Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2015

Open Access 01-12-2015 | Research article

Characteristics of patients with low back and leg pain seeking treatment in primary care: baseline results from the ATLAS cohort study

Authors: Kika Konstantinou, Kate M. Dunn, Reuben Ogollah, Steven Vogel, Elaine M. Hay, On the behalf of the ATLAS study research team

Published in: BMC Musculoskeletal Disorders | Issue 1/2015

Login to get access

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.
Appendix
Available only for authorised users
Footnotes
1
The physiotherapists were qualified on average 19.5 years (range 7–41 years) and had an average of 15 years’ experience (range 6–27 years) in predominately treating musculoskeletal conditions.
 
2
In this paper, we report on three psychological constructs from the IPQ-R, timeline-acute/chronic; personal control, identity. This is based on existing literature indicating the distinctiveness of these three factors and their predictive relation to outcome (Foster et al. Pain (2010) 148:398–406).
 
Literature
1.
Hill JC, Konstantinou K, Egbewale BE, Dunn KM, Lewis ML, et al. Clinical outcomes among low back pain consulters with referred leg pain in primary care. Spine. 2011;36:2168–75.CrossRefPubMed
2.
3.
4.
5.
van Tulder MW, Koes BW, Bouter LM. A cost-of-illness study of back pain in the Netherlands. Pain. 1995;62:233–40.CrossRefPubMed
6.
Konstantinou K, Hider SL, Jordan JL, Lewis ML, Dunn KM, Hay EM. The Impact of Low Back-related Leg Pain on Outcomes as Compared With Low Back Pain Alone: A Systematic Review of the Literature. Clin J Pain. 2013;29:644–54.CrossRefPubMed
7.
Hider SL, Whitehurst DGT, Thomas E, Foster NE. Pain location matters: the impact of leg pain on health care use, work disability and quality of life in patients with low back pain. Eur Spine J. 2014;24:444–51. doi:10.​1007/​s00586-014-3355-2.CrossRefPubMed
8.
Haswell K, Gilmour J, Moore B. Clinical decision rules for identification of low back pain patients with neurologic involvement in primary care. Spine. 2008;33(1):68–73.CrossRefPubMed
9.
Konstantinou K, Beardmore R, Dunn KM, Lewis ML, Hider SL, Sanders T, et al. Clinical course, characteristics and prognostic indicators in patients presenting with back and leg pain in primary care. The ATLAS study protocol. BMC Musculoskelet Disord. 2012;13:4.CrossRefPubMed
10.
11.
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
12.
Kigozi J, Lewis M, Jowett S, Barton P, Coast J. Construct validity and responsiveness of the single-item presenteeism question in patients with lower back pain for the measurement of presenteeism. Spine. 2014;39(5):409–16.CrossRefPubMed
13.
Roland MO, Morris RW. A study of the natural history of back pain. Part 1: Development of a reliable and sensitive measure of disability in low back pain. Spine. 1983;8:141–4.CrossRefPubMed
14.
Patrick DL, Deyo RA, Atlas SJ, Singer DE, Chapin A, et al. Assessing health-related quality of life in patients with sciatica. Spine. 1995;20(17):1899–908.CrossRefPubMed
15.
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
16.
Bennett MI, Smith BH, Torrance N, Potter J. The S-LANSS score for identifying pain of predominantly neuropathic origin: validation for use in clinical and postal research. J Pain. 2005;6:149–58.CrossRefPubMed
17.
Hill JC, Dunn KM, Lewis M, Mullis R, Main CJ, Foster NE, et al. A primary care back pain screening tool: identifying patient subgroups for initial treatment. Arthritis Rheum. 2008;59(5):632–41.CrossRefPubMed
18.
Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–70.CrossRefPubMed
19.
Nicholas MK. The pain self-efficacy questionnaire: taking pain into account. Eur J Pain. 2007;11:153–63.CrossRefPubMed
20.
Moss-Morris R, Weinman J, Petrie KJ, et al. The Revised Illness Perceptions Questionnaire (IPQ-R). Psychol Health. 2002;17(1):1–16.CrossRef
21.
22.
EuroQol Group. EuroQol–a new facility for the measurement of health-related quality of life. Health Policy. 1990;16:199–208.CrossRef
23.
Hestbaek L, Leboeuf-Yde C, Manniche C. Low back pain: what is the long term course? A review of studies of general patient populations. Eur Spine J. 2003;12:149–65.PubMedCentralPubMed
24.
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
25.
Suri P, Rainville J, Hunter DJ, Li L, Katz JN. Recurrence of radicular pain or back pain after nonsurgical treatment of symptomatic lumbar disc herniation. Arch Phys Med Rehabil. 2012;93:690–5.CrossRefPubMed
26.
Haugen AJ, Grovle L, Brox JI, Natvig B, Keller A, Soldal D, et al. Estimates of success in patients with sciatica due to lumbar disc herniation depend upon outcome measure. Eur Spine J. 2011;20:1669–75.PubMedCentralCrossRefPubMed
27.
28.
Dworkin RH. An overview of neuropathic pain: syndromes, symptoms, signs, and several mechanisms. Clin J Pain. 2002;18(6):343–9.CrossRefPubMed
29.
Stacey BR. Management of peripheral neuropathic pain. Am J Phys Med Rehabil. 2005;84 Suppl 3:4–16.
30.
Bouhassira D, Attal N. Diagnosis and assessment of neuropathic pain: the saga of clinical tools. Pain. 2011;152 Suppl 3:74–83.CrossRef
31.
Beith ID, Kemp A, Kenyon J, Prout M, Chestnut TJ. Identifying neuropathic back and leg pain: a cross-sectional study. Pain. 2011;152(7):1511–16.CrossRefPubMed
32.
Mahn F, Hüllemann P, Gockel U, Brosz M, Freynhagen R, Tolle TR, et al. Sensory symptom profiles and co-morbidities in painful radiculopathy. PLoS One. 2011;6(5):e18018.PubMedCentralCrossRefPubMed
33.
Hill JC, Whitehurst DG, Lewis M, Bryan S, Dunn KM, Foster NE, et al. Comparison of stratified primary care management for low back pain with current best practice (STarT Back): a randomised controlled trial. Lancet. 2011;378:1560–71.PubMedCentralCrossRefPubMed
34.
Lamb SE, Lall R, Hansen Z, Castelnuovo E, Withers EJ, Nichols V, et al. A multi-centred randomized controlled trial of a primary care-based cognitive behavioural programme for low back pain. The Back Skills Training (BeST) trial. Health Technol Assess. 2010;14:1–253.CrossRefPubMed
35.
Peul WC, van Houwelingen H, van den Hout WB, Brand R, Eekhof JAH, Tans JTJ, et al. Surgery versus prolonged conservative treatment for sciatica. N Engl J Med. 2007;356:2245–56.CrossRefPubMed
36.
Selim AJ, Ren XS, Fincke G, Deyo RA, Rogers N, Miller D, et al. The importance of radiating leg pain in assessing health outcomes among patients with low back pain. Results from the Veterans Health Study. Spine. 1998;23:470–4.CrossRefPubMed
37.
BenDebba M, Torgerson WS, Long DM. A validated, practical classification procedure for many persistent low back pain patients. Pain. 2000;87:89–97.CrossRefPubMed
38.
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
39.
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.
40.
Jordan KP, Kadam UT, Hayward R, Porcheret M, Young C, Croft P. Annual consultation prevalence of regional musculoskeletal problems in primary care: an observational study. BMC Musculoskelet Disord. 2010;11:144.PubMedCentralCrossRefPubMed
41.
Konstantinou K, Dunn KM. Sciatica. Review of epidemiological studies and prevalence estimates. Spine. 2008;33:2464–72.CrossRefPubMed
Metadata
Title
Characteristics of patients with low back and leg pain seeking treatment in primary care: baseline results from the ATLAS cohort study
Authors
Kika Konstantinou
Kate M. Dunn
Reuben Ogollah
Steven Vogel
Elaine M. Hay
On the behalf of the ATLAS study research team
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2015
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-015-0787-8

Other articles of this Issue 1/2015

BMC Musculoskeletal Disorders 1/2015 Go to the issue

Research article

How accurate is anatomic limb alignment in predicting mechanical limb alignment after total knee arthroplasty?

Research article

Is the state of health of rheumatoid arthritis patients receiving adequate treatment, predictable? - Results of a survey

Study protocol

Comparison of tonic spinal cord stimulation, high-frequency and burst stimulation in patients with complex regional pain syndrome: a double-blind, randomised placebo controlled trial

Research article

Validation of the German version of the STarT-Back Tool (STarT-G): a cohort study with patients from primary care practices

Case report

Bilateral diaphyseal bone cysts of the tibia mimicking shin splints in a young professional athlete—a case report and depiction of a less-invasive surgical technique

Erratum

Erratum to: Internet based patient education improves informed consent for elective orthopaedic surgery: a randomized controlled trial