Exploring factors influencing low back pain in people with non-dysvascular lower limb amputation: a national survey

Devan, Hemakumar, Hendrick, Paul, Hale, Leigh, Carman, Allan, Dillon, Michael and Riberio, Dan (2017) Exploring factors influencing low back pain in people with non-dysvascular lower limb amputation: a national survey. PM&R, 9 (10). pp. 949-959. ISSN 1934-1482

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Background: Chronic low back pain (LBP) is a common musculoskeletal impairment in people with lower limb amputation. Given the multifactorial nature of LBP, exploring the factors influencing the presence and intensity of LBP is warranted.

Objective: To investigate which physical, personal, and amputee-specific factors predicted presence and intensity of low back pain (LBP) in persons with non-dysvascular transfemoral (TFA) and transtibial amputation (TTA).

Design: A retrospective cross-sectional survey.

Setting: A national random sample of people with non-dysvascular TFA and TTA.

Participants: Participants (N = 526) with unilateral TFA and TTA due to non-dysvascular aetiology (i.e. trauma, tumours, and congenital causes) and a minimum prosthesis usage of one year since amputation were invited to participate in the survey. The data from 208 participants (43.4% response rate) were used for multivariate regression analysis

Methods (Independent variables): Personal (i.e. age, body mass, gender, work status, and presence of comorbid conditions), amputee-specific (i.e. level of amputation, years of prosthesis use, presence of phantom limb pain, residual limb problems, and non-amputated limb pain), and physical factors (i.e. pain provoking postures including standing, bending, lifting, walking,sitting, sit-to stand, and climbing stairs).

Main outcome measures (Dependent variables): LBP presence and intensity.

Results: A multivariate logistic regression model showed that the presence of two or more comorbid conditions (prevalence odds ratio (POR) = 4.34, p = .01), residual limb problems (POR 22 = 3.76, p<.01), and phantom limb pain (POR = 2.46, p = .01) influenced the presence of LBP.

Given the high LBP prevalence (63%) in the study, there is a tendency for overestimation of PORand the results must be interpreted with caution. In those with LBP, the presence of residual limb problems (beta = 0.21, p = .01), and experiencing LBP symptoms during sit-to-stand task (beta = 0.22, p = .03) were positively associated with LBP intensity, while being employed demonstrated a negative association (beta = - 0.18, p = .03) in the multivariate linear regression model.

Conclusions: Rehabilitation professionals should be cognisant of the influence that comorbid conditions, residual limb problems, and phantom pain have on the presence of LBP in people with non-dysvascular lower limb amputation. Further prospective studies could investigate the underlying causal mechanisms of LBP.

Item Type: Article
Keywords: activity, cross-sectional, low back pain, musculoskeletal, risk factors
Schools/Departments: University of Nottingham, UK > Faculty of Medicine and Health Sciences > School of Health Sciences
Identification Number: https://doi.org/10.1016/j.pmrj.2017.02.004
Depositing User: Hendrick, Dr Paul
Date Deposited: 24 Feb 2017 09:34
Last Modified: 16 Feb 2018 05:37
URI: https://eprints.nottingham.ac.uk/id/eprint/40815

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