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Alsubaie SF, Alkathiry AA, Aljuaid MI, Alnasser MA. The relationship between chronic diseases and the intensity and duration of low back pain. Eur J Phys Rehabil Med 2024; 60:55-61. [PMID: 38059574 PMCID: PMC10938039 DOI: 10.23736/s1973-9087.23.07649-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 07/11/2023] [Accepted: 11/22/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Low back pain (LBP) is a worldwide problem that affects numerous people and limits their mobility. Several factors, including chronic diseases, increase the risk of developing LBP. To date, the information available about the relationship between chronic diseases and the intensity and duration of LBP is quite limited. AIM The aim of the present study was to address the relationship between chronic diseases and both the intensity and duration of LBP. DESIGN This is an observational cross-sectional study. SETTING The study was conducted in the community of Saudi Arabia. POPULATION 2181 adult participants (aged 18 years or more, mean age of 33 and standard deviation [SD] of ±11, 61% females) from Saudi Arabia with either recent or recurring LBP participated in the study. METHODS The participants of this study were surveyed, and their demographic information was obtained. They were asked whether they had LBP during the past year, and if they had, they were asked about their LBP in terms of the pain intensity on a scale that runs from 0 to 10, where 0 indicates no pain and 10 indicates extreme pain. Further, the participants were asked how long their pain lasted (in days). They were also inquired whether they had any of the following chronic diseases: diabetes mellitus, high blood pressure, hypotension, arthritis, cardiopulmonary diseases, kidney diseases, and hypothyroidism. Logistic regression was used to analyze the relationships between both of LBP's intensity and duration, and the presence of chronic diseases, while adjusting for the potential effect of age and gender. RESULTS A total of 2181 adults with either new onset of or recurrent LBP during the past 12 months participated in the present study. Of these, 356 (16%), who had LBP, suffered from one or more of the said chronic diseases. It was found that having one or more chronic diseases had statistically significant relationship with increased LBP's intensity (P=0.002), as well as prolonged duration (P=0.001). In particular, hypertension, arthritis, and hypothyroidism have statistically significant relationship with increased the intensity of the pain (P<0.05). Only, hypertension and arthritis have statistically significant relationship with increased the duration of pain (P≤0.001). CONCLUSIONS The presence of chronic diseases was associated with a more intense and longer duration of LBP. CLINICAL REHABILITATION IMPACT In view of the results of this study, we expect that those who have chronic diseases will have a longer duration of LBP and more intense pain.
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Affiliation(s)
- Saud F Alsubaie
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Alkharj, Saudi Arabia -
| | - Abdulaziz A Alkathiry
- College of Applied Medical Sciences, Department of Physical Therapy and Health Rehabilitation, Majmaah University, Majmaah, Saudi Arabia
| | - Majed I Aljuaid
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Musab A Alnasser
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Alkharj, Saudi Arabia
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Kim S, Lee SM. Dyslipidemia Is Positively Associated with Chronic Low Back Pain in Korean Women: Korean National Health and Nutrition Examination Survey 2010-2012. Healthcare (Basel) 2024; 12:102. [PMID: 38201008 PMCID: PMC10778792 DOI: 10.3390/healthcare12010102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/27/2023] [Accepted: 12/30/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND This study aimed to evaluate the association between chronic low back pain (CLBP) and chronic diseases, such as hypertension, diabetes, and dyslipidemia. METHODS This study was a retrospective analysis using data from the Korea National Health and Nutrition Examination Survey (KNHANES) between 2010-2012 and included women who answered a questionnaire in the KNHANES asking whether they had low back pain for ≥3 months. Participants were divided into non-CLBP and CLBP groups. For statistical analysis, the Student's t-test, chi-square test, Fisher's exact test, and logistic regression analysis were performed using SPSS. RESULTS Of 5961 participants, the non-CLBP group comprised 4098 women and the CLBP group comprised 1863. Adjusted logistic regression model revealed that dyslipidemia was positively associated with CLBP (odds ratio, 1.32; 95% confidence interval, 1.140, 1.530; p < 0.001). However, hypertension and diabetes were not associated with CLBP. CONCLUSIONS Our results suggest that proper treatment of dyslipidemia may contribute to lowering the risk of CLBP later in life.
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Affiliation(s)
- Sunmin Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Gumi-dong 300, Bundang-gu, Seongnam-si 13620, Republic of Korea;
| | - Seon-Mi Lee
- Department of Obstetrics and Gynecology, Korea University College of Medicine, 73 Koreadae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
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Alzahrani A, Alshehri MA, Alzahrani H. Physiotherapists' awareness and use of red flags for the assessment of low back pain in Saudi Arabia. J Back Musculoskelet Rehabil 2024; 37:1333-1343. [PMID: 38758992 DOI: 10.3233/bmr-230410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
Abstract
BACKGROUND Physiotherapists must identify potential red flags that may impede recovery and function in individuals with low back pain (LBP) or put them at risk. OBJECTIVES This study aimed to (1) investigate physiotherapists' awareness and use of red flags for individuals with LBP in Saudi Arabia and (2) identify factors associated with their awareness and use of LBP red flags. METHODS This cross-sectional study collected data using an anonymous online questionnaire (February-July 2023). It included physiotherapists working in private/public hospitals in Saudi Arabia. The questionnaire asked about the participants' characteristics, their awareness of LBP red flags, and their use of red flags for LBP assessment. RESULTS A total of 643 participating physiotherapists (26.2 ± 3.8 years), 63.8% of whom were females, completed the survey. Most participants (94.4%) had adequate awareness of LBP red flags, and more than half (61%) had good utilization of red flags when assessing individuals with LBP. There was a positive correlation between the physiotherapists' awareness and use of LBP red flags. CONCLUSION The majority of the participating physiotherapists in Saudi Arabia were aware of LBP red flags, and many reported to have good use of red flags in clinical practice when assessing and managing individuals with LBP.
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Affiliation(s)
| | - Mansour Abdullah Alshehri
- Physiotherapy Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Mecca, Saudi Arabia
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Hosam Alzahrani
- Department of Physical Therapy, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
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Chen Y, Yang L, Gao X, Tang A, He H, Xiong C, Xu F, Sun C. The Impact of Diabetes Mellitus on Patient-Reported Outcomes of Chronic Low Back Pain with Modic Changes at One Year: A Prospective Cohort Study. Global Spine J 2023:21925682231206962. [PMID: 37824194 DOI: 10.1177/21925682231206962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVES Diabetes mellitus (DM) is associated with unfavourable patient-reported outcomes after spine surgery. Chronic low back pain (CLBP) with Modic Changes (MCs) in the lumbar vertebrae, as observed on MRI, forms a specific subgroup. This study aims to investigate the potential influence of DM on CLBP with MCs. METHODS This study involved 259 patients with CLBP accompanied MCs. We recorded the patient-reported outcomes (visual analogue scale (VAS), Oswestry Disability Index (ODI), and Roland-Morris Disability Questionnaire (RMDQ)) at baseline, 3, 6, and 12 months. Multivariable linear regression analyses were performed to determine predictors of patient-reported outcomes. RESULTS 103 patients had DM. Patients with DM exhibited higher VAS (P < .05), ODI (P < .001), and RMDQ (P < .001) scores at 3, 6, and 12 months, while patients without DM experienced more significant improvements in the scores over time (P < .001). Patients with DM reported longer durations of physical exercise (P = .007). Additionally, patients without DM had a significantly higher patient satisfaction index (P < .001) and a lower prevalence of hypertension (P < .001). Notably, significant differences were observed in the distribution of MCs of lumbar vertebrae (P = .034) and Pfirrmann grades of intervertebral disc degeneration between two groups (P < .001). CONCLUSION Patients with DM demonstrated poorer patient-reported outcomes compared to those without DM in 1-year. DM emerged as an independent predictor of adverse patient-reported outcomes. It can be utilized to enhance the management and treatment of CLBP in patients with MCs.
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Affiliation(s)
- Yongkang Chen
- Department of Orthopedics, General Hospital of Central Theatre Command of PLA, Wuhan, China
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Lei Yang
- Department of Orthopedics, General Hospital of Central Theatre Command of PLA, Wuhan, China
| | - Xiaofeng Gao
- School of Basic Medical Sciences, Xianning Medical College, Hubei University of Science and Technology, Xianning, China
| | - Aolin Tang
- Department of Orthopedics, General Hospital of Central Theatre Command of PLA, Wuhan, China
| | - Hang He
- Department of Orthopedics, General Hospital of Central Theatre Command of PLA, Wuhan, China
| | - Chengjie Xiong
- Department of Orthopedics, General Hospital of Central Theatre Command of PLA, Wuhan, China
| | - Feng Xu
- Department of Orthopedics, General Hospital of Central Theatre Command of PLA, Wuhan, China
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Chao Sun
- Department of Orthopedics, General Hospital of Central Theatre Command of PLA, Wuhan, China
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Alharbi AH, AlSindi T, Ashoor AF, Almalki AM, Aljabri MI, Almaghrabi M, Alothman AM, Almaghrabi NA, Boubaker AM. The Use of Pain Severity and Its Impact as a Predictor for MRI Findings: A Cross-Sectional Study in Ta'if, Saudi Arabia. Cureus 2023; 15:e45463. [PMID: 37859902 PMCID: PMC10583733 DOI: 10.7759/cureus.45463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
Background Low back pain (LBP) is common and considerably impacts daily lives across all age groups. MRI is not frequently used as a first-line investigation for patients presenting with LBP, except in the presence of red-flag symptoms. This study aimed to use pain severity and its impact as a predictor for MRI findings to help physicians decide whether a patient needs an MRI. Methods This cross-sectional study was conducted at the outpatient clinic of the neurosurgery department. The questionnaire included demographic data of the patients, red-flag symptoms, and the Dallas Pain Questionnaire (DPQ). The primary physician then determines whether the patient should have an MRI appointment. Results The study included 100 patients with LBP, of which 71 had chronic LBP (CLBP). Out of these 71, an MRI was requested for 62, but only 26 had findings related to LBP. Regarding the impact of CLBP on daily activities as measured by the DPQ, there was a significant association between those whose CLBP affected their daily activities and the decision to request an MRI. However, no significant statistical association was found between the three other parameters of the DPQ and the primary physician's decision to request an MRI. Conclusion Concerning the use of the DPQ questionnaire to predict MRI findings in patients with CLBP, the study indicates that significant pain impact on the DPQ does not necessarily correlate with MRI findings related to LBP. This suggests that the DPQ evaluation tool has no advantage over a physician's clinical judgment.
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Affiliation(s)
- Ahmad H Alharbi
- Department of Medicine and Surgery, College of Medicine, Umm Al-Qura University, Al-Abdia Main Campus, Makkah, SAU
| | - Tala AlSindi
- Department of Medicine and Surgery, College of Medicine, Umm Al-Qura University, Al-Abdia Main Campus, Makkah, SAU
| | - Albaraa F Ashoor
- Department of Medicine and Surgery, College of Medicine, Umm Al-Qura University, Al-Abdia Main Campus, Makkah, SAU
| | - Abdulrahman M Almalki
- Department of Medicine and Surgery, College of Medicine, Umm Al-Qura University, Al-Abdia Main Campus, Makkah, SAU
| | - Mansour I Aljabri
- Department of Medicine and Surgery, College of Medicine, Umm Al-Qura University, Al-Abdia Main Campus, Makkah, SAU
| | - Murouj Almaghrabi
- Department of Medicine and Surgery, College of Medicine, Umm Al-Qura University, Al-Abdia Main Campus, Makkah, SAU
| | - Ahmed M Alothman
- Department of Neurosurgery, King Faisal Specialist Hospital and Research Centre, Jeddah, SAU
| | | | - Adnan M Boubaker
- Department of Neurological Surgery, King Abdulaziz Specialist Hospital, Ta'if, SAU
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Xu W, Ran B, Zhao J, Luo W, Gu R. Risk factors for failed back surgery syndrome following open posterior lumbar surgery for degenerative lumbar disease. BMC Musculoskelet Disord 2022; 23:1141. [PMID: 36585650 PMCID: PMC9805251 DOI: 10.1186/s12891-022-06066-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 12/06/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND With the growing number of traditional posterior open surgery, the incidence of failed back surgery syndrome (FBSS) increases gradually. We aimed to investigate the incidence and risk factors for FBSS following open posterior lumbar surgery for degenerative lumbar disease (DLD). METHOD A multivariable regression analysis was performed for 333 consecutive patients to identify potential risk factors for FBSS. Clinical outcomes were evaluated by the validated North American Spine Society (NASS) Questionnaire and numerical rating scale (NRS) for pain. Demographics, diagnostic characteristics, surgical data, radiographic parameters for each patient were analyzed. RESULT 16.8% of the included patients were classified as FBSS. Univariate analysis showed that age, hypertension, symptom location, intermittent claudication, preoperative pain NRS-leg, HIZ, Modic changes (MCs), surgical strategy and postoperative rehabilitation were related to FBSS. Multivariable logistic regression analysis demonstrated that preoperative NRS-leg (OR:0.80, 95%CI:0.71-0.91, P = 0.001), hypertension (OR: 2.22, 95%CI: 1.10-4.51, P = 0.027), intermittent claudication with waking distance > 100 m (OR: 4.07, 95%CI: 1.75-9.47, P = 0.001) and waking distance ≤ 100 m (OR: 12.43, 95%CI: 5.54-27.92, P < 0.001), HIZ (OR: 8.26, 95%CI: 4.00-17.04, P < 0.001), MCs (OR: 3.41, 95%CI: 1.73-6.71, P < 0.001), postoperative rehabilitation (OR: 2.63, 95%CI: 1.13-6.12, P = 0.024) were risk factors for FBSS. CONCLUSION Open posterior lumbar surgery is an effective treatment for DLD which provides pain reduction and lumbar curve improvement with a considerable satisfaction rate. Lower preoperative NRS-leg, hypertension, intermittent claudication, HIZ, MCs and postoperative rehabilitation are risk factors for FBSS, which can serve as a tool for clinicians to identify at-risk population and provide more effective management to mitigate the doctor-patient contradictions and further occupation of medical resources.
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Affiliation(s)
- Wenbo Xu
- grid.64924.3d0000 0004 1760 5735Departments of Orthopedics, China-Japan Union Hospital of Jilin University, No.126 Xiantai Street, Changchun, 130033 Jilin P.R. China
| | - Bingbing Ran
- grid.478174.9Departments of Medical Cosmetology, Jilin Province People’s Hospital, No. 1183, Gongnong Road, Changchun, 130021 Jilin P.R. China
| | - Jianhui Zhao
- grid.64924.3d0000 0004 1760 5735Departments of Orthopedics, China-Japan Union Hospital of Jilin University, No.126 Xiantai Street, Changchun, 130033 Jilin P.R. China
| | - Wenqi Luo
- grid.64924.3d0000 0004 1760 5735Departments of Orthopedics, China-Japan Union Hospital of Jilin University, No.126 Xiantai Street, Changchun, 130033 Jilin P.R. China
| | - Rui Gu
- grid.64924.3d0000 0004 1760 5735Departments of Orthopedics, China-Japan Union Hospital of Jilin University, No.126 Xiantai Street, Changchun, 130033 Jilin P.R. China
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Lv Z, Cui J, Zhang J. Smoking, alcohol and coffee consumption and risk of low back pain: a Mendelian randomization 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 2022; 31:2913-2919. [PMID: 36114324 DOI: 10.1007/s00586-022-07389-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 05/07/2022] [Accepted: 09/12/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Low back pain (LBP) is a common health problem in the global population. This study aims to assess whether smoking initiation, alcohol consumption, and coffee consumption are causally with an increased risk of LBP. METHODS A two-sample Mendelian Randomization (MR) study was designed, based on summary-level data from the largest published genome-wide association studies. Single nucleotide polymorphisms with genome-wide significance level (P < 5.0 × 10-8) were selected as instrumental variables for each exposure. Standard inverse-variance weighted (IVW) method was used as the primary statistical method. The weighted median, MR-Egger regression, and MR-PRESSO methods, which relax some IV assumptions, were used for sensitivity analysis. RESULTS Genetically predicted smoking initiation was causally associated with higher odds of LBP. The pooled OR of LBP using IVW method was 1.36 (95%CI 1.22 1.52; P = 6.0 × 10-8) for one SD increase in the prevalence of smoking initiation, which was supported by the weighted median method (OR: 1.41, 95%CI 1.22, 1.64; P = 5.7 × 10-6). Sensitivity analysis confirmed the robustness of pooled OR of LBP. There was no evidence to suggest a causal effect of alcohol and coffee consumption on LBP. The pooled ORs of LBP were 1.36 (95%CI 0.94, 1.97; P = 0.10) for alcohol consumption and 1.00 (95%CI 0.99, 1.00; P = 0.17) for coffee consumption, respectively. CONCLUSION Smoking is casually associated with an increased risk of LBP. Smoking control should be recommended in LBP patients to avoid worsening the disease. The safety of LBP with moderate alcohol and coffee consumption merits more study.
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Affiliation(s)
- Zhengtao Lv
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jiarui Cui
- School of Rehabilitation and Health Preservation, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China.
| | - Jiaming Zhang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Selective Nerve Root Block in Treatment of Lumbar Radiculopathy: A Narrative Review. SURGERIES 2022. [DOI: 10.3390/surgeries3030028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Selective Nerve Root Block (SNRB) is a precise local injection technique that can be utilised to target a particular inflamed nerve root causing lumbar radiculopathy for both diagnostic and therapeutic purposes. Usually, for SNRB to be therapeutic, a combination of a local anaesthetic agent and a steroid is injected under imaging guidance, whereas for diagnostic purposes, just the local anaesthetic agent is injected. While the ideal treatment strategy is to relieve the nerve root from its compressing pathology, local injection of steroids targeted at the affected nerve root can also be attempted to reduce inflammation and thus achieve pain relief. Although the general principle for administering an SNRB remains largely the same across the field, there are differences in techniques depending on the region and level of the spine that is targeted. Moreover, drug combinations utilised by clinicians vary based on preference. The proven benefits of SNRBs largely outweigh their risks, and the procedure is deemed safe and well tolerated in a majority of patients. In this narrative, we explore the existing literature and seek to provide a comprehensive understanding of SNRB as a treatment for lumbar radiculopathy, its indications, techniques, outcomes, and complications.
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Alhowimel AS, Alfaifi RM, Alluhaybi AA, Alanazi MA, Alanazi KM, Almathami NS, Almedhwah SH, Almuayli AA, Alenazi AM, Alshehri MM, Alqahtani BA, Alodaibi F. Prevalence of Low Back Pain and Associated Risk Factors among Saudi Arabian Adolescents: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11217. [PMID: 36141490 PMCID: PMC9517652 DOI: 10.3390/ijerph191811217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 06/16/2023]
Abstract
Low back pain is the most prevalent musculoskeletal condition. Studies on adolescent low back pain are scarce, with no research to determine its prevalence in Saudi Arabia. This study aimed to assess the prevalence and associated risk factors of low back pain in Saudi Arabian adolescents. This cross-sectional study was conducted among Saudi Arabian high school students, which included demographic data, medical and low back pain history. The completed survey by 2000 participants showcased 57.9% of students experiencing low back pain in the last 12 months. This included 31.2% men and 26.7% women. This study found a link between low back pain and age, clinical symptoms of diabetes, heart disease, lung disease, thyroid disease, arthritis, and back surgery, a family history of low back pain, as well as smoking. There is substantial prevalence of low back pain in Saudi Arabian adolescents. This study identified several modifiable and non-modifiable risk factors stemming from adolescent low back pain.
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Affiliation(s)
- Ahmed S. Alhowimel
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 16278, Saudi Arabia
| | | | | | - Majed A. Alanazi
- Comprehensive Rehabilitation Center for People with Disabilities, Arar 73552, Saudi Arabia
| | - Khalid M. Alanazi
- National Guard Health Affairs, Western Section, Riyadh 11426, Saudi Arabia
| | - Nouf S. Almathami
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 16278, Saudi Arabia
| | | | | | - Aqeel M. Alenazi
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 16278, Saudi Arabia
| | | | - Bader A. Alqahtani
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 16278, Saudi Arabia
| | - Faris Alodaibi
- Department of Rehabilitation Science, King Saud University, Riyadh 11451, Saudi Arabia
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