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Abstract

This meta-analysis assessed the association between overweight/obesity and low back pain. The authors systematically searched the Medline (National Library of Medicine, Bethesda, Maryland) and Embase (Elsevier, Amsterdam, the Netherlands) databases until May 2009. Ninety-five studies were reviewed and 33 included in the meta-analyses. In cross-sectional studies, obesity was associated with increased prevalence of low back pain in the past 12 months (pooled odds ratio (OR) = 1.33, 95% confidence interval (CI): 1.14, 1.54), seeking care for low back pain (OR = 1.56, 95% CI: 1.46, 1.67), and chronic low back pain (OR = 1.43, 95% CI: 1.28, 1.60). Compared with non-overweight people, overweight people had a higher prevalence of low back pain but a lower prevalence of low back pain compared with obese people. In cohort studies, only obesity was associated with increased incidence of low back pain for > or =1 day in the past 12 months (OR = 1.53, 95% CI: 1.22, 1.92). Results remained consistent after adjusting for publication bias and limiting the analyses to studies that controlled for potential confounders. Findings indicate that overweight and obesity increase the risk of low back pain. Overweight and obesity have the strongest association with seeking care for low back pain and chronic low back pain.

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The rising prevalence of chronic low back pain.

Janet K Freburger, George M Holmes, Robert P Agans … (2009)

National or state-level estimates on trends in the prevalence of chronic low back pain (LBP) are lacking. The objective of this study was to determine whether the prevalence of chronic LBP and the demographic, health-related, and health care-seeking characteristics of individuals with the condition have changed over the last 14 years. A cross-sectional, telephone survey of a representative sample of North Carolina households was conducted in 1992 and repeated in 2006. A total of 4437 households were contacted in 1992 and 5357 households in 2006 to identify noninstitutionalized adults 21 years or older with chronic (>3 months), impairing LBP or neck pain that limits daily activities. These individuals were interviewed in more detail about their health and health care seeking. The prevalence of chronic, impairing LBP rose significantly over the 14-year interval, from 3.9% (95% confidence interval [CI], 3.4%-4.4%) in 1992 to 10.2% (95% CI, 9.3%-11.0%) in 2006. Increases were seen for all adult age strata, in men and women, and in white and black races. Symptom severity and general health were similar for both years. The proportion of individuals who sought care from a health care provider in the past year increased from 73.1% (95% CI, 65.2%-79.8%) to 84.0% (95% CI, 80.8%-86.8%), while the mean number of visits to all health care providers were similar (19.5 [1992] vs 19.4 [2006]). The prevalence of chronic, impairing LBP has risen significantly in North Carolina, with continuing high levels of disability and health care use. A substantial portion of the rise in LBP care costs over the past 2 decades may be related to this rising prevalence.

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Prevalence and pattern of lumbar magnetic resonance imaging changes in a population study of one thousand forty-three individuals.

Kenneth M. C. Cheung, Jaro Karppinen, Danny Chan … (2009)

A cross-sectional population study of magnetic resonance imaging (MRI) changes. OBJECTIVE.: To examine the pattern and prevalence of lumbar spine MRI changes within a southern Chinese population and their relationship with back pain. Previous studies on MRI changes and back pain have used populations of asymptomatic individuals or patients presenting with back pain and sciatica. Thus, the prevalence and pattern of intervertebral disc degeneration within the population is not known. Lumbar spine MRIs were obtained in 1043 volunteers between 18 to 55 years of age. MRI changes including disc degeneration, herniation, anular tears (HIZ), and Schmorl's nodes were noted by 2 independent observers. Differences were settled by consensus. Disc degeneration was graded using Schneiderman's classification, and a total score (DDD score) was calculated by the summation of the Schneiderman's score for each lumbar level. A K-mean clustering program was used to group individuals into different patterns of degeneration. Forty percent of individuals under 30 years of age had lumbar intervertebral disc degeneration (LDD), the prevalence of LDD increasing progressively to over 90% by 50 to 55 years of age. There was a positive correlation between the DDD score and low back pain. L5-S1 and L4-L5 were the most commonly affected levels. Apart from the usual patterns of degeneration, some uncommon patterns of degeneration were identified, comprising of subjects with skip level lesions (intervening normal levels) and isolated upper or mid lumbar degeneration. LDD is common, and its incidence increases with age. In a population setting, there is a significant association of LDD on MRI with back pain.

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Performance of the trim and fill method in the presence of publication bias and between-study heterogeneity.

Jaime Peters, Alex J Sutton, David Jones … (2007)

The trim and fill method allows estimation of an adjusted meta-analysis estimate in the presence of publication bias. To date, the performance of the trim and fill method has had little assessment. In this paper, we provide a more comprehensive examination of different versions of the trim and fill method in a number of simulated meta-analysis scenarios, comparing results with those from usual unadjusted meta-analysis models and two simple alternatives, namely use of the estimate from: (i) the largest; or (ii) the most precise study in the meta-analysis. Findings suggest a great deal of variability in the performance of the different approaches. When there is large between-study heterogeneity the trim and fill method can underestimate the true positive effect when there is no publication bias. However, when publication bias is present the trim and fill method can give estimates that are less biased than the usual meta-analysis models. Although results suggest that the use of the estimate from the largest or most precise study seems a reasonable approach in the presence of publication bias, when between-study heterogeneity exists our simulations show that these estimates are quite biased. We conclude that in the presence of publication bias use of the trim and fill method can help to reduce the bias in pooled estimates, even though the performance of this method is not ideal. However, because we do not know whether funnel plot asymmetry is truly caused by publication bias, and because there is great variability in the performance of different trim and fill estimators and models in various meta-analysis scenarios, we recommend use of the trim and fill method as a form of sensitivity analysis as intended by the authors of the method. Copyright 2007 John Wiley & Sons, Ltd.

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PubMed ID:: 20007994

DOI:: 10.1093/aje/kwp356

ScienceOpen disciplines: Chemistry

Keywords: Cohort Studies,Cross-Sectional Studies,Humans,Low Back Pain,complications,epidemiology,Obesity,Prevalence,Risk Factors

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ScienceOpen disciplines: Chemistry

Keywords: Cohort Studies, Cross-Sectional Studies, Humans, Low Back Pain, complications, epidemiology, Obesity, Prevalence, Risk Factors

The association between obesity and low back pain: a meta-analysis.

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A Sustainable Future

Most cited references 87

The rising prevalence of chronic low back pain.

Prevalence and pattern of lumbar magnetic resonance imaging changes in a population study of one thousand forty-three individuals.

Performance of the trim and fill method in the presence of publication bias and between-study heterogeneity.

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