A closer examination of the interaction among risk factors for low back pain

Knowledge related to low back pain and its associated factors in patients with low back pain: A cross-sectional study

BACKGROUND

Patients' knowledge about low back pain (LBP) negatively influences LBP prognosis. Studying the extent of patients' knowledge about LBP may help clinicians design effective LBP treatment strategies.

OBJECTIVE

To explore the level of LBP knowledge and its associated factors in patients with LBP.

METHODS

A cross-sectional study with a representative sample. Participants with acute or chronic LBP completed a self-administered questionnaire including sociodemographic and clinical characteristics. We used the Low Back Pain Knowledge Questionnaire (LBP_KQ) to assess knowledge, the Fear-Avoidance Beliefs Questionnaire for LBP (FABQ_LBP) to assess fear of movement, the Oswestry Disability Index (ODI) to assess functional disability, Depression Anxiety Stress Scales (DASS 21) to assess mental health status, and the Numeric Pain Rating Scale (NPRS) to assess pain intensity.

RESULTS

A total of 271 individuals with LBP completed the study. The mean age of participants was 39.86 (± 11.27), the LBP chronicity median was 18 (IQR = 44) months, and 56.5% of the participants were females. The mean LBP_KQ score was 9.29 (± 3.89)/24. An educational level higher than high school (diploma education (β= 1.202 [95%CI: 5.633 to 11.498], p< 0.001), bachelor or higher education (β= 2.270 [95%CI: 1.107 to 3.433], p< 0.001)), and using pain killers (β= 1.180 [95%CI: 0.140 to 2.221], p= 0.026) were significantly associated with higher LBP_KQ score. While being employed (β=-1.422 [95%CI: -2.462 to -0.382], p= 0.008) and having higher DASS Anxiety score (β=-0.144 [95%CI: -0.240 to -0.048], p= 0.003) were significantly associated with lower LBP_KQ score.

CONCLUSIONS

Individuals with chronic LBP in Jordan demonstrated relatively low levels of LBP knowledge related to their condition. Rehabilitation personnel, healthcare stakeholders, and policymakers should carefully monitor the level of LBP knowledge and its associated factors.

Applying classification and regression tree analysis to identify risks of developing sarcopenia in the older population

BACKGROUND AND OBJECTIVE

Variations in the risk factors for sarcopenia can lead to differences in the likelihood of developing sarcopenia among older adults; however, few studies have explored the interactions among the risk factors. This study examined the interactions among risk factors and identified a discriminative pathway for groups at risk of sarcopenia in community-dwelling older adults.

METHODS

A cross-sectional study was conducted between July and August 2019 to recruit 200 older adults from an outpatient department of a hospital providing care for older people. Data on various risk factors, namely demographics (age, gender, education, comorbidities, and body mass index [BMI]), dietary habits (weekly consumption of milk, coffee, and meat), lifestyle behaviours (vitamin D supplementation, smoking, drinking, and physical activity), and depression symptoms were collected. Sarcopenia was defined according to the Asian Working Group for Sarcopenia criteria. A classification and regression tree (CART) model was used to examine interactions among these factors and identify groups at risk of sarcopenia.

FINDINGS

The prevalence of sarcopenia was 38.5%. The CART model identified two end groups at differential risks of sarcopenia, with a minimum of one and a maximum of three risk factors. In the first group, low BMI (<18.5 kg/m² ) was a predominant risk factor for sarcopenia among older people. In the second group, older adults with a normal BMI, aged ≥68 years, and without a regular walking habit had a higher probability of developing sarcopenia than did their counterparts.

CONCLUSIONS

The interactive effects among older age, BMI, and walking may cause different probabilities of developing sarcopenia in the older population.

IMPLICATIONS FOR PRACTICE

Older adults with a low or normal BMI but without a regular walking habit could be a predominant risk group for sarcopenia. The appropriate maintenance of body weight and regular walking activity is suggested to prevent sarcopenia in community-dwelling older adults.

A predictive model for identifying low medication adherence among older adults with hypertension: A classification and regression tree model

Various individual characteristics may affect medication adherence; however, few studies have investigated the effect of interrelationships among these various individual characteristics on medication adherence. This cross-sectional study explored the interrelationships among risk factors for medication adherence and established a predictive model of low medication adherence among older adults with hypertension. Convenience sampling was used to recruit 300 older adults with hypertension. The following parameters were recorded: demographic and disease characteristics, health beliefs, self-efficacy, social support, and medication adherence of antihypertensive drugs. Classification and regression tree (CART) analysis was performed to develop a predictive model of low medication adherence. The CART model revealed that health belief, disease duration, self-efficacy, and social support interacted to contribute to various pathways of low medication adherence. The predicted accuracy of the model was validated with a low misclassification rate of 26%. The proposed classification model can help identify risk cases with low medication adherence. Suitable health education programs based on these risk factors to manage and improve medication adherence for older adults with hypertension could be considered.

Low back pain-associated factors in female hospital-based personal care attendants

BACKGROUND

Low back pain (LBP) is common in personal care attendants because this profession requires much physical work. Information about the prevalence of LBP and LBP-associated risk factors in this group is limited.OBJECTIVEThis study aimed to investigate the 1-year prevalence of LBP and identify LBP-associated factors in female hospital-based personal care attendants.

METHODS

Forty-seven female hospital-based personal care attendants were recruited. The Nordic Musculoskeletal Questionnaire was used to investigate the prevalence of LBP during the recent 12 months. Participants completed a personal traits and associated factors questionnaire. Physical fitness and the knowledge test of body mechanics were assessed. Multivariable logistic regression analysis was used to explore LBP-associated factors.

RESULTS

The 1-year prevalence of LBP was 46.8%. The strongest LBP-associated risk factor was poor abdominal muscle endurance, followed by insufficient knowledge on the test of body mechanics and higher psychological stress.

CONCLUSIONS

The results demonstrate that the prevalence of LBP in female hospital-based personal care attendants appears to be high. Preventive programs should be initiated to reduce LBP-associated risk factors, such as improving abdominal muscle endurance, providing education in the proper use of body mechanics, and providing psychological intervention services for female hospital-based personal care attendants.

Incidence of low back pain and potential risk factors among pharmacists: A population-based cohort study in Taiwan

Low back pain (LBP) is one of the most common symptoms of work-related musculoskeletal disorders in pharmacists. This can impede the physical functions of the body and lead to incapacitation, resulting in significant social and economic burden. This study aimed to investigate the incidence and risk factors that correlate with LBP in Taiwanese pharmacists.A retrospective cohort study was conducted among all registered pharmacists aged 20 to 40 years using the National Health Insurance Research Database (2000-2013) in Taiwan. The LBP diagnosis was confirmed with one episode of hospitalization or at least three claimed outpatient visits for LBP. Data on workplace characteristics as well as comorbidities were also collected for the analyses. A Cox proportional hazard regression was used to estimate the risk factors for LBP.The incidence rate of LBP among pharmacists was 16.60% in this study. Older pharmacists (28.49%; P < .01) and those who worked at district hospitals (23.51%; P < .01) showed a higher proportion of LBP. Furthermore, after adjustment for selected potential confounding factors, female pharmacists [adjusted hazard ratio (aHR): 1.12, 95% confidence interval (95% CI): 1.01-1.24, P = .0354] and pharmacists with diabetes (aHR: 1.55; 95% CI: 1.20-2.01; P = .0008) and gout (aHR: 1.70; 95% CI: 1.37-2.09; P < .0001) had significantly higher risks of LBP.In conclusion, age was positively correlated with LBP, and the workplace was an important factor in the development of LBP in pharmacists. We suggest that pharmacists who work in district hospitals should pay more attention to the development of LBP.

Can patients identify what triggers their back pain? Secondary analysis of a case-crossover study

There is evidence that patients can accurately nominate the activity that triggered their sudden-onset acute low back pain.

The aim of this case-crossover study was to investigate the extent to which patients can accurately nominate what triggered their new episode of sudden-onset acute low back pain (LBP). We interviewed 999 primary care patients to record exposure to 12 standard triggers and also asked the patients to nominate what they believed triggered their LBP. Exposure to the patient-nominated trigger during the case window was compared with exposure in the control window. Conditional logistic regression models were constructed to quantify the risk of LBP onset associated with the patient-nominated trigger. Sensitivity analyses were conducted varying the duration and timing of case/control windows. We compared the extent to which patient-nominated triggers matched standard triggers. The odds ratios for exposure to patient-nominated triggers ranged from 8.60 to 30.00, suggesting that exposure increases the risk of LBP. Patients' understanding of triggers however seems incomplete, as we found evidence that while some of the standard triggers were well recognised (such as lifting heavy loads), others (such as being distracted during manual tasks) were under-recognised as possible triggers of an episode of LBP. This study provides some evidence that patients can accurately nominate the activity that triggered their new episode of sudden-onset acute LBP.

Back pain in Poland and Germany: a survey of prevalence and association with demographic characters

Background. Back pain is the most common form of pain and leads to high costs in all medical care systems. Objective. The present study examines the prevalence of back pain and its associations with some basic demographics. Methods. Two samples from Poland and Germany (about n = 500 each) were examined via Internet regarding back pain, gender, age, and body mass index (BMI). Results. Back pain is more common in women than in men (risk ratio about 1.7), and a high BMI constitutes an additional risk factor. Age was not related to back pain prevalence. Conclusion. Congruent results in two countries based on the same measure of back pain lead to the assumption that much of the variety found in estimates of back pain are due to inconsistent assessment. For future research, a definition of common criteria on how to assess back pain would be an asset.