School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
Institute of Bone and Joint Research, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
Eur J Pain. 2021 May;25(5):1091-1106. doi: 10.1002/ejp.1731. Epub 2021 Feb 16.
Previous studies have only investigated how symptom presentation and socio-demographic factors influence care-seeking for low back pain (LBP). However, the influence of health and lifestyle factors remains unclear, and the potential confounding effects of aggregated familial factors (including genetics and the early shared environment) has not been considered extensively.
A cross-sectional analysis was performed on 1605 twins enrolled in the Murcia Twin Registry (Spain). The outcome was seeking medical care for LBP and various self-reported demographic, health and lifestyle factors were considered predictors. All variables except sleep quality and diabetes were collected in 2013, which were cross-referenced from 2009 to 2010. A multivariate logistic regression model was performed on the total sample, followed by a co-twin case-control analysis.
The only significant factor found to increase the odds of seeking medical care for LBP without being affected by familial factors was poor sleep quality (total sample OR = 1.58, 95%CI 1.24-2.01; case-control OR = 1.75, 95%CI 1.14-2.69). The factors that were associated with reduced odds of seeking medical care for LBP and not confounded by familial factors were male sex (case-control OR = 0.55, 95%CI 0.33-0.93), alcohol intake (case-control OR = 0.90, 95%CI 0.82-0.99) and a history of diabetes (case-control OR = 0.50, 95%CI 0.25-0.97). No other factors significantly influenced medical care-seeking for LBP.
People reporting poor sleep quality are more likely to seek medical care for LBP in the long term, with this relationship being independent from aggregated familial factors. Conversely, males, people reporting higher alcohol intake, and people with a history of diabetes are less likely to seek medical care for LBP.
This is the first study investigating the factors that influence seeking medical care for LBP, while adjusting for the influence of familial factors using a co-twin control design. Poor sleep quality is associated with seeking medical care for LBP in the long term and does not appear to be confounded by familial factors. Early screening for indicators of poor sleep quality and appropriate referral to interventions for improving sleep quality or reducing pain in sleep may improve LBP management.
先前的研究仅调查了症状表现和社会人口因素如何影响腰痛（LBP）的就医寻求。然而，健康和生活方式因素的影响仍不清楚，并且尚未广泛考虑聚集的家族因素（包括遗传和早期共同环境）的潜在混杂影响。
对参加穆尔西亚双胞胎登记处（西班牙）的 1605 对双胞胎进行了横断面分析。结果是为腰痛寻求医疗护理，并且考虑了各种自我报告的人口统计学，健康和生活方式因素作为预测因素。除睡眠质量和糖尿病外，所有变量均于 2013 年收集，这些变量在 2009 年至 2010 年交叉引用。对总样本进行了多变量逻辑回归模型分析，然后进行了同卵双胞胎病例对照分析。
唯一发现的增加无家族因素影响下腰痛寻求医疗护理几率的重要因素是睡眠质量差（总样本 OR=1.58，95％CI 1.24-2.01；病例对照 OR=1.75，95％CI 1.14-2.69）。与降低腰痛寻求医疗护理几率相关且不受家族因素混杂影响的因素是男性（病例对照 OR=0.55，95％CI 0.33-0.93），饮酒（病例对照 OR=0.90，95％CI 0.82-0.99）和糖尿病史（病例对照 OR=0.50，95％CI 0.25-0.97）。没有其他因素显着影响腰痛的医疗护理寻求。
报告睡眠质量差的人更有可能在长期内寻求腰痛的医疗护理，而这种关系不受聚集的家族因素的影响。相反，男性，报告饮酒量较高的人以及有糖尿病史的人不太可能因腰痛而寻求医疗护理。
这是第一项使用同卵双胞胎对照设计，在调整家族因素影响的情况下，调查影响腰痛医疗护理寻求的因素的研究。睡眠质量差与长期腰痛的医疗护理有关，似乎不受家族因素的混杂影响。早期筛查睡眠质量差的指标，并适当转介改善睡眠质量或减少睡眠中疼痛的干预措施，可能会改善腰痛的管理。
