A Systematic Review and Meta-Analysis
Jeffrey B. Taylor
The Spine Journal
Available online 23 January 2014
Abstract
Background Context
Great effort has been made toward limiting low back pain (LBP). Recent focus has included factors involved with secondary and tertiary prevention, with less attention given to primary prevention.
Purpose
This review provided a current estimate of the incidence of LBP and risk factors associated with either first-time LBP or transition to LBP from a baseline of a pain-free state.
Study Design
A systematic review and meta-analyses were performed according to PRISMA guidelines.
Patient Sample
Studies included subjects 18 years of age or older, from longitudinal, observational, cohort designs that included baseline risk factors to an outcome of either first-time LBP or transition to LBP from a baseline of a pain-free state.
Outcome Measures
Risk factors and incidence rates were reported using descriptive analysis and the PRISMA guidelines.
Methods
Electronic search strategies in PubMed, CINAHL/SPORTDiscus, and Cochrane Central Register of Controlled Trials were combined with a hand search to identify articles for inclusion. Studies were classified based on the population studied (community vs. occupational based) and type of LBP outcome (first-ever vs. transition from a baseline pain-free state). No funding was used in this study. The authors claim no conflicts of interest, though APG has received funding from the Agency for Health Care Research and Quality and SZG has received funding from the National Institutes of Health and Brooks Health.
Results
A total of 41 studies were included for review. Meta-analytic incidence rates for first-time LBP and transition to pain from a pain-free state were similar (∼25%) regardless of community or occupational populations. Risk factors for first-time LBP or transition to LBP from a baseline of a pain-free state were both psychosocial- and physically-related. No consistent risk factor emerged as predictive of first-time LBP, though prior LBP was a consistent predictor of future incident LBP. Significant heterogeneity was found across studies in most models, which limits these findings.
Conclusions
The results of this study suggest that incidence of LBP is similar in community and occupational settings regardless of LBP definition. There were multiple, diverse physical and psychosocial risk factors for first-time LBP. A previous history of LBP was the most consistent risk factor for transition to LBP from a baseline of a pain-free state.