The authors declare that they have no competing interests.
KK, KMD, EMH contributed to the conception and design. KK drafted the manuscript. RO undertook the statistical analysis with contributions from KK, KMD, SV. All authors contributed to the interpretation of the results, reviewed and approved the manuscript before submission.
Patients with back pain radiating to the leg(s) report worse symptoms and poorer recovery than those with back pain alone. Robust evidence regarding their epidemiological profile is lacking from primary care, the setting where most of these patients will present and be managed. Our objective was to describe the characteristics of patients with back and leg pain, including sciatica, seeking treatment in primary care.
Adults visiting their general practitioner with back and leg pain, of any duration and severity, were invited to participate. Participants completed questionnaires, underwent clinical assessments and received MRI scans. Characteristics of the sample are described, and differences between patients diagnosed with referred leg pain and those with sciatica are analysed.
Six hundred nine patients participated; 62.6 % were female, mean (SD) age 50.2 (13.9). 67.5 % reported pain below the knee, 60.7 % were in paid employment with 39.7 % reporting time off work. Mean disability (RMDQ) was 12.7 (5.7) and mean pain intensity was 5.6 (2.2) and 5.2 (2.4) for back and leg respectively. Mean sciatica bothersomeness index (SBI) was 14.9 (5.1). Three quarters (74.2 %) were clinically diagnosed as having sciatica. In the sciatica group, leg pain intensity, neuropathic pain, pain below the knee, leg pain worse than back pain, SBI and positive MRI findings were significantly higher as compared to patients with referred leg pain.
This primary care cohort reported high levels of disability and pain. This is the first epidemiological study of unselected primary care patients seeking healthcare for back and leg pain. Follow-up of this cohort will investigate the prognostic value of their baseline characteristics. This new information will contribute to our understanding of the characteristics and clinical features of this population, and will underpin future research aimed at defining prognostic subgroups to enable better targeting of health care provision.
Kessler RC, Barber C, Beck A, Berglund P, Cleary PD, McKenas D, et al. The World Health Organization Health and Work Performance Questionnaire (HPQ). Occup Environ Med. 2003;45(2):156–74. CrossRef
Dunn KM, Jordan KP, Croft PR. Recall of medication use, self-care activities and pain intensity: a comparison of daily diaries and self-report questionnaires among low back pain patients. Prim Health Care Res Dev. 2010;11:93–102. CrossRef
Moss-Morris R, Weinman J, Petrie KJ, et al. The Revised Illness Perceptions Questionnaire (IPQ-R). Psychol Health. 2002;17(1):1–16. CrossRef
EuroQol Group. EuroQol–a new facility for the measurement of health-related quality of life. Health Policy. 1990;16:199–208. CrossRef
Hayden JA, Dunn KM, van der Windt DA, Shaw WS. What is the prognosis of back pain? Best Pract Res Clin Rheumatology. 2010;24:167–9. CrossRef
Health Survey for England. http://www.hscic.gov.uk/catalogue/PUB16077 (access date:11th July 2015)
Stacey BR. Management of peripheral neuropathic pain. Am J Phys Med Rehabil. 2005;84 Suppl 3:4–16.
Bouhassira D, Attal N. Diagnosis and assessment of neuropathic pain: the saga of clinical tools. Pain. 2011;152 Suppl 3:74–83. CrossRef
Jensen M, Brant-Zawadski M, Obuchowski N, Modic MT, Malkasian D, Ross JS. MRI imaging of the lumbar spine in people without back pain. N Engl J Med. 1994;331:369–3737. CrossRef
Stynes S, Konstantinou K, Dunn KM, Lewis ML, Hay EM. Agreement among therapists when diagnosing low back-related leg pain. Bone Joint J. 2014;96-B Suppl 4:4.
- Characteristics of patients with low back and leg pain seeking treatment in primary care: baseline results from the ATLAS cohort study
Kate M. Dunn
Elaine M. Hay
On the behalf of the ATLAS study research team
- BioMed Central
Neu im Fachgebiet Orthopädie und Unfallchirurgie
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