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      Disability in people with chronic low back pain treated in primary care Translated title: Incapacidade em pessoas com dor lombar crônica atendidas na atenção primária

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          Abstract

          Abstract Introduction: Low back pain is a common musculoskeletal problem and can become chronic, with varying degrees of disability. Objective: Analyze the factors associated with disability in individuals with chronic low back pain (CLBP), treated in primary care. Methods: Cross-sectional study with 82 basic health unit (BHU) users in the municipality of Florianópolis (Brazil) with CLBP. Sociodemographic and clinical variables, health status, lifestyle and treatment were investigated. Self-rated disability was investigated using the Roland Morris questionnaire (≥ 14 points). The χ2 or Fisher’s exact tests were used in inferential analysis for univariate association and the presence of disability. Multivariate association was analyzed by logistical regression, estimating the crude and adjusted odds ratios (OR) and their respective confidence intervals (95%CI). Results: Adults aged 40-59 years had a greater chance of developing disability (OR: 8.17; 95%: 1.21 - 55.0), while professionally active individuals (OR: 0.08; 95%CI: 0.02 - 0.33) who reported engaging in physical activity ≥ 3 times a week (OR: 0.19; IC95%: 0.04 - 0.83) had less chance of the same outcome when compared to the other participants. Conclusion: Factors related to disability were age, employment status and frequency of physical activity. Incentive strategies to return to work and engage in regular physical activity and exercise should be encouraged.

          Translated abstract

          Resumo Introdução: A dor lombar é um problema musculoesquelético comum e pode tornar-se uma condição crônica, com níveis variados de incapacidade. Objetivo: Analisar os fatores associados à incapacidade em indivíduos com dor lombar crônica, acompanhados na Atenção Primária à Saúde. Métodos: Estudo transversal realizado com 82 usuários das unidades básicas de saúde do município de Florianópolis (Brasil), com queixa de dor lombar crônica. Foram investigadas variáveis sociodemográficas e clínicas, condições de saúde, estilo de vida e tratamento. A incapacidade percebida foi mensurada pelo questionário Roland Morris (≥ 14 pontos). Na análise inferencial foram utilizados os testes χ2 ou exato de Fisher para associação univariada e presença de incapacidade. A associação multivariável foi analisada por meio do modelo de regressão logística, estimando-se os valores das odds ratio (OR) brutas e ajustadas e seus respectivos IC95%. Resultados: Indivíduos adultos com 40-59 anos tiveram maiores chances de ter incapacidade (OR: 8,17; IC95%: 1,21 - 55,0), enquanto aqueles que eram profissionalmente ativos (OR: 0,08; IC95%: 0,02 - 0,33) e que relataram praticar atividade física com frequência ≥ 3 vezes na semana (OR: 0,19; IC95%: 0,04 - 0,83) tiveram menores chances do mesmo desfecho quando comparados aos demais. Conclusão: Os fatores relacionados à incapacidade foram idade, situação profissional e frequência de atividade física. Estratégias de incentivo de retorno ao trabalho e prática de atividade física e de exercícios devem ser incentivadas.

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          What low back pain is and why we need to pay attention

          Low back pain is a very common symptom. It occurs in high-income, middle-income, and low-income countries and all age groups from children to the elderly population. Globally, years lived with disability caused by low back pain increased by 54% between 1990 and 2015, mainly because of population increase and ageing, with the biggest increase seen in low-income and middle-income countries. Low back pain is now the leading cause of disability worldwide. For nearly all people with low back pain, it is not possible to identify a specific nociceptive cause. Only a small proportion of people have a well understood pathological cause-eg, a vertebral fracture, malignancy, or infection. People with physically demanding jobs, physical and mental comorbidities, smokers, and obese individuals are at greatest risk of reporting low back pain. Disabling low back pain is over-represented among people with low socioeconomic status. Most people with new episodes of low back pain recover quickly; however, recurrence is common and in a small proportion of people, low back pain becomes persistent and disabling. Initial high pain intensity, psychological distress, and accompanying pain at multiple body sites increases the risk of persistent disabling low back pain. Increasing evidence shows that central pain-modulating mechanisms and pain cognitions have important roles in the development of persistent disabling low back pain. Cost, health-care use, and disability from low back pain vary substantially between countries and are influenced by local culture and social systems, as well as by beliefs about cause and effect. Disability and costs attributed to low back pain are projected to increase in coming decades, in particular in low-income and middle-income countries, where health and other systems are often fragile and not equipped to cope with this growing burden. Intensified research efforts and global initiatives are clearly needed to address the burden of low back pain as a public health problem.
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            The global burden of low back pain: estimates from the Global Burden of Disease 2010 study.

            To estimate the global burden of low back pain (LBP). LBP was defined as pain in the area on the posterior aspect of the body from the lower margin of the twelfth ribs to the lower glutaeal folds with or without pain referred into one or both lower limbs that lasts for at least one day. Systematic reviews were performed of the prevalence, incidence, remission, duration, and mortality risk of LBP. Four levels of severity were identified for LBP with and without leg pain, each with their own disability weights. The disability weights were applied to prevalence values to derive the overall disability of LBP expressed as years lived with disability (YLDs). As there is no mortality from LBP, YLDs are the same as disability-adjusted life years (DALYs). Out of all 291 conditions studied in the Global Burden of Disease 2010 Study, LBP ranked highest in terms of disability (YLDs), and sixth in terms of overall burden (DALYs). The global point prevalence of LBP was 9.4% (95% CI 9.0 to 9.8). DALYs increased from 58.2 million (M) (95% CI 39.9M to 78.1M) in 1990 to 83.0M (95% CI 56.6M to 111.9M) in 2010. Prevalence and burden increased with age. LBP causes more global disability than any other condition. With the ageing population, there is an urgent need for further research to better understand LBP across different settings.
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              The fear-avoidance model of musculoskeletal pain: current state of scientific evidence.

              Research studies focusing on the fear-avoidance model have expanded considerably since the review by Vlaeyen and Linton (Vlaeyen J. W. S. & Linton, S. J. (2000). Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain, 85(3), 317--332). The fear-avoidance model is a cognitive-behavioral account that explains why a minority of acute low back pain sufferers develop a chronic pain problem. This paper reviews the current state of scientific evidence for the individual components of the model: pain severity, pain catastrophizing, attention to pain, escape/avoidance behavior, disability, disuse, and vulnerabilities. Furthermore, support for the contribution of pain-related fear in the inception of low back pain, the development of chronic low back pain from an acute episode, and the maintenance of enduring pain, will be highlighted. Finally, available evidence on recent clinical applications is provided, and unresolved issues that need further exploration are discussed.
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                Author and article information

                Journal
                fm
                Fisioterapia em Movimento
                Fisioter. mov.
                Pontifícia Universidade Católica do Paraná (Curitiba, PR, Brazil )
                1980-5918
                2021
                : 34
                : e34121
                Affiliations
                [3] Florianópolis SC orgnameSecretaria Municipal de Saúde Brazil
                [1] Florianópolis Santa Catarina orgnameUniversidade do Estado de Santa Catarina Brazil
                [2] Florianópolis Santa Catarina orgnameUniversidade Federal de Santa Catarina Brazil
                Article
                S0103-51502021000100224 S0103-5150(21)03400000224
                10.1590/fm.2021.34121
                3760bc5f-14d3-4a10-bae9-7ce27eef3c25

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 29 November 2020
                : 18 August 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 27, Pages: 0
                Product

                SciELO Brazil

                Categories
                Original Articles

                Physical and functional performance,Atenção Primária à Saúde,Desempenho físico funcional,Dor lombar,Primary care,Low back pain

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