Department of Public Health Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
Discipline of Public Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
BMJ Open. 2020 Sep 1;10(9):e039554. doi: 10.1136/bmjopen-2020-039554.
Low back pain (LBP) is a major public health concern, affecting individuals of all age groups across the world. In about 90% of LBP cases, there is no specific cause identified and is, therefore, referred to as non-specific LBP. Due to the non-specific nature of LBP, investigations such as radiological and laboratory investigations are unnecessary and results to delayed diagnosis and improper treatment culminating in LBP progressing into chronic LBP (CLBP). LBP is now the leading cause of disability with a significant socioeconomic burden. Despite all these challenges, CLBP is regarded as a trivial condition in low-and-middle-income countries and remains poorly investigated. The distribution of CLBP in Africa is unclear.
The research will be conducted in two phases. The initial phase will be an observational, cross-sectional hospital-based study that will be recruiting 650 participants, to determine the prevalence and risk factors of CLBP. A standardised questionnaire will be used to collect baseline data on the socio-demographic characteristics of participants and other variables of interest (exercise history, occupational posture, level of education and the income status). Disability will be assessed using the Oswestry Disability Questionnaire and the psychological risk factors will be assessed using the Illness-Behaviour Questionnaire (IBQ) and the Fear-Avoidance Belief Questionnaire (FABQ). The second phase will be a retrospective, top-down, prevalence-based cost-of-illness study of the 2018-2019 health records, to estimate the burden of CLBP from the healthcare system's perspective. The SPSS V.25.0 statistical package will be used for data entry and analysis. Statistical analysis will include descriptive statistics by means of graphs and cross tabulations, inferential statistics by means of logistic regression and χ test. A p value of 0.05 will be deemed statistically significant.
This protocol was approved by the University of KwaZulu-Natal's Biomedical Research Ethics Committee (Ref. No.: BREC/00000205/2019) and the KwaZulu-Natal Department of Health Research Ethics (Ref. No.: KZ_201909_002). This will be the first LBP cost-of-illness study in the sub-Saharan Africa, and, therefore, it will close these knowledge gaps and present important evidence on the estimated burden of CLBP in this context. The results of this study will be presented to the Department of Health and to the respective stakeholders and decision-makers to discuss the findings and draw their attention to the prioritisation of LBP research, its management, prevention programmes and implementation of educational programme and for the planning of cost-containment policies.
腰痛（LBP）是一个主要的公共卫生问题，影响着全球各年龄段的人群。在大约 90%的 LBP 病例中，没有发现特定的病因，因此被称为非特异性 LBP。由于 LBP 的非特异性性质，不需要进行影像学和实验室检查等调查，这导致了诊断的延迟和不当的治疗，最终导致 LBP 发展为慢性 LBP（CLBP）。LBP 现在是导致残疾的主要原因，给社会经济带来了巨大负担。尽管面临这些挑战，但在中低收入国家，CLBP 被视为一种微不足道的疾病，仍然缺乏研究。非洲 CLBP 的分布情况尚不清楚。
该研究将分两个阶段进行。第一阶段是一项基于医院的观察性横断面研究，将招募 650 名参与者，以确定 CLBP 的患病率和危险因素。将使用标准化问卷收集参与者的社会人口统计学特征和其他相关变量（运动史、职业姿势、教育水平和收入状况）的基线数据。将使用 Oswestry 残疾问卷评估残疾程度，使用疾病行为问卷（IBQ）和恐惧-回避信念问卷（FABQ）评估心理危险因素。第二阶段是对 2018-2019 年健康记录的回顾性、自上而下的基于患病率的疾病经济负担研究，从医疗保健系统的角度估计 CLBP 的负担。将使用 SPSS V.25.0 统计软件包进行数据录入和分析。数据分析将包括通过图表和交叉表进行描述性统计，通过逻辑回归和 χ 检验进行推断性统计。p 值为 0.05 将被视为具有统计学意义。
该方案已获得夸祖鲁-纳塔尔大学生物医学伦理委员会（注册号：BREC/00000205/2019）和夸祖鲁-纳塔尔省卫生研究伦理委员会（注册号：KZ_201909_002）的批准。这将是撒哈拉以南非洲地区的第一项 LBP 疾病经济负担研究，因此将填补这些知识空白，并提供有关该背景下 CLBP 估计负担的重要证据。研究结果将提交给卫生部和相关利益攸关方和决策者，以讨论研究结果，并提请他们注意 LBP 研究、管理、预防计划和教育计划的实施以及成本控制政策的制定的优先事项。
