Pain location matters: the impact of leg pain on health care use, work disability and quality of life in patients with low back pain.
OBJECTIVE
In low back pain (LBP) patients, those with radiating leg pain or sciatica have poorer pain and disability outcomes. Few studies have assessed the effect of leg pain on health care use and quality of life.


METHODS
Prospective cohort study of 1,581 UK LBP primary care consulters. Back pain, employment, health care utilisation, and quality of life (EQ-5D) data were collected at baseline, 6 and 12 months. At baseline, patients were classified as reporting (1) LBP only, (2) LBP and leg pain above the knee only (LBP + AK) or (3) LBP and leg pain extending below the knee (LBP + BK).


RESULTS
Self-reported leg pain was common; at baseline 645 (41 %) reported LBP only, 392 (25 %) reported LBP + AK and 544 (34 %) reported LBP + BK. Patients with LBP + BK, compared to those with LBP only, were significantly more likely to be unemployed, take time off work, consult their family doctor, receive physical therapy, or be referred to other health care practitioners. There were statistically significant decrements in EQ-5D scores for LBP + AK compared to LBP only, and for LBP + BK compared to LBP + AK (p ≤ 0.05 for all comparisons).


CONCLUSIONS
Patients with self-reported leg pain below the knee utilise more health care are more likely to be unemployed and have poorer quality of life than those with LBP only 12 months following primary care consultation. The presence of leg pain warrants early identification in primary care to explore if targeted interventions can reduce the impact and consequences of leg pain.
Arthritis Research UK Primary Care Centre, Keele University, Keele, Staffordshire, ST5 5BG, UK, s.hider@keele.ac.uk.
Samantha L
SL
Hider
David G T
DG
Whitehurst
Elaine
E
Thomas
Nadine E
NE
Foster
D000293:Adolescent; D000328:Adult; D004651:Employment; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000150:complications* / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011788:Quality of Life; D012585:Sciatica / Q000150:complications* / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D057566:Self Report; D006113:United Kingdom; D014938:Work Capacity Evaluation; D055815:Young Adult