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Low Back Pain: With Special Reference to Prevalence, Diagnosis, Treatment and Prognosis
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Objectives. Ascertain if there has been a secular trend in 3-months prevalence of casually reported back pain. Evaluate if such back pain predicts concurrent health as well as future sick leave, disability pension, hospitalization and survival. Study differences in diagnostic assessment and labelling between physicians. Evaluate if a comprehensive manual therapy programme reduces sickness absence.

Materials and methods. Combined population samples from 1973 to 2003 with a total of 12,891 observations with self-reported back pain and covariates. 7,074 of these individuals were followed for an average of 8.5 years and outcomes were self-reported health as well as official register data on sick leave, disability pension, hospitalisation and mortality. The Gotland Low Back Pain Study, a randomised controlled trial with participation of two general practitioners and two orthopaedic surgeons treating 160 patients with acute/subacute low back pain, with 10 weeks diagnostic evaluation and treatment and a two-year follow up.

Results. Back pain prevalence increased 16% per ten years (OR 1.16, 95%CI 1.11-1.22). Back pain was negatively associated with self-rated health (p<0.0001), increased the risk of disability pension (p<0.002), and hospital admissions (p<0.0005), but not number of days in hospital, sick leave or mortality. General practitioners used terms from manual medicine and reported more pseudoradicular pain, while orthopaedic surgeons used non-specific pain labels, reported more true radicular pain and used more x-ray examinations. Among those on sick leave at baseline, manual therapy patients showed faster return to work (HR 1.62, 95%CI 1.006–2.60) and a lower point-prevalence of sick leave than reference patients at end of treatment period (ratio 0.35, 95% CI 0.13–0.97) but not after two years.

Conclusions. There was a strong secular trend towards increase in self-reported back pain from 1973 to 2003. Such pain had a negative effect on some of the health outcomes and does not appear to be harmless. Physicians from different specialities labelled the condition differently. The manual therapy programme proved to be more effective than the established treatment regarding return to work.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2009. , p. 78
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 481
Keywords [en]
cohort study, time trends, sickness absence, randomised controlled trial, practice patterns, observer variation
National Category
General Practice
Research subject
Family Medicine
Identifiers
URN: urn:nbn:se:uu:diva-108070ISBN: 978-91-554-7601-4 (print)OAI: oai:DiVA.org:uu-108070DiVA, id: diva2:234192
Public defence
2009-10-16, Rudbeckssalen, Rudbecklaboratoriet, Dag Hammarskjölds väg 20, Uppsala Science Park, Uppsala, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2009-09-25 Created: 2009-09-06 Last updated: 2018-01-13Bibliographically approved
List of papers
1. Medical and social consequences of back pain: a longitudinal study of 7,074 men and women sampled from the general population
Open this publication in new window or tab >>Medical and social consequences of back pain: a longitudinal study of 7,074 men and women sampled from the general population
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(Swedish)Manuscript (preprint) (Other (popular science, discussion, etc.))
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-108069 (URN)
Available from: 2009-09-06 Created: 2009-09-06 Last updated: 2012-08-24Bibliographically approved
2. Diagnostic differences between general practitioners and orthopaedic surgeons in low back pain patients
Open this publication in new window or tab >>Diagnostic differences between general practitioners and orthopaedic surgeons in low back pain patients
2007 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 112, no 2, p. 199-212Article in journal (Refereed) Published
Abstract [en]

Background. There is a growing consensus on low back pain treatment. However, whether this extends to diagnostic labelling is still largely unknown. The aim of this report was to compare the diagnostic assessment of low back pain patients between general practitioners trained in manual therapy and orthopaedic surgeons. Methods. Population-based randomized controlled trial in which 160 patients with acute or sub-acute low back pain were assessed and treated by general practitioners or orthopaedic surgeons. Information on diagnoses and use of diagnostic imaging was obtained from medical records and physician questionnaires covering the ten-week treatment period. The Quebec Task Force classification and free text analysis were used to group diagnostic labels. Results: At baseline there were no significant differences in medical history, findings at physical examination and distribution of the Quebec Task Force diagnostic classification between the patient groups, indicating that they were similar. However, there were significant differences in physicians' use of diagnostic labels for local pain and their characterisation of radiating pain. General practitioners used more terms from manual medicine and reported more pseudoradicular pain than orthopaedic surgeons, who used non-specific pain labels, reported more true radicular pain and used more x-ray examinations. Differences were found at all times from first visit to ten week follow-up. Conclusions: There were significant differences in diagnostic assessment and use of diagnostic radiology between general practitioners and orthopaedic surgeons.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-11765 (URN)000253452000007 ()17578820 (PubMedID)
Available from: 2007-10-17 Created: 2007-10-17 Last updated: 2017-12-11Bibliographically approved
3. Sick leave reductions from a comprehensive manual therapy programme for low back pain: the Gotland Low Back Pain Study
Open this publication in new window or tab >>Sick leave reductions from a comprehensive manual therapy programme for low back pain: the Gotland Low Back Pain Study
2008 (English)In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 22, no 6, p. 529-41Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To evaluate if a comprehensive manual therapy programme reduces sick leave due low back pain and facilitates return to work more than the conventional optimized activating care. DESIGN: A randomized controlled trial over a 10-week period with a two-year follow-up. SETTING: Primary health care and Visby Hospital, Municipality of Gotland, Sweden. SUBJECTS: One hundred and sixty patients (70 women, 90 men, ages 20-55 years) with acute or subacute low back pain with or without pain radiation into the legs. INTERVENTIONS: Standardized optimized activating care (n = 71) versus a comprehensive pragmatic manual therapy programme including specific corticosteroid injections (n = 89). MAIN MEASURES: Sick leave measured as net sick leave volume, point prevalence and return to work. RESULTS: After 10 weeks, significantly more manual therapy patients than reference patients had returned to work (hazards ratio 1.62, 95% confidence interval (CI) 1.006-2.60, P<0.05), and among those on sick leave at baseline, significantly fewer were still on sick leave (8/58 versus 13/40, ratio 0.35, 95% CI 0.13-0.97, P<0.05). For all other measures there were inconclusive differences in favour of the manual therapy group. No significant differences remained after two years. CONCLUSIONS: The manual therapy programme used in this study decreased sick leave and increased return to work more than the standardized optimized activating care only up to 10 weeks but not up to two years.

National Category
General Practice
Identifiers
urn:nbn:se:uu:diva-17529 (URN)10.1177/0269215507087294 (DOI)000257151400006 ()18511533 (PubMedID)
Available from: 2008-06-27 Created: 2008-06-27 Last updated: 2018-01-12Bibliographically approved
4. Age and time trends in back pain prevalence among men and women sampled from the general population
Open this publication in new window or tab >>Age and time trends in back pain prevalence among men and women sampled from the general population
Show others...
(English)Manuscript (preprint) (Other academic)
National Category
General Practice
Research subject
Family Medicine
Identifiers
urn:nbn:se:uu:diva-108068 (URN)
Available from: 2009-09-06 Created: 2009-09-06 Last updated: 2018-01-13Bibliographically approved

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