Werber Andreas, Zimmermann-Stenzel Monique, Moradi Babak, Neubauer Eva, Schiltenwolf Marcus
University Hospital Heidelberg, Heidelberg, Germany.
Pain Physician. 2014 May-Jun;17(3):217-26.
Several countries developed guidelines in order to provide a systematic approach for treatment of (chronic) lower back pain. The risk of suffering from (chronic) lower back pain differs significantly within the general population. A serious lack of research exists concerning the risk factor "dysfunctional behavior of the subjects in terms of acute lower back pain."
The purpose of this study was to assess the knowledge of the German population regarding the availability of guidelines about managing lower back pain.
Prospective observational cohort study.
We interviewed 983 subjects by phone. The study population included 50 - 70-year-old men and women with German residency and sufficient language ability.
Of all the subjects, 70.2% claimed that they suffered at least once in their lifetime with lower back pain. Lower back pain with radiating symptoms occurred in 28.7%. Women were affected significantly more frequently compared to the epidemiological data. Of all the subjects with lower education, 82.9% suffered from lower back pain at least once in their lifetime compared to only 62.4% of people with university degrees. Education was also a protective factor for lower back pain with radiating pain. People who completed secondary modern school were 42% less likely to suffer from lower back pain than those who did not graduate. Knowing active rules of conduct occurred significantly more often at higher educational levels (i.e. all kinds of sports and exercises requiring physical strength, flexibility, power, agility, coordination, grace, balance and control, in particular stretching exercises) odds ratio = 7.78, physical activities odds ratio = 3.92, relaxation exercises odds ratio = 3.51).
Data acquisition was performed by an external company and therefore provided only limited options for external validity. Furthermore data acquisition was restricted to 50 - 70-year-old patients, since this age group is at higher risk of suffering from lower back pain. A conclusion upon the knowledge of the whole population has to be drawn with caution, especially when considering the size of the study population. The life-time prevalence of lower back pain was assessed by interviewing patients about prior episodes of lower back pain. Slightly biased results may have occurred since the memory of prior episodes might result in too many or too few episodes.
The study revealed a lack of awareness of common available guidelines and an uneven distribution of existing knowledge throughout the population. Passive coping strategies like taking pain medication or ointment therapy were favored over active coping strategies like gymnastics, physical activities, and relaxation exercises. Respondents with a higher level of education suffered significantly less often from lower back pain and tended toward active treatment strategies. Respondents with lower levels of education more often demanded passive treatment strategies. The general population, especially those with lower education, is not sufficiently aware of behavioral strategies for managing lower back pain as proposed in available guidelines.
多个国家制定了指南，以便为（慢性）下背痛的治疗提供系统方法。在普通人群中，患（慢性）下背痛的风险差异显著。关于“受试者在急性下背痛方面的功能失调行为”这一风险因素，存在严重的研究不足。
本研究的目的是评估德国人群对下背痛管理指南可用性的了解情况。
前瞻性观察队列研究。
我们通过电话采访了983名受试者。研究人群包括年龄在50至70岁之间、具有德国居留权且语言能力足够的男性和女性。
在所有受试者中，70.2%称他们一生中至少患过一次下背痛。伴有放射症状的下背痛发生率为28.7%。与流行病学数据相比，女性受影响的频率明显更高。在所有受教育程度较低的受试者中，82.9%一生中至少患过一次下背痛，而大学学历的人群中这一比例仅为62.4%。教育程度也是伴有放射痛的下背痛的一个保护因素。完成现代中学学业的人患下背痛的可能性比未毕业的人低42%。在较高教育水平的人群中，了解积极行为规则的情况明显更常见（即各种需要体力、柔韧性、力量、敏捷性、协调性、优雅、平衡和控制的运动和锻炼，特别是伸展运动）优势比 = 7.78，体育活动优势比 = 3.92，放松运动优势比 = 3.51）。
数据采集由外部公司进行，因此外部有效性的选择有限。此外，数据采集仅限于50至70岁的患者，因为这个年龄组患下背痛的风险更高。在得出关于整个人群知识水平的结论时必须谨慎，尤其是考虑到研究人群的规模。下背痛的终生患病率是通过询问患者以前的下背痛发作情况来评估的。由于对以前发作情况的记忆可能导致发作次数过多或过少，可能会出现略有偏差的结果。
该研究表明，人们对常见可用指南缺乏认识，现有知识在人群中的分布不均衡。服用止痛药或软膏治疗等被动应对策略比体操、体育活动和放松运动等主动应对策略更受青睐。教育程度较高的受访者患下背痛的频率明显较低，并且倾向于采用主动治疗策略。教育程度较低的受访者更常要求采用被动治疗策略。普通人群，尤其是受教育程度较低的人群，对现有指南中提出的下背痛管理行为策略认识不足。
