Background
Methods
Search strategy
Eligibility criteria
Study selection
Quality assessment
Statistical analysis
Results
Study identification
Characteristics of included studies
Study | Participants | Description of LBP/determination of a previous episode | Outcome measure (e.g. survey) | # that developed LBP in follow up year |
---|---|---|---|---|
Adams et al [29] |
n = 403 Mean age (yr) = 27 Population = Health care workers Gender = 92% F Region: United Kingdom | History of LBP: n = 141 Pain free at baseline: not stated | Self-administered postal questionnaire, n = 399 (1% percent lost in follow up period) |
n = 159 (39.5%) first time LBP |
Biering-Sorensen et al [30] |
n = 928 Mean age (yr) = not stated, range 30-60 Population = community members Gender = 52% F Region: Denmark | History of LBP: not stated Pain free at baseline: not stated | Self-administered postal questionnaire or telephone, n = 920 (1% percent lost in follow up period) |
n = 170 (M), 185 (F) [recurrence or persistence of LBP]; n = 28 (M), 30 (F) [first time LBP 6.3%] |
Feldman et al [31] |
n = 810 Mean age (yr) = 14.1 Population = Adolescent students Gender = 47% F Region: Canada | History of LBP: n = 125 Pain free at baseline: not stated | Self-administered questionnaire, n = 502 (38% lost in follow up period) |
n = 65 developed first time LBP (17.2%)) |
Fortin et al [40] |
n = 99 Mean age (yr) = 47.3 Population = Monozygotic twins Gender = 0% F Region: Finland | History of LBP: 68 Pain free at baseline: not stated | Numeric pain scale, n = 98 (1% lost in follow up period) |
n = 68 (recurrence or persistence of LBP, 69.4%) |
Gibbons et al [32] |
n = 130 Mean age (years) = 48 Population = Twins Gender = 0% F Region: Finland | History of LBP: n = 85 (in past year) Pain free at baseline: yes | Telephone, n = 128 (2% lost in follow up period) |
n = 13 developed first time LBP (out of 43 that reported no history of LBP at baseline, 30.2%)); n = not reported for those 85 participants that declared a history of LBP in 12/12 before baseline testing |
Kanchanomai et al [33] |
n = 684 Mean age (years) = 19.4 Population = University students Gender = 74% F Region: Thailand | History of LBP: n = 0 (in past 3 months) Pain free at baseline: yes | Self-administered questionnaire, n = 524 (23% lost in follow up period) |
n = 160 (23.4%) developed first time LBP |
Kountouris et al [34] |
n = 23 Mean age (years) = 24 Population = Elite fast bowlers Gender = 0% F Region: Australia | History of LBP: n = not stated Pain free at baseline: yes | Sports Medicine Physician and MRI, n = 23 (0% lost in follow up period) |
n = 18 developed first time LBP (72.3%) |
Kujala et al [35] |
n = 138 Mean age (years) = not stated, range 10.3-13.3 Population = athletes and non-athletes Gender = not stated, 56% F at follow up Region: Finland | History of LBP: n = 28 (in past year) Pain free at baseline: not stated | Self-administered postal questionnaire, n = 119 (14% lost in follow up period) |
n = 24 (11 recurrence of LBP [39.3%], 13 first time LBP [11.8%) |
Luoto et al [36] |
n = 167 Mean age (years) = not stated Population = blue and white collar workers Gender = 56% F Region: Finland | History of LBP: n = 0 (in past year) Pain free at baseline: yes | Nordic questionnaire, n = 126 (25% lost in follow up period) |
n = 33 developed first time LBP (19.8%) |
Milgrom et al [37] |
n = 395 Mean age (years) = 18 Population = infantry recruits Gender = 0% F Region: Israel | History of LBP: n = 0 Pain free at baseline: not stated | Physical examination, n = not clear how many were lost in follow up period |
n = 40 developed first time LBP (10.1%) |
Nissinen et al [39] |
n = 859 Mean age (years) = 12.8 Population = School children Gender = 48% F Region: Finland | History of LBP: n = 0 (in past year) Pain free at baseline | Self-administered standardised pain questionnaire, n = 859 (0% lost in follow up period) |
n = 151 developed first time LBP (17.6%) |
Van Nieuwenhuyse et al [38] |
n = 823 Mean age (years) = 26 Population = workers at health care and distribution facilities Gender = 60% F Region: Belgium | History of LBP: n = 337 (in past year) Pain free at baseline: n = 688 (4 of the participants with history of LBP reported LBP at baseline) | Self-administered questionnaire, n = 692 (16% lost in follow up period) |
n = 34 developed first time LBP (out of 355 that reported no history of LBP at baseline, 9.6%), n = 52 (out of 337 that reported LBP in 12/12 before testing, 15.4%) |
Study quality
Adams et al [29] | Biering-Sorensen et al [30] | Feldman et al [31] | Fortin et al [40] | Gibbons et al [32] | Kanchanomai et al [33] | Kountouris et al [34] | Kujala et al [35] | Luoto et al [36] | Milgrom et al [37] | Nissinen et al [39] | Van Nieuwenhuyse et al [38] | |
---|---|---|---|---|---|---|---|---|---|---|---|---|
1. Is the study relevant to the needs of the Project? | yes | yes | yes | yes | yes | yes | yes | yes | yes | yes | yes | yes |
2. Does the paper address a clearly focused issue? | yes | yes | yes | yes | yes | yes | yes | yes | yes | yes | yes | yes |
3. Is the choice of study method appropriate? | yes | yes | yes | yes | yes | yes | yes | yes | yes | yes | yes | yes |
4. Is the population studied appropriate? | yes | yes | yes | yes | yes | yes | yes | yes | yes | yes | yes | yes |
5. Is confounding and bias considered? | can’t tell | can’t tell | yes | yes | can’t tell | yes | yes | yes | can’t tell | can’t tell | can’t tell | can’t tell |
6. Was follow up for long enough? | yes | yes | yes | yes | yes | yes | yes | yes | yes | can’t tell | yes | yes |
7. Are tables/graphs adequately labelled and understandable? | yes | yes | yes | yes | yes | yes | yes | yes | yes | yes | yes | yes |
8. Are you confident with the authors' choice and use of statistical methods, if employed? | yes | yes | yes | yes | yes | yes | yes | yes | yes | yes | yes | yes |
9. What are the results of this piece of research? Are the authors' conclusions adequately supported by the information cited? | yes | yes | yes | yes | yes | yes | yes | yes | yes | yes | yes | yes |
10. Can the results be applied to the local situation? | can’t tell | can’t tell | can’t tell | can’t tell | can’t tell | can’t tell | can’t tell | can’t tell | can’t tell | can’t tell | Can’t tell | can’t tell |
11. Were all important outcomes/results considered? | yes | yes | yes | yes | yes | no | yes | no | no | yes | yes | yes |
12. Is any cost information provided? | no | yes | no | no | no | yes | yes | yes | yes | no | yes | yes |
13. Accept for further use as Type IV evidence? | yes | yes | yes | yes | yes | yes | yes | yes | yes | yes | yes | yes |
Meta-analyses
Risk Factor | Study | Measurement technique | Effect size (95% CI) | Weight |
---|---|---|---|---|
Lateral flexion range of motion (ROM) | Adams et al [29] | Equipment: 3Space Isotrak device Method: Sensors on sacrum and L1 spinous process measured degree change between upright standing and max lateral flexion | 0.50 (0.29-0.86) | 65.06 |
Kujala et al [35] | Equipment: Tape measure Methods: Difference between middle finger position on ipsilateral thigh to most distal position of middle finger achieved in max lateral flexion | 0.49 (0.14-1.74) | 17.71 | |
Van Nieuwenhuyse et al [38] | Equipment: Tape measure Methods: Difference between middle finger position on ipsilateral thigh to most distal position of middle finger achieved in max lateral flexion | 0.17 (0.05-0.61) | 17.23 | |
Overall effect size (I-squared = 15.9%, p = 0.304) | 0.41 (0.24-0.73, p = 0.002) | 100 | ||
Lumbar lordosis | Adams et al [29] | Equipment: 3Space Isotrak device Method: Sensors on sacrum and L1 spinous process measured degrees of lordosis in upright standing | 0.56 (0.38-0.83) | 35.48 |
Milgrom et al [37] | Equipment: Cybex (EDI 320) inclinometer Method: Inclinometer place over spinous process of L4 and lordosis angle measured relative to horizontal | 0.88 (0.48-1.62) | 18.37 | |
Nissinen et al [39] | Equipment: Spinal pantograph Method: Spinal pantograph used to measure lordosis angle in an upright standing | 0.84 (0.61-1.16) | 46.15 | |
Overall effect size (I-squared = 29.7%, p = 0.241) | 0.73 (0.55-0.98, p = 0.034) | 100 | ||
Hamstring flexibility | Feldman et al [31] | Equipment: Goniometer Method: Supine position with hip at 90°, ipsilateral knee extended from 90° of flexion | 0.96 (0.94-0.98) | 99.92 |
Kujala et al [35] | Equipment: Hydrogoniometer Method: Straight leg raise | 0.70 (0.20-2.45) | 0.04 | |
Van Nieuwenhuyse et al [38] | Equipment: Inclinometer Method: Straight leg raise | 1.00 (0.31-3.2) | 0.04 | |
Overall effect size (I-squared = 0%, p = 0.883) | 0.96 (0.94-0.98, p = 0.001) | 100 | ||
Back muscle strength | Biering-Sorensen et al [30] | Equipment: Strain gauge dynamometer Methods: Device attached to shoulders of participant and the MVC of 3 attempts of extension in upright standing | 1.49 (0.70-3.16) | 71.35 |
Gibbons et al [32] | Equipment: not clear Methods: Max isokinetic strength from forward flexion to upright standing | 1.81 (0.55-5.93) | 28.65 | |
Overall effect size (I-squared = 0%, p = 0.788) | 1.58 (0.83-2.97, p = 0.160) | 100 | ||
Back muscle fatigability | Adams et al [29] | Equipment: Stopwatch Methods: Biering-Sorensen test | 0.80 (0.60-1.07) | 42.59 |
Biering-Sorensen et al [30] | Equipment: Stopwatch Methods: Biering-Sorensen test | 0.42 (0.16-1.14) | 16.57 | |
Gibbons et al [32] | Equipment: Stopwatch Methods: Biering-Sorensen test | 0.85 (0.26-2.77) | 12.97 | |
Kujala et al [35] | Equipment: Stopwatch Methods: Biering-Sorensen test | 1.87 (0.53-6.56) | 11.80 | |
Luoto et al [36] | Equipment: Stopwatch Methods: Biering-Sorensen test | 0.29 (0.11-0.81) | 16.06 | |
Overall effect size (I-squared = 41.2%, p = 0.147) | 0.68 (0.42-1.12 p = 0.160) | 100 | ||
Lumbar flexion range of motion (ROM) | Adams et al [29] | Equipment: 3Space Isotrak device Method: Sensors on sacrum and L1 spinous process measured degree change between upright standing and max forward flexion sitting with legs extended | 1.25 (0.94-1.67) | 50.92 |
Biering-Sorensen et al [30] | Equipment: Tape measure Method: Modified Schober | 2.59 (1.23-5.46) | 19.98 | |
Feldman et al [31] | Equipment: Tape measure Method: Schober | 0.93 (0.45-1.93) | 20.43 | |
Kujala et al [35] | Equipment: Tape measure Method: Modified Schober | 0.88 (0.25-3.07) | 8.67 | |
Overall effect size (I-squared = 34%, p = 0.209) | 1.32 (0.89-1.96, p = 0.167) | 100 | ||
Lumbar extension ROM | Adams et al [29] | Equipment: 3Space Isotrak device Method: Sensors on sacrum and L1 spinous process measured degree change between upright standing and max extension in prone position | 0.95 (0.67-1.34) | 45.69 |
Kujala et al [35] | Equipment: Draughtsman’s flexible curve Method: Devices placed on spinous process of S2, L4, and T12 in prone position with max extension. Curve traced on paper then angle in degrees measured. | 1.19 (0.34-4.14) | 22.76 | |
Van Nieuwenhuyse et al [38] | Equipment: none Method: passive extension of lower back measured as presence or absence of pain | 0.29 (0.12-0.70) | 31.55 | |
Overall effect size (I-squared = 68.7%, p = 0.041) | 0.69 (0.31-1.55, p = 0.367) | 100 | ||
Isometric abdominal strength | Biering-Sorensen et al [30] 0 | Equipment: Strain gauge dynamometer Methods: Device attached to shoulders of participant and the MVC of 3 attempts of flexion in upright standing | 1.20 (0.56-2.53) | 16.62 |
Feldman et al [31] | Equipment: Hand held myometer Methods: Sit-up, stop midway then resistance applied to the sternum. Max force that participant could hold in that position recorded | 0.96 (0.69-1.34) | 83.38 | |
Overall effect size (I-squared = 0%, p = 0.602) | 1.00 (0.73-1.35, p = 0.976) | 100 | ||
Fingertip to floor distance | Biering-Sorensen et al [30] | Equipment: Tape measure Method: Distance from tips of the middle fingers to the ground during max forward bending with feet together and knees extended | 0.96 (0.40-2.28) | 0.13 |
Feldman et al [31] | Equipment: Sit and reach box Method: Sitting with hips flexed and knees extended | 1.00 (0.97-1.03) | 99.53 | |
Kujala et al [35] | Equipment: Tape measure Method: Distance from tips of the middle fingers to the ground during max forward bending with feet together and knees extended | 2.65 (0.75-9.37) | 0.06 | |
Van Nieuwenhuyse et al [38] | Equipment: Tape measure Method: Distance from tips of the middle fingers to the ground during max forward bending with feet together and knees extended | 1.00 (0.55-1.81) | 0.28 | |
Overall effect size (I-squared = 0%, p = 0.515) | 1.00 (0.97-1.03, p = 0.973) | 100 | ||
Quadriceps flexibility | Feldman et al [31] | Equipment: Goniometer Method: Degrees of knee flexion in a prone position | 1.02 (0.92-1.13) | 62.13 |
Kanchanomai et al [33] | Equipment: Goniometer Method: Stationary arm of device aligned with the lateral midline of the thigh, fulcrum is placed over the lateral epicondyle of the femur and the moving arm is aligned with the lateral midline of the fibula. Smaller degrees of knee flexion equated to tighter quadriceps | 1.71 (1.03-2.84) | 37.87 | |
Overall effect size (I-squared = 73.9%, p = 0.050) | 1.24 (0.76-2.03, p = 0.389) | 100 | ||
Erector spinae CSA | Fortin et al [40] | Equipment: 1.5 Tesla Magnetom SP 4000 magnetic resonance imager Method: T2-weighted techniques at L3-4 and L5-S1 | -0.09 (-0.48-0.31) | 27.25 |
Gibbons et al [32] | Equipment: 1.5 tesla Magnetom magnetic resonance imager Method: Slice thickness was 3 mm and gaps between the slices 0.3 mm at the L3-4 level. | 0.00 (-0.65-0.65) | 72.75 | |
Overall effect size (I-squared = 0%, p = 0.823) | -0.06 (-0.40-0.28, p = 0.722) | 100 | ||
Quadratus lumborum CSA | Gibbons et al [32] | Equipment: 1.5 tesla Magnetom magnetic resonance imager Method: Slice thickness was 3 mm and gaps between the slices 0.3 mm at the L3-4 level. | 2.96 (0.89-9.86) | 82.85 |
Kountouris et al [34] | Equipment: MRI and imaging software Method: Axial MR images measured at L2 and L4 levels | 0.55 (0.03-10.37) | 17.15 | |
Overall effect size (I-squared = 8%, p = 0.297) | 2.22 (0.63-7.74, p = 0.212) | 100 |