Personal Risk Factors for First-Time Low Back Pain

Abstract

A prospective study of personal risk factors for first-time low back pain. To construct and validate a multivariate model to predict low back pain. Various physical and psychological factors have been reported to increase the risk of low back pain, but conflicting results may be attributable to inaccurate “clinical” measures and to poorly validated statistical models. A total of 403 health care workers aged 18–40 years volunteered for the study. None had any history of “serious” back pain requiring medical attention or time off work. The volunteers completed the following questionnaires: the modified somatic perception questionnaire, the Zung depression scale, and the Health Locus of Control. Anthropometric factors were quantified using standard techniques. The 3Space Isotrak device (Polhemus, VT) was used to measure lumbar curvature and hip and lumbar spine mobility. Leg and back strength and back muscle fatiguability were measured in functional postures. Postal follow-up questionnaires, sent after 6, 12, 18, 24, 30, and 36 months, inquired about back pain, and multivariate logistic regression was used to identify risk factors at each follow-up. The response rate fell from 99% at 12 months to 90% at 36 months, at which time 90 volunteers reported “serious” back pain and 266 reported “any” back pain. The following were consistent predictors of serious back pain: reduced range of lumbar lateral bending, a long back, reduced lumbar lordosis, increased psychological distress, and previous nonserious low back pain. Only the latter three were consistent predictors of “any” back pain. Physical factors had the most influence in a subpopulation of volunteers who were new to the job. Personal risk factors explained up to 12% of first-time low back pain.