title: Low back pain in adolescents: is quality of life poorer in those seeking medical attention?
abstract: METHODS
  Paired case-control study.
  
  
  OBJECTIVE
  To assess health-related quality of life (HRQOL) and disability in adolescents with low back pain (LBP) referred to a hospital and compare it with adolescents with and without LBP from the general population.
  
  
  BACKGROUND
  Recent studies show that the effect of LBP on HRQOL of adolescents from the general population is insignificant. Poorer HRQOL is attributed to those soliciting specialized medical attention. No study has evaluated HRQOL in adolescents with LBP who seek specialized attention.
  
  
  METHODS
  All consecutive adolescents with nonspecific LBP referred to a hospital outpatient clinic (cases-patients) between January 2006 and October 2007 were compared to two control groups: adolescents with LBP and adolescents without LBP from a representative sample of students. Two controls from each group were randomly paired with each case by city of residence, sex, and age. Cases and controls completed the same self-administered questionnaires, including a generic quality-of-life (KIDSCREEN-52) and two LBP-specific (Roland-Morris Disability Questionnaire, Hannover Functional Ability Questionnaire) instruments. A group of teenagers with juvenile idiopathic arthritis completing the same questionnaire was used as external reference. The sample was calculated to detect a difference of more than 4.68 units in KIDSCREEN scores. Comparisons were made using t tests and effect size estimation.
  
  
  RESULTS
  Patients (n = 76) had more frequent (P = 0.005) and intense (P < 0.001) LBP than adolescents with LBP in the general population (n = 152) and a poorer score on the Roland-Morris (5.5 vs. 4.3, P = .023) and Hanover (4.5 vs. 3.5, P = 0.032) questionnaires. Nonetheless, in all KIDSCREEN dimensions, patient scores and scores of adolescents with juvenile idiopathic arthritis were similar or better than those of the general adolescent population with or without LBP (n = 152).
  
  
  CONCLUSIONS
  Adolescents with LBP seeking specialized medical attention have better HRQOL than symptomatic peers from the general population but report worse clinical and functional status.
authors.affiliation: Paediatric Orthopaedic Unit, Hospital Universitari Vall d'Hebron and Universitat Autònoma de Barcelona (UAB), Spain.
authors.forename: Cesar G
authors.initials: CG
authors.lastname: Fontecha
authors.forename: Federico
authors.initials: F
authors.lastname: Balagué
authors.forename: Ferran
authors.initials: F
authors.lastname: Pellisé
authors.forename: Luis
authors.initials: L
authors.lastname: Rajmil
authors.forename: Mario
authors.initials: M
authors.lastname: Aguirre
authors.forename: Maribel
authors.initials: M
authors.lastname: Pasarín
authors.forename: Christine
authors.initials: C
authors.lastname: Cedraschi
authors.forename: Montse
authors.initials: M
authors.lastname: Ferrer
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D000293:Adolescent; D000367:Age Factors; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D008297:Male; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011788:Quality of Life / Q000523:psychology*; D011795:Surveys and Questionnaires