Determinants Of Low Back Pain Research Articles

Prevalence and determinants of low back pain among residents in Abha City, Saudi Arabia.

Healthcare work is a major risk for having musculoskeletal disorders (MSDs), including low back pain (LBP). This study aimed to estimate the prevalence of LBP and define its associated risk factors among resident physicians. A descriptive cross-sectional survey was conducted among all resident physicians of all specialties in Abha city during the period from July 2020 to September 2020. Data were collected using an online pre-structured data collection tool. The Nordic Musculoskeletal Questionnaire (NMQ) (back pain section) was applied to assess the effect of LBP on the residents' ability to perform job duties effectively. A total of 312 resident physicians responded. Their age ranged between 25 and 41 years. Males represented 57.7% of them. The prevalence of LBP was 64.7%. The most common reported aggravating factors for LBP were working in uncomfortable posture (73.3%), standing for long periods (64.4%), and long sitting sessions (51.5%). Regarding the pain-relieving factors, sleeping ranked first (60.4%), followed by taking analgesics (48.5%) and maintaining a good posture (35.6%). Multivariate logistic regression analysis revealed that obese subjects were at higher risk than underweight subjects to develop LBP (adjusted odds ratio (AOR) =6.18, 95% confidence interval (CI): 1.26-30.34, P = 0.025). Compared to resident physicians without family history of back pain, those with such history were at almost 4-fold higher risk of developing LBP (AOR = 3.90, 95% CI: 2.33-6.52, P < 0.001). LBP is a very prevalent problem among resident physicians, particularly obese subjects and those with family history of back pain. LBP adversely impacts the work performance of the affected physicians.

Prevalence of Low Back Pain, Disability Among Dentists In Saudi Arabia: A Cross Sectional Study

Background: Low back pain (LBP) is a major global health condition which affects individuals across various occupational groups. Dentists, specifically, are prone to experiencing LBP due to the physically demanding nature of their work. This study aims to investigate the prevalence and determinants of LBP among dentists. Methodology: This cross-sectional study was carried out among dentists working in different regions in Saudi Arabia. Sociodemographic characteristics, Modified Oswestry Low Back Pain Disability grading, self-perceived health were collected. SPSS version 20 was used to calculate frequency, percentage and p values. Results: Among 116 participants, majority 66 (56.9%) were males, 83 (71.5%) had Low back pain. Onset of LBP was gradual in 111(95.7%), majority (37%) have worked in health care profession for 6 to 10 years. Majority 52 (44.8%) work 5 days a week, 67 (80.7) had mild LBP. Conclusion: The prevalence of LBP was 71.5%. Occupational prevention activities should be planned to alleviate the presence of LBP among dentists.

The key determinants of low back pain among lifestyle behaviors in adolescents: A cross-sectional study from Saudi Arabia.

Establishing preventive measures and treatment strategies for adolescents with low back pain (LBP) may be greatly enhanced by fully grasping the complex interaction between LBP and lifestyle behaviors. The key objective of this study was to explore the possible associations between lifestyle behaviors and LBP among adolescents in Saudi Arabia. A cross-sectional study was conducted among high school students from 5 major regions in Saudi Arabia. Participants were enlisted for the research project between May and November 2021. To evaluate the presence/severity of LBP, physical activity, sedentary duration, sleep quality, nutrition, health responsibility, interpersonal relationships, spiritual growth, and stress management, a well-established web-based survey was employed. A total of 2000 students participated, with 57.9% reporting LBP. Students with LBP had lower scores on overall health-promoting lifestyle behaviors and all subscales, including physical activity, compared to those without LBP. Linear regression analysis revealed significant associations between sedentary duration and global sleep quality with pain severity among students with LBP. This study highlights the association between lifestyle behaviors and LBP among adolescents in Saudi Arabia. Promoting physical activity, reducing sedentary behavior, and improving sleep quality may be crucial in preventing and managing LBP in this population. Comprehensive strategies targeting lifestyle behaviors should be implemented to improve the well-being of adolescents and reduce the burden of LBP. Further research is needed to better understand the underlying mechanisms and develop effective preventive and treatment strategies for LBP among adolescents.

Determinants of Low Back Pain (LBP) Complaints among Garbage Truck Drivers

Low back pain (LBP) is one of the musculoskeletal disorders with the highest intensity in truck drivers. LBP is a work-related disorder that is one of the leading causes of activity limitations, disability, inability to work, and absence from work. This research analyzes the determinants of LBP complaints among garbage truck drivers. The method used a cross-sectional approach. The respondents in this study were garbage truck drivers at TPA Sukawinatan in Palembang City, with a sample size of 76 drivers taken by purposive sampling. The research results showed that there was a significant correlation between exercise habits (p-value = 0.024), work period (p-value = 0.041), driving duration (p-value = 0.011), and complaints of LBP among garbage truck drivers. There was no significant correlation between age (p-value = 0.762), smoking status (p-value = 0.915), and job satisfaction (p-value = 0.648) with complaints of LBP among garbage truck drivers. The conclusion showed that LBP complaints among garbage truck drivers were reported by 52 respondents (68.4%). Exercise habits, work period, and driving duration were significant determinants of LBP complaints among garbage truck drivers at the TPA Sukawinatan.

STUDY OF LOW BACK PAIN AMONG NURSES WORKING IN A TERTIARY CARE HOSPITAL

Background: Possibility of healthcare personnel to encounter occupational risks varies according to their profession, job and the department in which they work. Nursing is accepted as a stressful profession with work overload due to several negative factors (overwork, overtime and long working hours, role conict and ambiguity, problems with shift work etc.) arising from work circumstances. Healthcare workers are at a higher risk of developing low back pain due to a variety of factors. This problem is associated with major consequences in terms of disability and frequent absence. LBP might lead to activity limitation and sick leaves for more than 50 % of the nurses. This study aims to assess the prevalence and risk factors of LBP among nurses in a tertiary care center. 1. To determine the fre Objectives: quency of low back pain and associated factors among nurses working in a tertiary care hospital 2. To assess the level of functional disability due to low back pain. A cross-sectional study Methodology: was conducted on 125 nurses, aged between 25 and 60 years, who had been working for at least 1 year at CPR Hospital Kolhapur (Maharashtra). Both male and female staff nurses were included in the study. Those who were pregnant and who were not willing to participate were excluded from the study. A self-administered Oswestry Low Back Pain Disability questionnaire which was applied to obtain data from the respondents. Both descriptive and inferential statistics was used. The baseline characteristics were presented as mean with standard deviation or frequencies and percentages whichever appropriate. The determinants of low back pain and knowledge on body mechanics were found using Chi-square. P value &lt;0.05 is considered signicant at 95% condence interval. In the present study, out Results: of 125 participants, 56% were aged 31 to 40 years. Mean age was 32.68±7.32 years. There was female preponderance with 82.4. 71.2% had LBP. Based on Oswestry LBP Disability (OLBPD) Score, 28.8% were found to be free from any disability, 50.4% had minimal, 18.4%) had moderate and only 3 nurses had severe disability. Association was signicant between higher age groups, history of caesarian (44.9%), no history of exercise (53.9%), designation of staff nurse (91.0%), physical exertion during work (92.1%), &gt; 10 years of work experience (43.8%), attending &gt;50 patients per day (22.5%), standing time &gt; 5 hours in duty hours (82.0%) were found to be signicantly associated with LBP (all p values &lt;0.05).

Determinants of Low Back Pain among Health-Care Providers in a Federal Tertiary Hospital in Ekiti State, Southwestern Nigeria

Introduction: Low back pain (LBP) is a usual musculoskeletal system disorder among the working population, especially among health-care providers (HCPs). It is a significant contributor to work disability, work absenteeism, and lost hours globally. The study objectives are to find the prevalence and determinants of LBP among HCPs in a Federal Tertiary Hospital in Ido-Ekiti, Ekiti State, Nigeria. Subjects and Methods: A cross-sectional study was done among HCPs in a Federal Tertiary Hospital, Ido-Ekiti, Ekiti State, Nigeria. The study included 336 participants working in the hospital. The respondents were selected using stratified sampling. Data were collected through an adapted questionnaire, which was pretested, semi-structured, and self-administered. The data were analyzed using STATA version 12. Univariate, bivariate, and binary logistic analysis was used to find the prevalence and determinants of LBP. The significance level was set at 95% confidence interval and P ≤ 0.05. Results: The point prevalence, period prevalence, and lifetime prevalence were 39.9%, 44.6%, and 67.6%, respectively. The findings showed that the prevalence of LBP was higher among respondents who turn patient on the bed regularly (&gt;3 times weekly) (odds ratio [OR] =18.46, 95% CL [6.84–49.81], P &lt; 0.0001); and pulls and pushes object or people (more than 10 kg thrice a week) (OR = 8.22, 95% CL [3.46–19.56], P &lt; 0.0001) were statistically significant. Conclusion: The study revealed that HCPs suffered from a high prevalence of LBP, and the identified risk factors (turning of the patient and pulling and pushing of an object or people) can be modified using an informed health intervention program (health education and ergonomics).

The Prevalence and its determinants of Low Back Pain among Female Secondary School Teachers in Eastern region at Makkah city, Saudi Arabia, January 2020

Background: Low back pain (LBP) is a major cause of disability, interfere with quality of life and work performance. Very limited studies have been carried in Saudi Arabia among teachers. Objectives: To estimate the prevalence and identify the determinants of LBP among female secondary school teachers in Eastern region at Makkah city. Subjects and methods: A cross-sectional analytic study was conducted among female secondary school teachers in Makkah city (eastern region) throughout the scholastic year 2019-2020 (December- January). A self- administered valid Arabic questionnaire was used in data collection. Results: The study included 207 female teachers. Most of them (60.4%) aged between 40 and 49 years. History of having low back pain during the last week (Point prevalence) was 62.8% whereas total prevalence of LBP during the last 12 months was77.8%. Multivariate logistic regression analysis revealed that married teachers were 86% at lower risk for LBP compared to singles (Adjusted odds ratio “AOR”:0.14, 95% confidence interval “CI”: 0.02-0.83, p=0.030. Teachers with more number of teaching hours/week (>20) were at almost double-risk for having LBP compared to those with 1-10 hours/week (AOR: 2.13, 95%CI: 1.63-24.02, p=0.036). Teachers with history of chronic diseases were at greater risk for developing LBP compared to those without chronic diseases (AOR: 4.21, 95%CI: 1.03-17.19, p=0.045). Feeling anxious within the last two weeks was accompanied by significant increased risk for LBP (AOR: 3.77, 95%CI: 1.46-9.75, p=0.006). Similarly, complaining of upper back pain, neck pain, throat infection was significantly associated with greater risk of LBP (AOR: 5.62, 95%CI: 2.18-14.48, pConclusion: Low back pain is a very common problem, affecting most of female secondary school teachers in Eastern Region of Makkah city, with adverse impact on sleeping quality and work performance. Such a common medical problem needs to be further studied in our community.

Work-related risk factors and the prevalence of low back pain among low wage workers: results from a cross-sectional study

BackgroundLow back pain, the most commonly reported musculoskeletal problem, is a major burden on individuals, health systems and social care systems with the indirect cost being predominant. It results in disability, poor service, low quality of life and sickness absences in working places. The problem of low back pain and its risk factors among hotel housekeepers are not well known in Ethiopia. Therefore, this study was aimed to investigate the prevalence and identify determinants of low back pain among hotel industries’ housekeepers in Gondar town, Ethiopia.MethodsInstitutional based cross-sectional study was conducted from March to May 2017. A systematic random sampling technique was applied to select 422 study participants, and the data was collected by a standardized Nordic questionnaire for the analysis of musculoskeletal symptoms. Bivariate and multivariable binary logistic regression analyses were performed using SPSS version 20. The significance level was obtained at 95% CI and p-value ≤ 0.05.ResultsThe prevalence of low back pain among hotel housekeepers in Gondar town was 58.1% (95% CI: 53.6, 62.8%). Being temporary employee (AOR: 3.22), type of job which requires reaching/overstretching (AOR: 2.93), engaging in a job that requires repetitive bending (AOR: 1.97), making > 30 beds per day (AOR: 3.19) signified the significant risk factors for low back pain. However, hotel housekeepers who were satisfied in their current job were less impacted by low back pain (AOR: 0.49).ConclusionA high proportion of hotel housekeepers in this study reported they had low back pain. Employment pattern, rest break taken, reaching/overstretching, repetitive bending, job satisfaction, training related to health and safety and numbers of beds making were among the factors associated with low back pain. Hence, ergonomic measures focusing on correcting the arrangement of work station, rest breaks and changing some equipment are potentially important targets to reduce the problem.

Prevalence and Determinants of Low Back Pain among Lecturers: A Quantitative Approach

Introduction: Lower back pain is one of the most common work-related problems among teaching professionals in both developed and developing nations and it often leads to absenteeism or early retirement of workers. Thus the aim of this study was to investigate the prevalence and associated risk factors of low back pain among academic staff.&#x0D; Methods: An institutional based cross-sectional study was adopted. Five faculties were randomly selected in Ekiti State University, Nigeria and a self-structured questionnaire was purposively administered; depending on interest and availability of the respondents. The data was explored and Chi-square analysis alongside binary logistic regression was applied in order to evaluate the relationship between low back pain and some associated factors. Analysis was carried out in SPSS version 20.&#x0D; Results: This study comprises 127 lecturers with a mean age of (41.95±9.42). There were more males (55.9%) than females. More than thirty six percent of the lecturers had teaching experience below 5 years while 44.9% had 5 to 10 years and 18.9% had above 10 years of teaching experience. The results show that age, gender, prolonged sitting and prolonged standing significantly (p-value &lt;.05) associated with occurrence of low back pain among lecturers while mixed teaching posture serves a protective against low back pain.&#x0D; Conclusion: The results reveal a very high prevalence of low back pain. Findings show that female gender, old age and inappropriate work postures are the risk factors of low back pain. It is suggested that effort should be to ameliorate occupational stress among academic staff.

Social Determinants of Low Back Pain in Females of Reproductive Age Group Residing in Urban Lahore, Pakistan

Background: Nonspecific low back pain (LBP) is a common problem among females of reproductive age group that leads to low quality of life to a greater extent. Nonspecific LBP is other than any diagnosed pathological or structural cause of back pain. Objectives: 1) to determine trends of back pain in females of reproductive age group 2) to identify association between social determinants and LBP. Methods: It was a cross sectional study conducted in one town of Lahore, Pakistan; selected randomly. Convenient sampling technique was applied to recruit the study subjects. Sample size was calculated on Sample Size Determination in Health Studies Software by WHO. Calculated sample size was 89, and researcher had taken a sample of 100 females. Target group for current study was females of reproductive age (15-49 years); and age was categorized into two categories i.e.≤30 years and ≥30 years for frequency determination. Data collection tool was self-developed questionnaire and data collection was done through interview method. Data analysis was done using SPSS 20. Results: Age range was 18-46 years; Mean age was 32.59 ± 7.73. 27% females had LBP in the ≤30 year category and 60% females had LBP in the ≥30 year category. A total of 87% females were found to have LBP, whereas 13% females did not have LBP. Chi square application revealed statistically significant association (P-value ˂0.05) between LBP and variables studied: marital status, onset age of menarche, number of children, pressure of daily additional home chores, feeling fatigued by 2pm after doing work since morning, and irregular sleep pattern. Conclusions: Significant association between LBP and social determinants in present study emphasize upon further research in this area with a representative sample of the total population and more detailed and comprehensive questionnaire. This will help to plan and implement health education and preventive plan in this age group.

Morpho-Physical and Psycho-Social Determinants of Low Back Pain in Midwives Population in Benin

Background: Low back pain is a real public health problem. Lots of studies have been done about it, but not in midwives group. The latter seem to be exposed to low back pain due to morphological, physical and psycho-social factors. We therefore study the place of these factors in the occurrence of low back pain in midwives. Method: Prospective, cross-sectional and analytical study, it is done with 102 midwives of university hospitals in Benin. They were interviewed and examined. An eventual link with their history of low back pain, for at least 3 months during the last 12 months before the study, was checked to their morphological aspects (spinal curvatures, BMI), physical examinations data (strength and muscular flexibility) and psycho-social factors (relationship with colleagues and either, stress, ...). The effect of these factors was assessed using relative risk (RR) with a 95% confidence interval. Results: Different morpho-physical and psychosocial disturbances were observed in midwives. 81% had a history of low back pain. The latter have a statistically significant relationship with the different factors studied. These were mostly exposure factors, but poor midwife relationship with their hierarchical superiors was a protective factor (RR = 0.69 and p = 0.0106). Discussion-Conclusion: In Benin, health workers and especially midwives are very exposed to low back pain. The latter are often associated with different morphological, physical and psycho-social disturbances. The knowledge of those parameters is interesting to reduce this high prevalence of low back pain in midwives.

244 Determinants of Low Back Pain Among Workers from 18 Countries: The Cupid Study

244 Determinants of Low Back Pain Among Workers from 18 Countries: The Cupid Study

Prevalence, Risk Factors, and Preference-Based Health States of Low Back Pain in a Turkish Population

A community-based cross-sectional survey was conducted using face-to-face interviews. To estimate the point, 12-month period, and lifetime prevalence of low back pain (LBP) in the general population of Turkey, and to determine the factors associated with LBP. We also aim to determine self-reported health states differences between patients and the general population by the EuroQol-5D & Visual Analogue Scale (EQ5D-VAS). LBP as a major public health problem has been unquestionably the most serious pain problem. LBP generally appears between 35 and 64 years of age. Little was known about the prevalence and determinants of LBP among populations from developing areas; information mostly comes from industrialized countries. This epidemiologic study reported the prevalence of LBP in the general population in Turkey. In Turkey, community-based trials on the prevalence of LBP were scarce. A total of 7,000 participants selected by randomly sampling from seven regions of Turkey. A comprehensive questionnaire on demographics, physical and emotional stress, LBP, and EQ5D-VAS was administered to 4,990 men and women (age range, 18-70 years). The lifetime, 12-month period, and point prevalence of LBP were 44.1%, 34.0%, and 19.7%, respectively. The prevalence of LBP in women was consistently higher than in men across all age groups. The proportion of specific LBP was 10.2%, and most common etiology of specific LBP was disc hernia. In regression analysis, occupation, physical, and emotional stress showed significant associations with having LBP. The EQ5D-VAS scores of patients with LBP were significantly lower than self-reported assessments of the population without LBP (64.6, 63.0 vs. 73.8, P < 0.05). In comparison with other developing countries, the prevalence of LBP is higher in Turkey and approximates prevalence estimates of LBP in developed countries. LBP is associated with occupation. Smoking is not associated with having LBP. This study also shows that LBP influences disability and quality of life.

Prevalence and Physical Determinants of Low Back Pain in a Rural Chinese Population

This was a community-based cross-sectional study that is part of an ongoing study of genetics and osteoporosis. To estimate the 1-year self-reported prevalence of low back pain (LBP); and to assess the association between physical exposures (occupation, physical stress, and vibration) and LBP in a rural Chinese population. This study also explored how these associations change when individuals with LBP report additional pains in other parts of the body. Little is known about the prevalence and determinants of LBP in rural developing populations, even though approximately half of the world's population, mostly from the developing world, is engaged in agriculture, a known strenuous activity. Families with at least three participating siblings residing in the surrounding rural region of Anqing city, Anhui Province, China, were invited to participate in the study through public announcements and direct invitations by village physicians. A questionnaire including demographics, physical exposures, and musculoskeletal pain was administered to 13,965 men and women (age, 25-64 years). Generalized estimating equations were used to estimate LBP prevalence and examine associations between LBP and physical exposures. The 1-year prevalence of LBP was 64%. Twenty-five percent reported no pain at any body site. Women had higher prevalence of LBP than men across all age groups. Being a farmer, reporting moderate or heavy physical stress, and having had former or current exposures to vibration were positively associated with LBP (P < 0.05). Physical exposures were also associated with cases of LBP combined with other musculoskeletal pains, and generally, the more pains individuals reported, the more likely it was that they were farmers and were exposed to vibration. A high prevalence of LBP and LBP with additional musculoskeletal pain existed in this rural Chinese sample. We found evidence of a link between physical exposures and LBP, and LBP with additional musculoskeletal pain. Further understanding of the characteristics and risk factors of LBP in rural developing areas is needed.

Soft tissue determinants of low back pain

Low back pain is one of the complaints most commonly seen in the clinical setting. Correctly or incorrectly, these patients are often given the diagnosis of fibromyalgia, myofascial pain syndrome, disk herniation, or some other label. It is important to recognize the soft tissue causes of low back pain and understand how they can be most appropriately diagnosed and managed. Nonligamentous disorders of the low back region may occur in isolation or in combination with underlying discogenic, ligamentous, and facet-mediated causes of pain. Therefore, in order to fully evaluate and treat a patient with low back pain, it is necessary to consider and address these soft tissue conditions. This paper reviews soft tissue causes of low back pain and discusses how they are most appropriately diagnosed and managed.

Factors associated with the subject's ability to quantify their lumbar flexion demands at work

Continuous measurements of lumbar posture provide the basis for determining the factors influencing the difference between subjective and objective assessments of lumbar posture. The lumbar flexion posture during an entire work day was registered in a group of 13 sewage workers and 14 physical therapists. Subjective lumbar posture data, perceived occupational stress, job satisfaction and 12 month prevalence of low back pain were obtained using standardized questionnaires. For the entire sample, a significant positive correlation was found between the degree of overestimation of the lumbar bending demands at work and the level of occupational stress (p > 0.01) as well as the low back pain prevalence in the past 12 months. Continuous measurement of spinal posture is an important tool not only for comparisons of posture demands during various activities but also for investigations into the complex interactions between the biomechanical and psychosocial determinants of low back pain.

Individual and occupational determinants of low back pain according to various definitions of low back pain

OBJECTIVESTo test associations between non-specific low back pain and several risk factors when definitions of low back pain vary.DESIGN/SETTING/PARTICIPANTSA cross sectional study was set up in 1991, 725 workers from...

Prevalence and consequences of low back problems in the Netherlands, working vs non-working population, the MORGEN-study

To study the burden of illness of low back problems--prevalence and consequences--in the working and the non-working population. Data from the Monitoring Project on Risk factors for Chronic Diseases, the MORGEN-study, were used. This project provided data on a probability sample of the general population aged 20-59 y in the Netherlands. Cross-sectional questionnaire data on 6317 men (24% non-working) and 7505 women (47% non-working) gathered over the period 1993-1995 were analysed. The 12 month period prevalence of low back problems for the working and non-working population was 44.4% and 45.8% for men, and 48.2% and 55.0% for women. Larger differences were found for chronic low back problems, and activity limitation and use of health services due to low back problems. More than one-third of those who were disabled were so because of low back problems. When those unable to work because of disability (work disabled) were excluded, the prevalence and consequences of low back pain were still higher in the non-working group in comparison with the working population. Most of the non-working women were housewives and this group was both large in size and had a high prevalence of low back problems. Among the men studied, more than a quarter of the total burden of low back problems in those aged 20-59 y were found in the non-working population, among women this was 50%. Both research on causes and determinants of low back pain and the development of preventive actions--now being extensively focused on the working population--should also be translated to the non-working population.

Prevalence and consequences of low back problems in the Netherlands, working vs non-working population, the MORGEN-study

Objective: To study the burden of illness of low back problems—prevalence and consequences—in the working and the non-working population. Methods: Data from the Monitoring Project on Risk factors for Chronic Diseases, the MORGEN-study, were used. This project provided data on a probability sample of the general population aged 20–59 y in the Netherlands. Cross-sectional questionnaire data on 6317 men (24% non-working) and 7505 women (47% non-working) gathered over the period 1993–1995 were analysed. Results: The 12 month period prevalence of low back problems for the working and non-working population was 44.4% and 45.8% for men, and 48.2% and 55.0% for women. Larger differences were found for chronic low back problems, and activity limitation and use of health services due to low back problems. More than one-third of those who were disabled were so because of low back problems. When those unable to work because of disability (work disabled) were excluded, the prevalence and consequences of low back pain were still higher in the non-working group in comparison with the working population. Most of the non-working women were housewives and this group was both large in size and had a high prevalence of low back problems. Conclusions: Among the men studied, more than a quarter of the total burden of low back problems in those aged 20–59 y were found in the non-working population, among women this was 50%. Both research on causes and determinants of low back pain and the development of preventive actions—now being extensively focused on the working population—should also be translated to the non-working population.

Methodologic issues in low back pain research in primary care.

Narrative review and discussion of the selected literature. To discuss some important methodologic challenges in low back pain research in primary care. Many methodologic problems must be confronted when conducting low back pain research. Some of these problems are back pain specific or specific to the primary care setting. Methodologic problems related to four research issues will be discussed: study designs, definition of low back pain, determinants of low back pain, and outcome assessment. Two fundamentally different study designs are frequently used in low back pain research, namely observational studies and experimental studies. The definition of low back pain is typically restricted to a highly variables self-reported symptom, the sensation of pain in the back. There clearly is a need for an evidence-based classification system for low back pain. Because a tenable theoretical framework is lacking, it is difficult to know which determinants of low back pain should be quantified. Low back pain studies focus usually on health-related quality-of-life outcome parameters. The identification of the minimum clinically relevant changes for the most important outcome instruments needs further consideration. In years to come, low back pain researchers are challenged to overcome some of these (and other) problems to enhance the quality of low back pain research in primary care.