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The nature of back pain in a general adult population: A longitudal study
Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
2000 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The purpose of this thesis was to study in a general adult population the prevalence and incidence of back trouble, predictive factors for new episodes of back pain, new sick leave episodes, and factors important for recovery from back pain. The pain drawing method was used in an epidemiological survey to identify pain in the entire back area. The bias that knowledge of back pain history has on the interpretation of pain drawings was studied in a separate study.

The cross-sectional main study population consisted of 2000 individuals aged 20-59 years. A prospective survey was conducted after one year on the study population of factors important for new sick leave, new back pain episodes and recovery and after five years on two age strata of factors important for retaining back health. After ten years the number of disability pensions granted for back pain during the time period was studied. The socio-demographic and work-related factors that predicted disability pension were studied.

The prevalence of back pain was found to be 23%. Back pain with radiation was reported by 40%, according to the pain drawings. Only 4% reported localised neck pain. Sick leave was reported by 12% of those with back pain. The more generalised pain pattern suggested that back pain is more than a local back pain problem.

The one-year incidence of new back pain was 24%. Seventy-nine percent of the episodes lasted less than 2 months. A history of previous back pain predicted new back pain episodes, while stress at work and low work satisfaction was associated factors. Low age, more qualified work tasks and residence predicted recovery from back pain. New sick leave periods were predicted by unqualified work tasks, pain debut at work, previous back pain history and pain at the primary survey.

The clinical findings in the group with pain at the primary survey showed that the absence of tenderness in the trapezium muscle was the strongest predictor of recovery. It was also found that straighter lordosis and restricted mobility in the cervical spine were associated with new sick leaves in the prospective year.

The pain drawing study showed that knowledge of the pain history affected the interpretation and reliability of the pain drawing evaluation.

The five-year survey showed that absence of physical load in the old age group and absence of psychological stress at work in the younger age group predicted retained back health.

The study of disabilities granted on the grounds of back pain during ten prospective years has shown that age over 40, sick leave at the primary survey together with perceiving the work tasks as meaningless predicted disability pension.

The results of this thesis suggest that back pain should be seen as arecurrent problem, where previous episodes strongly predict new episodes. The complex nature of back pain as a health problem suggests that the rehabilitation should be individualised and include both work-related factors as well as a wide range of factors not related to paid work.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet , 2000. , 64 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 640
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-28067Local ID: 12831ISBN: 91-7219-741-2 (print)OAI: oai:DiVA.org:liu-28067DiVA: diva2:248618
Public defence
2000-09-29, Berzeliussalen, Universitetssjukhuset, Linköping, 09:00 (Swedish)
Opponent
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-08-14Bibliographically approved
List of papers
1. The epidemiology of back pain in vocational age groups
Open this publication in new window or tab >>The epidemiology of back pain in vocational age groups
1999 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 17, no 1, 17-21 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To investigate the prevalence of back pain in a general population aged between 20 and 59 years.

POPULATION: A representative sample of 2000 individuals from Ostergotland County, Sweden (population 400,000).

STUDY DESIGN: Cross-sectional study using a questionnaire including the pain drawing.

RESULTS: The observed point prevalence was 28% (95% confidence interval 26-31%). The adjusted prevalence taking into account the non-responders was 23% (21-25%). Lumbar pain with radiation was reported by 40%, while 4% had only cervical pain with radiation. Twelve per cent were on sick-leave due to back pain. Activity of daily life was affected mainly in the group of men aged 40-59 and only in household tasks. The back problems did not affect social activity.

CONCLUSIONS: The prevalence of back problems in the vocational ages was found to be 23%. Only small parts of a pain population are on sick-leave or have changed working tasks because of back problems. The distribution of pain in most cases is combined with radiation to extremities and not isolated to a single region. The combination of different localisations shows the pain problem to be more than just a "low back" problem.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-26127 (URN)10.1080/028134399750002836 (DOI)10586 (Local ID)10586 (Archive number)10586 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
2. Pain drawing evaluation–the problem with the clinically biased surgeon: Intra- and interobserver agreement in 50 cases related to clinical bias
Open this publication in new window or tab >>Pain drawing evaluation–the problem with the clinically biased surgeon: Intra- and interobserver agreement in 50 cases related to clinical bias
1998 (English)In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 69, no 4, 408-411 p.Article in journal (Refereed) Published
Abstract [en]

To assess whether the clinical knowledge of the treating surgeon had any effect on the reliability of the pain-drawing evaluation, drawings from 50 low-back pain patients were evaluated by the treating surgeon and by three colleagues who had no clinical knowledge of the patient. The evaluation was repeated after 10 days. The treating surgeons were also blinded to clinical data. The kappa value in the evaluation when the surgeon had clinical knowledge of the patient was lower (0.29 (95% CI 0.13–0.45)) than the kappa value in the evaluations made without clinical knowledge (0.60 (CI 0.45–0.75)). The differences observed in interobserver reliability between open and blind evaluations suggest that clinical knowledge of a patient influences the evaluation of the pain drawings.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-79751 (URN)10.3109/17453679808999057 (DOI)
Available from: 2012-08-13 Created: 2012-08-13 Last updated: 2017-12-07Bibliographically approved
3. Back pain in an adult population: One year incidence, sick leave, and recovery from pain
Open this publication in new window or tab >>Back pain in an adult population: One year incidence, sick leave, and recovery from pain
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Objective - To study the incidence of self-reported hack pain in a general population and to identify risk factors for sick leave and factors associated with recovery from back pain.

Population - A cross-sectional sample (n=1344) of a general adult population.

Setting - In a semi-urban Swedish county.

Design - One-year prospective study of a single cohort.

Main outcome measures - The incidence of back pain, risk factors for sick leave, factors predisposing for recovery.

Results - The incidence of back pain was 24 % (95% C.I. 22% to 27%). 79% of the pain episodes lasted less than two months. History of previous back pain predisposed to developing new episodes of back pain, while stress at work combined with low work satisfaction were associated factors. Factors predisposing to recovery were young age, skilled work, and living in the countryside. Unskilled work, pain debut at work, previous history and back pain at the start of the study were factors predisposing to sick listing for back pain. Long-term sick leave was predisposed by previous history of back pain and ongoing back pain at the start of the study.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-79752 (URN)
Available from: 2012-08-13 Created: 2012-08-13 Last updated: 2013-09-05Bibliographically approved
4. Clinical findings in a population with back pain: Relation to one-year outcome and long-term sick leave
Open this publication in new window or tab >>Clinical findings in a population with back pain: Relation to one-year outcome and long-term sick leave
2000 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 18, no 4, 208-214 p.Article in journal (Refereed) Published
Abstract [en]

Objective - To investigate whether physical examination findings can be used in predicting recovery from back pain and new episodes of sick leave.

Design - One-year prospective study of a single cohort.

Settings - Semi-rural Swedish county.

Population - A cross-section of a general population with back pain (207 women, 176 men) between 20 and 59 years of age.

Main outcome measures - Cumulative incidence of sick leave due to back pain, cumulative incidence of sick leave due to back pain > 30 days, incidence of recovery from back pain.

Results - For recovery from pain, the absence of tenderness in the trapezius muscle (OR 0.33, CI 0.1-0.5) was predictive. New sick leave was predicted by tenderness in the trapezius muscle (OR 2.67, CI 1.5-4.9), and had a tendency to be associated with a flattened lumbar lordosis and a restricted cervical range of motion. For long-term sick leave, the same findings and also observation of scoliosis (OR 3.44, CI 1.1-10.5) were predictive.

Conclusion - There are subgroups with back pain predisposed to development of more persistent symptoms and a higher risk for sick-listing.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-47518 (URN)10.1080/028134300448760 (DOI)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-13Bibliographically approved
5. Absence of back disorders in adults and work-related predictive factors in a 5-year perspective
Open this publication in new window or tab >>Absence of back disorders in adults and work-related predictive factors in a 5-year perspective
2001 (English)In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 10, no 3, 215-220 p.Article in journal (Refereed) Published
Abstract [en]

Factors important for avoiding back disorders in different age-groups have seldom been compared and studied over time. We therefore set out to study age-related differences in socio-economic and work-related factors associated with the absence of back disorders in a 5-year comparative cohort study using a mailed questionnaire. Two subgroups (aged 25-34 and 54-59 years) derived from a representative sample of the Swedish population were followed at baseline, 1 year and 5 years. Questions were asked about the duration of back pain episodes, relapses, work changes and work satisfaction. A work adaptability, partnership, growth, affection, resolve (APGAR) score was included in the final questionnaire. Multivariate logistic regression was used to identify factors predicting the absence of back disorders. Absence of physically heavy work predicted an absence of back disorders [odds ratio (OR), 2.86, 95% confidence interval (CI), 1.3-6.3] in the older group. In the younger age-group, the absence of stressful work predicted absence of back disorders (OR, 2.0, 95% CI, 1.1-3.6). Thirty-seven per cent of the younger age-group and 43% of the older age-group did not experience any back pain episodes during the study period. The exploratory work APGAR scores indicated that back disorders were only associated with lower work satisfaction in the older group. The analyses point out the importance of avoiding perceived psychological stress in the young and avoiding perceived physically heavy work in the older age-group for avoiding back disorders. The results suggest a need for different programmes at workplaces to avoid back disorders depending on the age of the employees concerned.

Keyword
Absence of back disorders, Longitudinal study, Predictive factors
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-47314 (URN)10.1007/s005860100253 (DOI)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-13Bibliographically approved
6. Disability pension due to back pain: A ten-year prospective survey
Open this publication in new window or tab >>Disability pension due to back pain: A ten-year prospective survey
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Back pain contributes to a large number of disability pensions. The process toward disability is not well understood. In a 10-year (1988-1998) prospective study of a single cohort (n=1902) representative of the general adult population in a semi-nrban Swedish county, the incidence of disability pensions based on back pain was studied. Socio-demographic and work-related risk factors for disability pension were analysed.

Eigbt percent of respondents to a baseline survey (n=1344) and 10% of the non-respondents (n=558) were granted full-time disability pension on back pain diagnosis during the 10-year period. Age over 40, low professional status, primary sick leave because of back pain and the perception of work tasks as unsatisfying were found to predict disability.

Disability pension granted due to back pain appears to have a variation over time and is affected by both social insurance and work-related factors.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-79778 (URN)
Available from: 2012-08-14 Created: 2012-08-14 Last updated: 2013-09-05Bibliographically approved

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Reigo, Tomas

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