Systematic review of the global prevalence of low back pain

Global people

Many of my Musculoskeletal Elf colleagues make their livelihood from building and constructing; therefore, I was quite excited to see that the focus of this year’s National Back Pain week in the UK is on “Builders’ Backs”. According to the statistics in the campaign pack by BackCare (the UK’s National Pack Pain Association) 30,000 UK construction workers injure their back every year, with 10,000 of them still in pain after 12 months and 6,000 off work for over 3 months (although, I don’t imagine that any of these are Elves!).

Low back pain (LBP) is a global phenomenon, as highlighted by a systematic review of its prevalence published recently by Hoy et al (2012) in Arthritis and Rheumatism. The specific aim of their study was to perform an up-to-date systematic review of the global prevalence of LBP for informing the World Health Association’s Global Burden of Disease (GBD) study (WHO, 2010), and, in doing so, examine the influence that case definition, prevalence period, and other variables have on prevalence.

Here’s what they did

The authors conduced a new systematic review of the global prevalence of low back pain that included all general population-based studies published between 1980 and 2009 in which the prevalence of LBP was reported. The Ovid Medline, EMBase, and CINAHL electronic databases were searched. The methods used conformed to the Meta-analysis of Observational Studies in Epidemiology and the Cochrane Collaboration recommendations.

Here’s what they found

The electronic database search yielded 8,727 studies; of these, a total of 165 studies from 54 countries were met the inclusion criteria. Of these, 64% had been published since the last comparable review. 

The review showed that low back pain is a major problem throughout the world and is most prevalent among females and persons ages 40–80 years. After adjusting for methodologic variation, the mean ± SD point prevalence of activity-limiting low back pain lasting more than 1 day was estimated to be 11.9 ± 2.0%, and the 1-month prevalence was estimated to be 23.2 ± 2.9%.

The authors concluded

“A standardised definition of LBP will assist future reviews, enable greater comparisons between countries, and ultimately lead to a far-improved understanding of low back pain.”

The Musculoskeletal Elf’s view

The Musculoskeletal ElfI know first-hand that trying to get healthcare professionals to agree on standardised terminology is a real challenge. In terms of a definition of LBP, Dionne et al (2008) recommended using the following questions in prevalence studies:

  1. In the past 4 weeks, have you had pain in your low back? and
  2. If yes, was this pain bad enough to limit your usual activities or change your daily routine for more than one day?

Further to this, they emphasised the importance of describing the specific anatomic area and, when possible, using a diagram of the body with the low back area shaded. The area they recommend for the low back is “the posterior aspect of the body from the lower margin of the twelfth ribs to the lower gluteal folds”.

Have you considered the use of standardised definitions within your area of practice? Have you struggled to find definitions and get them agreed with others?

Send us your views on this blog and become part of the ever expanding Musculoskeletal Elf community.

Links

Hoy D, Bain C, Williams G, March L, Brooks P, Blyth F, Woolf A, Vos T, Buchbinder R. (2012) A systematic review of the global prevalence of low back pain, Arthritis & Rheumatism, 64 (6): 2028-37 http://www.ncbi.nlm.nih.gov/pubmed/22231424 [PubMed abstract] doi: 10.1002/art.34347

Dionne CE, Dunn KM, Croft PR, Nachemson AL, Buchbinder R, Walker BF, et al. (2008) A consensus approach toward the standardization of back pain definitions for use in prevalence studies. Spine; 33: 95-103 http://www.ncbi.nlm.nih.gov/pubmed/18165754 [PubMed abstract]

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Heather Gray

I am currently a Senior Lecturer in Physiotherapy and Learning, Teaching and Quality Lead at Glasgow Caledonian University, as well as being a Researcher at the University of Glasgow. I am also the Research Officer for the Association of Chartered Physiotherapists in Occupational Health and Ergonomics. Other work in which I am involved is as an Educational Consultant with NHS Education for Scotland. Prior to moving into academia I worked in the National Health Service (NHS) in Scotland as a physiotherapist for 11 years.

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