Living conditions, including life style, in primary-care patients with nonacute, nonspecific spinal pain compared with a population-based sample: a cross-sectional study

Odd Lindell, Sven-Erik Johansson, Lars-Erik Strender
Clinical Epidemiology 2010, 2: 261-71

BACKGROUND: Nonspecific spinal pain (NSP), comprising back and/or neck pain, is one of the leading disorders behind long-term sick-listing, including disability pensions. Early interventions to prevent long-term sick-listing require the identification of patients at risk. The aim of this study was to compare living conditions associated with long-term sick-listing for NSP in patients with nonacute NSP, with a nonpatient population-based sample. Nonacute NSP is pain that leads to full-time sick-listing >3 weeks.

METHODS: One hundred and twenty-five patients with nonacute NSP, 2000-2004, were included in a randomized controlled trial in Stockholm County with the objective of comparing cognitive-behavioral rehabilitation with traditional primary care. For these patients, a cross-sectional study was carried out with baseline data. Living conditions were compared between the patients and 338 nonpatients by logistic regression. The conditions from univariate analyses were included in a multivariate analysis. The nonsignificant variables were excluded sequentially to yield a model comprising only the significant factors (P < 0.05). The results are shown as odds ratios (OR) with 95% confidence intervals.

RESULTS: In the univariate analyses, 13 of the 18 living conditions had higher odds for the patients with a dominance of physical work strains and Indication of alcohol over-consumption, odds ratio (OR) 14.8 (95% confidence interval [CI] 3.2-67.6). Five conditions qualified for the multivariate model: High physical workload, OR 13.7 (CI 5.9-32.2); Hectic work tempo, OR 8.4 (CI 2.5-28.3); Blue-collar job, OR 4.5 (CI 1.8-11.4); Obesity, OR 3.5 (CI 1.2-10.2); and Low education, OR 2.7 (CI 1.1-6.8).

CONCLUSIONS: As most of the living conditions have previously been insufficiently studied, our findings might contribute a wider knowledge of risk factors for long-term sick-listing for NSP. As the cross-sectional design makes causal conclusions impossible, our study should be complemented by prospective research.

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