title: Patients with low back pain differ from those who also have leg pain or signs of nerve root involvement - a cross-sectional study.
abstract: BACKGROUND
  Leg pain associated with low back pain (LBP) is recognized as a risk factor for a poor prognosis, and is included as a component in most LBP classification systems. The location of leg pain relative to the knee and the presence of a positive straight leg raise test have been suggested to have clinical implications. To understand differences between such leg pain subgroups, and whether differences include potentially modifiable characteristics, the purpose of this paper was to describe characteristics of patients classified into the Quebec Task Force (QTF) subgroups of: 1) LBP only, 2) LBP and pain above the knee, 3) LBP and pain below the knee, and 4) LBP and signs of nerve root involvement.
  
  
  METHODS
  Analysis of routine clinical data from an outpatient department. Based on patient reported data and clinical findings, patients were allocated to the QTF subgroups and described according to the domains of pain, activity limitation, work participation, psychology, general health and clinical examination findings.
  
  
  RESULTS
  A total of 2,673 patients aged 18-95 years (median 47) who were referred for assessment of LBP were included. Increasing severity was consistently observed across the subgroups from LBP only to LBP with signs of nerve root involvement although subgroup differences were small. LBP patients with leg pain differed from those with LBP only on a wide variety of parameters, and patients with signs of nerve root involvement had a more severe profile on almost all measures compared with other patients with back-related leg pain.
  
  
  CONCLUSIONS
  LBP patients with pain referral to the legs were more severely affected than those with local LBP, and patients with signs of nerve root involvement were the ones most severily affected. These findings underpin the concurrent validity of the Quebec Task Force Classification. However, the small size of many between-subgroup differences amid the large variability in this sample of cross-sectional data also underlines that the heterogeneity of patients with LBP is more complex than that which can be explained by leg pain patterns alone. The implications of the observed differences also require investigation in longitudinal studies.
authors.affiliation: Research Department, The Spine Centre of Southern Denmark, Hospital Lillebaelt, Institute of Regional Health Services Research, University of Southern Denmark, Clinical Locomotion Science Network, Middelfart, Denmark. a.kongsted@nikkb.dk
authors.forename: Alice
authors.initials: A
authors.lastname: Kongsted
authors.forename: Peter
authors.initials: P
authors.lastname: Kent
authors.forename: Hanne
authors.initials: H
authors.lastname: Albert
authors.forename: Tue Secher
authors.initials: TS
authors.lastname: Jensen
authors.forename: Claus
authors.initials: C
authors.lastname: Manniche
mesh_terms: D000041:Absenteeism; D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D006304:Health Status; D006801:Humans; D007866:Leg / Q000503:physiopathology*; D017116:Low Back Pain / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D010147:Pain Measurement; D011237:Predictive Value of Tests; D011379:Prognosis; D011843:Radiculopathy / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D012017:Referral and Consultation; D012720:Severity of Illness Index; D018582:Sick Leave; D013126:Spinal Nerve Roots / Q000503:physiopathology*; D055815:Young Adult