Machado Gustavo C, Ferreira Paulo H, Maher Chris G, Latimer Jane, Steffens Daniel, Koes Bart W, Li Qiang, Ferreira Manuela L
The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia.
Spine J. 2016 Dec;16(12):1445-1452. doi: 10.1016/j.spinee.2016.08.010. Epub 2016 Aug 5.
A previous study has shown that transient physical and psychosocial activities increased the risk of developing low back pain. However, the link between these factors in triggering nonpersistent or persistent episodes remains unclear.
We aimed to investigate the association of transient exposures to physical and psychosocial activities with the development of nonpersistent or persistent low back pain.
This was a case-crossover study with 12 months follow-up.
We included 999 consecutive participants seeking care for a sudden onset of low back pain.
Development of low back pain was the outcome measure.
At baseline, participants reported transient exposures to 12 predefined activities over the 4 days preceding pain onset. After 12 months, participants were asked whether they had recovered and the date of recovery. Exposures in the 2-hour period preceding pain onset (case window) were compared with the 2-hour period, 24 hours before pain onset (control window) in a case-crossover design for all participants. Conditional logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CI), and interaction analyses were used to compare estimates of nonpersistent (i.e., <6 weeks duration) and persistent cases. This study received funding from Australia's National Health and Medical Research Council (APP1003608).
There were 832 participants (83%) who completed the 12 months follow-up successfully. Of these, 430 participants had nonpersistent low back pain (<6 weeks duration), whereas 352 reported persistent symptoms (≥6 weeks duration). Exposure to several transient activities, such as manual tasks involving heavy loads, awkward postures, live people or animals, moderate or vigorous physical activity, and being fatigued or tired during a task or activity, significantly increased the risk of both nonpersistent and persistent low back pain, with ORs ranging from 2.9 to 11.7. Overall, the risk of developing a persistent or a nonpersistent episode of low back pain associated with the included physical factors did not differ significantly.
Our results revealed that previously identified triggers contribute equally to the development of both nonpersistent and persistent low back pain. Future prevention strategies should focus on controlling exposure to these triggers as they have the potential to decrease the burden associated with both acute and chronic low back pain.
先前的一项研究表明，短暂的身体和心理社会活动会增加患下腰痛的风险。然而，这些因素在引发非持续性或持续性发作之间的联系仍不清楚。
我们旨在研究短暂暴露于身体和心理社会活动与非持续性或持续性下腰痛发展之间的关联。
这是一项为期12个月随访的病例交叉研究。
我们纳入了999名因突然发作下腰痛而寻求治疗的连续参与者。
下腰痛的发生是结局指标。
在基线时，参与者报告在疼痛发作前4天内短暂暴露于12项预先定义的活动。12个月后，询问参与者是否康复以及康复日期。在病例交叉设计中，将所有参与者疼痛发作前2小时（病例窗口）的暴露情况与疼痛发作前24小时的2小时时间段（对照窗口）进行比较。使用条件逻辑回归计算比值比（OR）和95%置信区间（CI），并使用交互分析比较非持续性（即持续时间<6周）和持续性病例的估计值。本研究获得了澳大利亚国家卫生与医学研究委员会（APP1003608）的资助。
有832名参与者（83%）成功完成了12个月的随访。其中，430名参与者患有非持续性下腰痛（持续时间<6周），而352名报告有持续性症状（持续时间≥6周）。暴露于几种短暂活动，如涉及重物的体力任务、笨拙姿势、接触人或动物、中度或剧烈体育活动以及在任务或活动期间感到疲劳或疲倦，会显著增加非持续性和持续性下腰痛的风险，OR范围为2.9至11.7。总体而言，与所纳入的身体因素相关的持续性或非持续性下腰痛发作风险没有显著差异。
我们的结果表明，先前确定的触发因素对非持续性和持续性下腰痛的发展贡献相同。未来的预防策略应侧重于控制对这些触发因素的暴露，因为它们有可能减轻与急性和慢性下腰痛相关的负担。
