Abstract
Primary prevention studies suggest that additional research on identifying risk factors predictive of low back pain (LBP) is necessary before additional interventions can be developed. In the current study we assembled a large military cohort that was initially free of LBP and followed over 2 years. The purposes of this study were to identify baseline variables from demographic, socioeconomic, general health, and psychological domains that were predictive of a) occurrence; b) time; and c) severity for first episode of self-reported LBP. Baseline and outcome measures were collected via web-based surveillance system or phone to capture monthly information over 2 years. The assembled cohort consisted of 1230 Soldiers who provided self-report data with 518 (42.1%) reporting at least one episode of LBP over 2 years. Multivariate logistic regression analysis indicated that gender, active duty status, mental and physical health scores were significant predictors of LBP. Cox regression revealed that the time to first episode of LBP was significantly shorter for Soldiers that were female, active duty, reported previous injury, and had increased BMI. Multivariate linear regression analysis investigated severity of the first episode by identifying baseline predictors of pain intensity, disability, and psychological distress. Education level and physical fitness were consistent predictors of pain intensity, while gender, smoking status, and previous injury status were predictors of disability. Gender, smoking status, physical health scores, and beliefs of back pain were consistent predictors of psychological distress. These results provide additional data to confirm the multi-factorial nature of LBP and suggest future preventative interventions focus on multi-modal approaches that target modifiable risk factors specific to the population of interest.
Highlights
In general populations low back pain (LBP) is the most prevalent form of chronic musculoskeletal pain [1] often leading to disability [2,3]
The focus on secondary prevention has been productive in reducing disability from acute episodes of LBP, but there remains the potential of primary prevention for limiting the negative impact of LBP
The primary aim of the POLM trial was to determine if corestabilization exercise and psychosocial education resulted in decreased LBP incidence during 2 years of military duty
Summary
In general populations low back pain (LBP) is the most prevalent form of chronic musculoskeletal pain [1] often leading to disability [2,3]. As a result of its negative impact prevention of LBP has remained a research priority for both general [6] and military populations [4,7]. Factors involved in the transition from acute to chronic LBP have been a recent focus of disability prevention research. Such an approach is consistent with secondary prevention [8], and studies in this area have provided important information on effective management of acute LBP. The focus on secondary prevention has been productive in reducing disability from acute episodes of LBP, but there remains the potential of primary prevention for limiting the negative impact of LBP
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