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; Riberio, Dan

Abstract

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.

Citation

Devan, H., Hendrick, P., Hale, L., Carman, A., Dillon, M., & Riberio, D. (in press). Exploring factors influencing low back pain in people with non-dysvascular lower limb amputation: a national survey. PM&R, 9(10), https://doi.org/10.1016/j.pmrj.2017.02.004

• Journal Article Type: Article
• Acceptance Date: Feb 3, 2017
• Online Publication Date: Feb 15, 2017
• Deposit Date: Feb 24, 2017
• Publicly Available Date: Feb 24, 2017
• Journal: PM&R
• Print ISSN: 1934-1482
• Electronic ISSN: 1934-1482
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 9
• Issue: 10
• DOI: https://doi.org/10.1016/j.pmrj.2017.02.004
• Keywords: activity, cross-sectional, low back pain, musculoskeletal, risk factors
• Public URL: https://nottingham-repository.worktribe.com/output/845668
• Publisher URL: http://www.pmrjournal.org/article/S1934-1482(17)30175-2/abstract
• Contract Date: Feb 24, 2017