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BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2016

Open Access 01-12-2016 | Research article

Obesity is associated with more disability at presentation and after treatment in low back pain but not in neck pain: findings from the OIOC registry

Authors: Maria M. Wertli, Ulrike Held, Marco Campello, Shira Schecter Weiner

Published in: BMC Musculoskeletal Disorders | Issue 1/2016

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Abstract

Background

The influence on the treatment response in patients with low back pain (LBP) and neck pain (NP) is unknown. The aim of the study was to investigate the influence of body weight in patients with low back pain (LBP) and neck pain (NP) on baseline and end of treatment disability.

Methods

Cross-sectional analysis of baseline factors. Longitudinal analysis of prospectively collected patient information at an outpatient physical therapy registry (data from June 2010 to December 2012). WHO-BMI classification was used: underweight, lean, overweight, obesity class I, obesity class II and III. The influence of body weight and a predefined set of confounders was analyzed by multiple regression models.

Results

In LBP, disability increased with increasing BMI [lean = reference, obesity class I Beta 5.41 (95 % CI 0.75; 10.07), obesity class II-III Beta 7.58 (95 % CI 2.13; 13.03)]. Compared to lean patients, disability after treatment improved in overweight subjects [Beta −3.90 (95 % CI −7.4; −0.41)] but not in subjects with obesity class II–III [Beta 3.43 (95 % CI −3.81; 10.68)]. There were insufficient patients in the sample with severe obesity and therefore this trend has to be confirmed. The likelihood for meaningful important change (MID) was similar in all BMI subgroups. For patients with NP, BMI was not associated with baseline disability, and did not predict end of treatment disability or the likelihood of a MID. These findings must be interpreted with caution as BMI subgroups did not meet the required sample size.

Conclusion

Overweight and obesity are associated with higher levels of disability before treatment in LBP patients, but not in NP. In severely obese patients class II–III with LBP the rate of MID was lowest indicating that these patients experienced the least treatment response compared to the other groups. Further studies should address the impact of severe obesity on the prognosis of LBP. In patients with LBP, severe obesity may be an important factor to consider during the physical therapy treatment. In particular, combined treatment strategies combining weight management, cardiovascular fitness, and low back pain rehabilitation should be investigated.
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Literature
1.
Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999-2008. JAMA. 2010;303(3):235–41.CrossRefPubMed
2.
Ricci JA, Chee E. Lost productive time associated with excess weight in the U.S. workforce. J Occup Environ Med. 2005;47(12):1227–34.CrossRefPubMed
3.
Capodaglio P, Castelnuovo G, Brunani A, Vismara L, Villa V, Capodaglio EM. Functional limitations and occupational issues in obesity: a review. Int J Occup Saf Ergon. 2010;16(4):507–23.CrossRefPubMed
4.
Vismara L, Menegoni F, Zaina F, Galli M, Negrini S, Capodaglio P. Effect of obesity and low back pain on spinal mobility: a cross sectional study in women. J Neuroeng Rehabil. 2010;7:3.CrossRefPubMedPubMedCentral
5.
Mantyselka P, Kautiainen H, Vanhala M. Prevalence of neck pain in subjects with metabolic syndrome--a cross-sectional population-based study. BMC Musculoskelet Disord. 2010;11:171.CrossRefPubMedPubMedCentral
6.
Ma VY, Chan L, Carruthers KJ. Incidence, prevalence, costs, and impact on disability of common conditions requiring rehabilitation in the United States: stroke, spinal cord injury, traumatic brain injury, multiple sclerosis, osteoarthritis, rheumatoid arthritis, limb loss, and back pain. Arch Phys Med Rehabil. 2014;95(5):986–95. e981.CrossRefPubMedPubMedCentral
7.
8.
Hogg-Johnson S, van der Velde G, Carroll LJ, Holm LW, Cassidy JD, Guzman J, Côté P, Haldeman S, Ammendolia C, Carragee E et al: The burden and determinants of neck pain in the general population: results of the bone and joint decade 2000–2010 Task Force on neck pain and its associated disorders. J Manipulative Physiol Ther. 2009;32(2, Supplement):S46–60.
9.
Carroll L, Hogg Johnson S, Côté P, van der Velde G, Holm L, Carragee E, Hurwitz E, Peloso P, Cassidy JD, Guzman J et al: Course and prognostic factors for neck pain in workers: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine (Philadelphia, Pa 1976). 2008;33(4 Suppl):S93–100.
10.
Carroll L, Hogg Johnson S, van der Velde G, Haldeman S, Holm L, Carragee E, Hurwitz E, CÃtà P, Nordin M, Peloso P et al: Course and prognostic factors for neck pain in the general population: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine (Philadelphia, Pa 1976). 2008;33(4 Suppl):S75–82.
11.
Chou R, Loeser JD, Owens DK, Rosenquist RW, Atlas SJ, Baisden J, Carragee EJ, Grabois M, Murphy DR, Resnick DK et al: Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. Spine. 2009;34(10):1066–77.
12.
Hurwitz EL, Carragee EJ, van der Velde G, Carroll LJ, Nordin M, Guzman J, Peloso PM, Holm LW, Cote P, Hogg-Johnson S et al: Treatment of neck pain: noninvasive interventions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine. 2008;33(4 Suppl):S123–52.
13.
Hill J, Whitehurst DGT, Lewis M, Bryan S, Dunn K, Foster N, Konstantinou K, Main C, Mason E, Somerville S 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(9802):1560–71.
14.
Pransky G, Borkan JM, Young AE, Cherkin DC. Are we making progress? The tenth international forum for primary care research on low back pain. Spine. 2011;36(19):1608–14.CrossRefPubMed
15.
Bener A, Alwash R, Gaber T, Lovasz G. Obesity and low back pain. Collegium Antropologicum. 2003;27(1):95–104.PubMed
16.
Anandacoomarasamy A, Caterson I, Sambrook P, Fransen M, March L. The impact of obesity on the musculoskeletal system. Int J obesity (2005). 2008;32(2):211–22.CrossRef
17.
Auffinger B, Lam S, Kraninger J, Shen J, Roitberg BZ: The Impact of Obesity on Surgeon Ratings and Patient-Reported Outcome Measures After Degenerative Cervical Spine Disease Surgery. World Neurosurg. 2014;82(1-2):e345-52. doi:10.​1016/​j.​wneu.​2013.​09.​053. Epub 2013 Oct 18.
18.
Perrot S, Allaert FA, Concas V, Laroche F. “When will I recover?” A national survey on patients’ and physicians’ expectations concerning the recovery time for acute back pain. Eur Spine J. 2009;18(3):419–29.CrossRefPubMedPubMedCentral
19.
Shiri R, Karppinen J, Leino-Arjas P, Solovieva S, Viikari-Juntura E. The association between obesity and low back pain: a meta-analysis. Am J Epidemiol. 2010;171(2):135–54.CrossRefPubMed
20.
Dionne CE, Koepsell TD, Von Korff M, Deyo RA, Barlow WE, Checkoway H. Predicting long-term functional limitations among back pain patients in primary care settings. J Clin Epidemiol. 1997;50(1):31–43.CrossRefPubMed
21.
Wertli MM, Burgstaller JM, Weiser S, Steurer J, Kofmehl R, Held U. Influence of catastrophizing on treatment outcome in patients with nonspecific low back pain: a systematic review. Spine. 2014;39(3):263–73.CrossRefPubMed
22.
Wertli MM, Rasmussen-Barr E, Held U, Weiser S, Bachmann LM, Brunner F: Fear-avoidance beliefs-a moderator of treatment efficacy in patients with low back pain: a systematic review. Spine J. 2014;14(11):2658-78. doi:10.​1016/​j.​spinee.​2014.​02.​033. Epub 2014 Mar 12.
23.
Leboeuf-Yde C. Body weight and low back pain. A systematic literature review of 56 journal articles reporting on 65 epidemiologic studies. Spine. 2000;25(2):226–37.CrossRefPubMed
24.
Sellinger JJ, Clark EA, Shulman M, Rosenberger PH, Heapy AA, Kerns RD. The moderating effect of obesity on cognitive-behavioral pain treatment outcomes. Pain Med. 2010;11(9):1381–90.CrossRefPubMed
25.
Vincent HK, Omli MR, Day T, Hodges M, Vincent KR, George SZ. Fear of movement, quality of life, and self-reported disability in obese patients with chronic lumbar pain. Pain Med. 2011;12(1):154–64.CrossRefPubMed
26.
Malmqvist S, Leboeuf-Yde C, Ahola T, Andersson O, Ekstrom K, Pekkarinen H, et al. The Nordic back pain subpopulation program: predicting outcome among chiropractic patients in Finland. Chiropr Osteopath. 2008;16:13.CrossRef
27.
Macfarlane GJ, Thomas E, Croft PR, Papageorgiou AC, Jayson MI, Silman AJ. Predictors of early improvement in low back pain amongst consulters to general practice: the influence of pre-morbid and episode-related factors. Pain. 1999;80(1-2):113–9.CrossRefPubMed
28.
Lis A, Weiser S, Campello MA, Hiebert R, Nordin M. Development of a conservative care registry for patients with spine pain. Spine J. 2012;12(9):S55–6.CrossRef
29.
vvon Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, Initiative S: Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007;335(7624):806–8.
30.
Pincus T, Santos R, Breen A, Burton AK, Underwood M. A review and proposal for a core set of factors for prospective cohorts in low back pain: A consensus statement. Arthritis Care Res (Hoboken). 2008;59(1):14–24.CrossRef
31.
32.
33.
Chou R, Qaseem A, Snow V, Casey D, Cross JT, Shekelle P, Owens D: Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147(7):478–91.
34.
Fritz JM, Irrgang JJ. A comparison of a modified oswestry low back pain disability questionnaire and the quebec back pain disability scale. Phys Ther. 2001;81(2):776–88.PubMed
35.
Howard V. The neck disability index: State-of-the-Art, 1991-2008. J Manip Physiol Ther. 2008;31(7):491–502.CrossRef
36.
Ostelo RW, Deyo RA, Stratford P, Waddell G, Croft P, Von Korff M, Bouter LM, de Vet HC: Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change. Spine. 2008;33(1):90–4.
37.
38.
Hoy D, Brooks P, Blyth F, Buchbinder R. The Epidemiology of low back pain. Best Practice Res Clin Rheumatol. 2010;24(6):769–81.CrossRef
39.
40.
Waddell G, Newton M, Henderson I, Somerville D, Main CJ. A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain. 1993;52(2):157–68.CrossRefPubMed
41.
Wertli MM, Rasmussen-Barr E, Weiser S, Bachmann LM, Brunner F. The role of fear avoidance beliefs as a prognostic factor for outcome in patients with nonspecific low back pain: a systematic review. Spine J. 2014;14(5):816–36. e814.CrossRefPubMed
42.
Rothman KJ, Greenland S, Lash TL. Introduction to stratified analysis. In: Sonya S, editor. Modern epidemiology, vol. 1. Third Editionth ed. Philadelphia, PA 19106 USA: Lippincott William & Wilkins; 2008. p. 258–82.
43.
44.
Mangwani J, Giles C, Mullins M, Salih T, Natali C. Obesity and recovery from low back pain: a prospective study to investigate the effect of body mass index on recovery from low back pain. Ann R Coll Surg Engl. 2010;92(1):23–6.CrossRefPubMedPubMedCentral
45.
Cuesta-Vargas AI, Gonzalez-Sanchez M. Obesity effect on a multimodal physiotherapy program for low back pain suffers: patient reported outcome. J Occup Med Toxicol (London, England). 2013;8(1):13.CrossRef
46.
Vincent HK, Ben-David K, Conrad BP, Lamb KM, Seay AN, Vincent KR. Rapid changes in gait, musculoskeletal pain, and quality of life after bariatric surgery. Surg Obes Relat Dis. 2012;8(3):346–54.CrossRefPubMed
47.
Khoueir P, Black MH, Crookes PF, Kaufman HS, Katkhouda N, Wang MY. Prospective assessment of axial back pain symptoms before and after bariatric weight reduction surgery. Spine J. 2009;9(6):454–63.CrossRefPubMed
48.
Rejeski WJ, Ip E, Bertoni A, Bray G, Evans G, Gregg E, Zhang Q: Lifestyle change and mobility in obese adults with type 2 diabetes. N Engl J Med. 2012;366(13):1209–17.
49.
Urquhart DM, Berry P, Wluka AE, Strauss BJ, Wang Y, Proietto J, Jones G, Dixon JB, Cicuttini FM: 2011 Young Investigator Award winner: Increased fat mass is associated with high levels of low back pain intensity and disability. Spine. 2011;36(16):1320–5.
50.
Wong JJ, Côté P, Quesnele JJ, Stern PJ, Mior SA. The course and prognostic factors of symptomatic cervical disc herniation with radiculopathy: a systematic review of the literature. Spine J. 2014;14(8):1781–9.CrossRefPubMed
51.
Rasmussen Barr E, Bohman T, Hallqvist J, Holm LW, Skillgate E. Do physical activity level and body mass index predict recovery from persistent neck pain in men and women of working age? A population-based cohort study. Eur Spine J. 2013;22(9):2077–83.CrossRefPubMedPubMedCentral
52.
Murton AJ, Marimuthu K, Mallinson JE, Selby AL, Smith K, Rennie MJ, Greenhaff PL: Obesity appears to be associated with altered muscle protein synthetic and breakdown responses to increased nutrient delivery in older men, but not reduced muscle mass or contractile function. Diabetes. 2015;64(9):3160-71. doi:10.​2337/​db15-0021. Epub 2015 May 26.
53.
Murton AJ, Marimuthu K, Mallinson JE, Selby AL, Smith K, Rennie MJ, Greenhaff PL: Edmonton Obesity Staging System: association with weight history and mortality risk. Appl Physiol Nutr Metab. 2011;36(4):570–6.
54.
Abdullah A, Wolfe R, Mannan H, Stoelwinder JU, Stevenson C, Peeters A. Epidemiologic merit of obese-years, the combination of degree and duration of obesity. Am J Epidemiol. 2012;176(2):99–107.CrossRefPubMed
55.
Cakir T, Oruc MT, Aslaner A, Duygun F, Yardimci EC, Mayir B, Bulbuller N: The effects of laparoscopic sleeve gastrectomy on head, neck, shoulder, low back and knee pain of female patients. Int J Clin Exp Med. 2015;8(2):2668–73.
Metadata
Title
Obesity is associated with more disability at presentation and after treatment in low back pain but not in neck pain: findings from the OIOC registry
Authors
Maria M. Wertli
Ulrike Held
Marco Campello
Shira Schecter Weiner
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2016
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-016-0992-0

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