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      Prevalence of chronic low back pain: systematic review

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          Abstract

          OBJECTIVE

          To estimate worldwide prevalence of chronic low back pain according to age and sex.

          METHODS

          We consulted Medline (PubMed), LILACS and EMBASE electronic databases. The search strategy used the following descriptors and combinations: back pain, prevalence, musculoskeletal diseases, chronic musculoskeletal pain, rheumatic, low back pain, musculoskeletal disorders and chronic low back pain. We selected cross-sectional population-based or cohort studies that assessed chronic low back pain as an outcome. We also assessed the quality of the selected studies as well as the chronic low back pain prevalence according to age and sex.

          RESULTS

          The review included 28 studies. Based on our qualitative evaluation, around one third of the studies had low scores, mainly due to high non-response rates. Chronic low back pain prevalence was 4.2% in individuals aged between 24 and 39 years old and 19.6% in those aged between 20 and 59. Of nine studies with individuals aged 18 and above, six reported chronic low back pain between 3.9% and 10.2% and three, prevalence between 13.1% and 20.3%. In the Brazilian older population, chronic low back pain prevalence was 25.4%.

          CONCLUSIONS

          Chronic low back pain prevalence increases linearly from the third decade of life on, until the 60 years of age, being more prevalent in women. Methodological approaches aiming to reduce high heterogeneity in case definitions of chronic low back pain are essential to consistency and comparative analysis between studies. A standard chronic low back pain definition should include the precise description of the anatomical area, pain duration and limitation level.

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          Most cited references 46

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          The rising prevalence of chronic low back pain.

          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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            A consensus approach toward the standardization of back pain definitions for use in prevalence studies.

            A modified Delphi study conducted with 28 experts in back pain research from 12 countries. To identify standardized definitions of low back pain that could be consistently used by investigators in prevalence studies to provide comparable data. Differences in the definition of back pain prevalence in population studies lead to heterogeneity in study findings, and limitations or impossibilities in comparing or summarizing prevalence figures from different studies. Back pain definitions were identified from 51 articles reporting population-based prevalence studies, and dissected into 77 items documenting 7 elements. These items were submitted to a panel of experts for rating and reduction, in 3 rounds (participation: 76%). Preliminary results were presented and discussed during the Amsterdam Forum VIII for Primary Care Research on Low Back Pain, compared with scientific evidence and confirmed and fine-tuned by the panel in a fourth round and the preparation of the current article. Two definitions were agreed on a minimal definition (with 1 question covering site of low back pain, symptoms observed, and time frame of the measure, and a second question on severity of low back pain) and an optimal definition that is made from the minimal definition and add-ons (covering frequency and duration of symptoms, an additional measure of severity, sciatica, and exclusions) that can be adapted to different needs. These definitions provide standards that may improve future comparisons of low back pain prevalence figures by person, place and time characteristics, and offer opportunities for statistical summaries.
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              Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement

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                Author and article information

                Journal
                Rev Saude Publica
                Rev Saude Publica
                rsp
                Revista de Saúde Pública
                Faculdade de Saúde Pública da Universidade de São Paulo
                0034-8910
                1518-8787
                05 October 2015
                2015
                : 49
                Affiliations
                [I ] Divisão de População e Saúde. Faculdade de Medicina. Universidade Federal do Rio Grande. Rio Grande, RS, Brasil
                [II ] Programa de Pós-Graduação em Epidemiologia. Universidade Federal de Pelotas. Pelotas, RS, Brasil
                [III ]Prefeitura Municipal de Bento Gonçalves. Bento Gonçalves, RS, Brasil
                Author notes
                Correspondence: Rodrigo Dalke Meucci. Divisão de População e Saúde. Faculdade de Medicina. Universidade Federal do Rio Grande. Rua Visconde de Paranaguá, 102 Centro. 96203-900 Rio Grande, RS, Brasil. E-mail: rodrigodalke@ 123456gmail.com

                Based on the doctoral thesis by Rodrigo Dalke Meucci, titled: “Dor lombar em fumicultores do município de São Lourenço do Sul, RS”, presented in the Graduate Program in Epidemiology at Universidade Federal de Pelotas, 2014.

                The authors declare no conflict of interest.

                Article
                S0034-8910.2015049005874
                10.1590/S0034-8910.2015049005874
                4603263
                26487293

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Page count
                Figures: 3, Tables: 3, Equations: 0, References: 40, Pages: 1
                Categories
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