Disability, pain, psychological factors and physical performance in healthy controls, patients with sub-acute and chronic low back pain: a case-control study.
OBJECTIVE
To compare measures of disability, psychological factors, pain and physical performance in healthy controls, and patients with sub-acute and chronic low back pain. To evaluate the concept of the deconditioning syndrome and to explore factors that may contribute to chronicity.


METHODS
Case-control study.


METHODS
Three age- and gender-matched groups were included in the study; healthy controls (n = 45), patients sick-listed 8-12 weeks (n = 46) and patients with chronic low back pain on a waiting list for lumbar instrumented fusion (n = 45).


METHODS
Measures of disability, pain, psychological factors, and physical performance were obtained from the 3 groups using validated measures.


RESULTS
Gender, age, body weight and height were not significantly different between the groups. Comparable scores were found for self-rated working ability, fear-avoidance beliefs for physical activity and aerobic capacity in the 2 patient groups. Oswestry Disability Index, pain, emotional distress, abdominal and back muscle endurance were significantly different between the 3 groups. Self-efficacy for pain and fear-avoidance beliefs for work was significantly different between the 2 patient groups.


CONCLUSIONS
The results suggest a stepwise deterioration of impairment and disability from healthy controls to patients with chronic low back pain. Most variables distinguished between healthy controls and patients with sub-acute or chronic low back pain. Deconditioning was more related to psychophysical measures of abdominal and back muscle endurance than to cardiovascular fitness. Comparable scores for fear-avoidance and working ability in the 2 patient categories suggest that these factors appear at an early stage and contribute to the transition from acute to chronic low back pain.
Brox
Jens Ivar
JI
Department of Orthopaedic Surgery, Section for Back Surgery and Physical Medicine and Rehabilitation, National Hospital, Oslo, Norway. jens.ivar.brox@rikshospitalet.no
Storheim
Kjersti
K
Holm
Inger
I
Friis
Astrid
A
Reikerås
Olav
O
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002908:Chronic Disease; D004185:Disability Evaluation; D005239:Fear; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D008875:Middle Aged; D020377:Self Efficacy; D018582:Sick Leave; D014938:Work Capacity Evaluation