Department of General Medicine, INSERM, Centre d'Investigations Cliniques Plurithématique 1433, UMR 1116, University of Lorraine, 20199, 9, avenue de la Forêt de Haye, 54500, Vandoeuvre-lès-Nancy, Meurthe-et-Moselle, France.
Institut National de la Santé et de la recherche médicale (INSERM), unit 1178, CESP, Paris Sud University, Paris Descartes University, Maison de Solenn, 97, Boulevard de Port Royal, 75679, Paris Cedex 14, France.
Eur Spine J. 2023 Jun;32(6):2069-2077. doi: 10.1007/s00586-023-07679-4. Epub 2023 Apr 27.
Low back pain (LPB) is mostly left untreated (LBP) and may increase the injury risk due to associated behavioral-health difficulties (BHDs) among adolescents. This study assessed the association between LBP (vs. treated LBP (LBP)) and injuries and the mediating role of BHDs among younger adolescents (10-16 years).
This population-based study compared 328 adolescents with LBP (mean age = 13.7 ± 1.3) with 291 with LBP (mean age = 13.3 ± 1.2) from north-eastern France. They completed a questionnaire collecting, at school-year end, socioeconomic features, LBP/LBP, BHDs (alcohol/tobacco use, excessive screen-time, poor social support, poor physical health, depressive symptoms, and pain limiting activities), and injuries during the current school-year. Data were analyzed using multinomial logistic regression models and Kaplan-Meier estimates.
The proportion of subjects without alcohol/tobacco use or depressive symptoms decreased with time more quickly since age 10 among the adolescents with LBP than among those with LBP. Hence, most LBP early started and the subjects with LBP had a higher risk of single injury (sex-age-class-level-socioeconomic-features-adjusted relative risk ratio RR = 1.63, p < 0.05, vs. LBP) and a much higher risk of ≥ 2 injuries (RR = 2.60, p < 0.001). BHDs played a strong mediating role in the association between LBP and ≥ 2 injuries (contribution = 48%) but a modest mediating role in that between LBP and single injury (contribution = 10%) (pseudo R = 7.6%).
LBP is common and associated with injuries partly due to BHDs (which may alter physical/mental capabilities, risk perception/awareness, and vigilance) among younger adolescents. Our results may inform healthcare providers that they can detect/treat LBP and BHDs to prevent their aggravation and injuries.
大多数青少年的下腰痛（LPB）未经治疗（LBP），并且由于相关的行为健康困难（BHD），可能会增加受伤风险。本研究评估了青少年中 LPB（与治疗 LPB（LBP）相比）与伤害之间的关联，以及 BHD 在其中的中介作用。
本基于人群的研究比较了法国东北部的 328 名 LPB 青少年（平均年龄=13.7±1.3）和 291 名 LBP 青少年（平均年龄=13.3±1.2）。他们在学年末完成了一份问卷，收集了社会经济特征、LPB/LBP、BHD（饮酒/吸烟、过度使用屏幕、社会支持差、身体健康状况差、抑郁症状和疼痛限制活动）以及当前学年期间的伤害情况。数据使用多项逻辑回归模型和 Kaplan-Meier 估计进行分析。
在 LPB 青少年中，与 LBP 青少年相比，从 10 岁开始，没有饮酒/吸烟或抑郁症状的受试者比例随着时间的推移下降得更快。因此，大多数 LPB 很早就开始了，并且 LPB 患者发生单一伤害的风险更高（性别-年龄-班级-社会经济特征调整后的相对风险比 RR=1.63，p<0.05，与 LBP 相比），发生≥2 次伤害的风险高得多（RR=2.60，p<0.001）。BHD 在 LPB 与≥2 次伤害之间的关联中起主要中介作用（贡献=48%），但在 LPB 与单一伤害之间的关联中起次要中介作用（贡献=10%）（伪 R=7.6%）。
LPB 在年轻青少年中很常见，并且与伤害有关，部分原因是 BHD（这可能会改变身体/心理能力、风险感知/意识和警觉性）。我们的研究结果可能会告知医疗保健提供者，他们可以检测/治疗 LPB 和 BHD，以防止其恶化和受伤。
