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Ho EK, Ferreira ML, Bauman A, Carvalho-E-Silva AP, Pinheiro MB, Hübscher M, Calais-Ferreira L, Simic M, Ferreira PH. Beneficial and harmful effects of physical activity on care-seeking for low back pain: the AUTBACK study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:481-489. [PMID: 37728638 DOI: 10.1007/s00586-023-07935-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/11/2023] [Accepted: 08/30/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE People who seek more care for low back pain (LBP) tend to experience poorer recovery (e.g. higher pain and disability levels). Understanding the factors associated with care-seeking for LBP might improve patient outcomes and potentially alleviate the burden of LBP on global health systems. This study aimed to investigate the relationship between different intensities, volumes, and domains of physical activity and care-seeking behaviours, in people with a history of LBP. METHODS Longitudinal data from adult twins were drawn from the AUstralian Twin BACK study. The primary outcome was the total self-reported frequency (counts) of overall utilisation of care for LBP, over 1 year. Secondary outcomes were the utilisation of health services, and the utilisation of self-management strategies, for LBP (assessed as total frequency over 1 year). Explanatory variables were device-based measures of sedentary behaviour and moderate-to-vigorous intensity physical activity, and self-reported physical workload, and work, transport, household, and leisure domain physical activity, at baseline. RESULTS Data from 340 individuals were included. Median age was 56.4 years (IQR 44.9-62.3 years) and 73% of participants were female. Medium-to-high baseline volumes of sedentary behaviour were significantly associated with greater counts of overall care utilisation (IRR 1.60, 95%CI 1.04-2.44) and utilisation of self-management strategies (IRR 1.60, 95%CI 1.02-2.50) for LBP, over 1 year. Medium-to-high baseline volumes of household domain physical activity were significantly associated with greater counts of utilising self-management strategies for LBP over 1 year (IRR 1.62, 95%CI 1.04-2.53). No explanatory variables were associated with the utilisation of health services for LBP. CONCLUSION People who engage in higher baseline volumes of sedentary behaviour or physical activity in the household setting (e.g. housework, gardening, yard work, general household maintenance) utilise 1.6 times more care for LBP over 1 year. Findings suggest that higher volumes of these behaviours may be harmful for LBP. No intensities, volumes, or domains of physical activity demonstrated clear benefits for LBP. Where feasible, patients and clinicians should collaborate to screen and develop strategies to reduce engagement in sedentary behaviour or physical activity in the household setting. Contextual factors (e.g. patient symptom severity, sociocultural roles, occupational demands) should be considered when devising appropriate behaviour change strategies.
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Affiliation(s)
- E K Ho
- Faculty of Medicine and Health, Sydney Musculoskeletal Health, School of Health Sciences, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia.
- Faculty of Medicine and Health, School of Health Sciences, Sydney Musculoskeletal Health, The Kolling Institute, The University of Sydney and Northern Sydney Local Health District, Level 10, Kolling Building, Gamaragal Country, St Leonards, NSW, Australia.
- University of Sydney, Level 7, D18 Susan Wakil Health Building, Western Avenue, Camperdown, NSW, 2050, Australia.
| | - M L Ferreira
- Faculty of Medicine and Health, School of Health Sciences, Sydney Musculoskeletal Health, The Kolling Institute, The University of Sydney and Northern Sydney Local Health District, Level 10, Kolling Building, Gamaragal Country, St Leonards, NSW, Australia
| | - A Bauman
- Faculty of Medicine and Health, Sydney Musculoskeletal Health, The University of Sydney, Sydney, NSW, Australia
| | - A P Carvalho-E-Silva
- Faculty of Medicine and Health, Sydney Musculoskeletal Health, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, School of Health Sciences, Sydney Musculoskeletal Health and Kolling Institute, The University of Sydney and Northern Sydney Local Health District, Level 12, Kolling Building, Gamaragal Country, St Leonards, Sydney, NSW, Australia
| | - M B Pinheiro
- Faculty of Medicine and Health, Sydney Musculoskeletal Health, The University of Sydney, Sydney, NSW, Australia
- Sydney Musculoskeletal Health, Institute for Musculoskeletal Health, The University of Sydney, Sydney Local Health District, Sydney, NSW, Australia
| | - M Hübscher
- Neuroscience Research Australia, Sydney, NSW, Australia
| | - L Calais-Ferreira
- Twins Research Australia, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - M Simic
- Faculty of Medicine and Health, Sydney Musculoskeletal Health, The University of Sydney, Sydney, NSW, Australia
| | - P H Ferreira
- Faculty of Medicine and Health, Sydney Musculoskeletal Health, School of Health Sciences, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
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Patterson T, Beckenkamp P, Ferreira M, Bauman A, Carvalho-E-Silva AP, Ferreira LC, Ferreira P. The impact of different intensities and domains of physical activity on analgesic use and activity limitation in people with low back pain: a prospective cohort study with a one-year follow-up. Eur J Pain 2022; 26:1636-1649. [PMID: 35642334 PMCID: PMC9544541 DOI: 10.1002/ejp.1987] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 05/16/2022] [Accepted: 05/21/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Analgesics are the most common form of managing low back pain (LBP). No previous study has examined which domains and intensities of physical activity are most beneficial in reducing the frequency of analgesic use for LBP, and its related activity limitation. METHODS This cohort study forms part of the AUstralian Twin low BACK pain study, investigating the impact of physical activity on LBP. Information on demographics, LBP and health-related factors, including physical activity were collected at baseline. Data on the total counts of analgesic use and activity limitation for LBP were collected weekly for one-year. Negative binomial regression models were conducted separately for each type of physical activity. Results were presented as Incidence Rate Ratios (IRR) and 95% Confidence Intervals (CI). RESULTS From an initial sample of 366 participants, 86 participants reported counts of analgesic use and 140 recorded counts of activity limitation across the follow up period. The negative binomial regression models for analgesic use counts indicated moderate-vigorous physical activity (IRR 0·97, 95% C.I 0·96-0·99) and physical workload (IRR 1·02, 95% C.I 1·01-1·05) to be significant. For activity limitation counts, significant associations were shown for sedentary time (IRR 1·04, 95% C.I 1·01-1·09) and leisure activity (IRR 0·94, 95% C.I 0·81-0·99). CONCLUSIONS Our findings highlight the potential importance of supporting engagement in moderate-vigorous and leisure physical activity, as well as minimising sedentary time and physical workload to reduce the risk of activity limitation and the need for analgesic use in people with LBP.
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Affiliation(s)
- Thomas Patterson
- The University of Sydney, Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, Susan Walking Building D18 Western Avenue, Camperdown, NSW, Australia
| | - Paula Beckenkamp
- The University of Sydney, Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, Susan Walking Building D18 Western Avenue, Camperdown, NSW, Australia
| | - Manuela Ferreira
- The University of Sydney, Sydney Musculoskeletal Health, School of Health Sciences, The Kolling Institute of Medical Research, Faculty of Medicine and Health, Kolling Building, St Leonards, NSW, Australia
| | - Adrian Bauman
- The University of Sydney, Public Health, Sydney School of Public Health, Faculty of Medicine and Health, Edward Ford Building A27 Fisher Rd, Camperdown, NSW, Australia
| | - Ana Paula Carvalho-E-Silva
- The University of Sydney, Public Health, Sydney School of Public Health, Faculty of Medicine and Health, Edward Ford Building A27 Fisher Rd, Camperdown, NSW, Australia
| | - Lucas Calais Ferreira
- The University of Melbourne, Twins Research Australia Unit, School of Population and Global Health, 207 Bouverie St, Carlton, VIC, Australia
| | - Paulo Ferreira
- The University of Sydney, Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, Susan Walking Building D18 Western Avenue, Camperdown, NSW, Australia
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Jacob L, Rathmann W, Koyanagi A, Haro JM, Kostev K. Association between type 2 diabetes and chronic low back pain in general practices in Germany. BMJ Open Diabetes Res Care 2021; 9:9/1/e002426. [PMID: 34266855 PMCID: PMC8286747 DOI: 10.1136/bmjdrc-2021-002426] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 06/30/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION There are conflicting results on the association between type 2 diabetes and chronic low back pain (CLBP). Therefore, the goal was to investigate the relationship between type 2 diabetes and CLBP in individuals followed in general practices in Germany. RESEARCH DESIGN AND METHODS Adults diagnosed for the first time with type 2 diabetes in 809 general practices in Germany between 2005 and 2018 (index date) were included. Adults without type 2 diabetes were matched (1:1) to those with type 2 diabetes by sex, age, index year, and the annual number of medical consultations (index date: a randomly selected visit date). The association between type 2 diabetes and the 10-year incidence of CLBP was analyzed in conditional Cox regression models adjusted for a wide range of comorbidities, including hypertension, lipid metabolism disorders, and obesity. RESULTS There were 139 002 individuals included in this study (women: 58.0%; mean (SD) age 62.5 (13.4) years). There was a positive association between type 2 diabetes and the incidence of CLBP in the overall sample (HR=1.23, 95% CI: 1.13 to 1.35). Sex-stratified analyses showed a higher risk of CLBP in women (HR=1.68, 95% CI: 1.43 to 1.90) and a lower risk in men with than in their counterparts without type 2 diabetes (HR=0.83, 95% CI: 0.71 to 0.97). CONCLUSIONS Newly diagnosed type 2 diabetes was associated with an increased risk of CLBP. There were important sex differences in the type 2 diabetes-CLBP relationship, and more research is warranted to investigate the underlying factors explaining these differences.
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Affiliation(s)
- Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | - Wolfgang Rathmann
- German Diabetes Center, Institute for Biometrics and Epidemiology, Leibniz Institute for Diabetes Research at Heinrich Heine University, Duesseldorf, Germany
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - Josep Maria Haro
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
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