary based on education level?

Answer 6

Those with lower education levels have higher prevalence of LBP compared to those with higher education levels.

Question 7

How does the prevalence of LBP vary based on family income?

Answer 7

Those with lower family income have a higher prevalence of LBP compared to those with higher family incomes.

Question 8

Is the prevalence of chronic LBP increasing or decreasing?

Answer 8

Increasing

Question 9

What are the traditional clinical classifications of back pain based on time course?

Answer 9

Acute = current symptoms less than 6 weeks

Subacute = current symptoms 6 weeks-3 months

Chronic = current symptoms more than 3 months

Question 10

What is the strongest predictor of a new episode of LBP?

Answer 10

A previous episode of LBP

Question 11

How should LBP be viewed opposed to the traditional clinical classification system?

Answer 11

As a chronic problem with a pattern of periods of relative freedom from pain interspersed with acute episodes and recurrences

Question 12

What are the top 3 most common bodily symptoms reported by people?

Answer 12

(1) headache
(2) fatigue
(3) LBP

Question 13

What other comorbidities are also associated with LBP?

Answer 13

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%)

Question 14

What is the annual prevalence of work missed due to LBP?

Answer 14

about 12%

Question 15

What is the annual cost of LBP? What accounts for the largest percentage of this cost?

Answer 15

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

Question 16

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

Answer 16

• 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

Question 17

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

Answer 17

• 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

Question 18

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

Answer 18

• 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

Question 19

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?

Answer 19

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

Question 20

What is illness behavior?

Answer 20

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

Question 21

What can be utilized to recognize abnormal signs and symptoms of illness behavior?

Answer 21

Waddell’s Signs

Question 22

What are Waddell’s Symptoms/Nonorganic Symptoms?

Answer 22

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?

Question 23

What are Waddell’s Signs/Nonorganic signs?

Answer 23

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

Question 24

How do you interpret Waddell’s signs or symptoms?

Answer 24

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

Question 25

How was you treat someone that is positive for Waddell’s signs/symptoms?

Answer 25

You would include treatment options that address their psychosocial issues along with your treatment for their LBP.