Abstract
BackgroundLeg pain associated with low back pain (LBP) is recognized as a risk factor for a poor prognosis, and is included as a component in most LBP classification systems. The location of leg pain relative to the knee and the presence of a positive straight leg raise test have been suggested to have clinical implications. To understand differences between such leg pain subgroups, and whether differences include potentially modifiable characteristics, the purpose of this paper was to describe characteristics of patients classified into the Quebec Task Force (QTF) subgroups of: 1) LBP only, 2) LBP and pain above the knee, 3) LBP and pain below the knee, and 4) LBP and signs of nerve root involvement.MethodsAnalysis of routine clinical data from an outpatient department. Based on patient reported data and clinical findings, patients were allocated to the QTF subgroups and described according to the domains of pain, activity limitation, work participation, psychology, general health and clinical examination findings.ResultsA total of 2,673 patients aged 18–95 years (median 47) who were referred for assessment of LBP were included. Increasing severity was consistently observed across the subgroups from LBP only to LBP with signs of nerve root involvement although subgroup differences were small. LBP patients with leg pain differed from those with LBP only on a wide variety of parameters, and patients with signs of nerve root involvement had a more severe profile on almost all measures compared with other patients with back-related leg pain.ConclusionLBP patients with pain referral to the legs were more severely affected than those with local LBP, and patients with signs of nerve root involvement were the ones most severily affected. These findings underpin the concurrent validity of the Quebec Task Force Classification. However, the small size of many between-subgroup differences amid the large variability in this sample of cross-sectional data also underlines that the heterogeneity of patients with LBP is more complex than that which can be explained by leg pain patterns alone. The implications of the observed differences also require investigation in longitudinal studies.
Highlights
Leg pain associated with low back pain (LBP) is recognized as a risk factor for a poor prognosis, and is included as a component in most Low back pain (LBP) classification systems
The belief that non-specific LBP (NSLBP) consists of a number of subgroups, with different prognoses and different treatment responses, has increased over the last decade, and this has been mirrored in a proliferation of studies reporting research into NSLBP subgroups aimed at identifying homogeneous groups of patients with similar trajectories or who would benefit from a certain intervention [6,7,8,9,10]
It is well-established that patients with leg pain in addition to LBP have a poorer prognosis than patients with local LBP only [11] and leg pain is a component of most LBP classification tools [12,13,14,15]
Summary
Leg pain associated with low back pain (LBP) is recognized as a risk factor for a poor prognosis, and is included as a component in most LBP classification systems. The report of the 1987 Quebec Task Force suggested distinguishing between pain referral above and below the knee [17] This has since been shown to be associated with prognosis [18,19], and a recent study in primary care showed that patients with leg pain referred above or below the knee differed on symptom severity as well as psychological characteristics compared with each other and compared with patients who had no pain referral. One application of knowledge of such potentially modifiable characteristics associated with different leg pain patterns is that they may provide direction for the development of treatments targeted to different types of radiating leg pain
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