title: Low back pain patients in Sweden, Denmark and the UK share similar characteristics and outcomes: a cross-national comparison of prospective cohort studies.
abstract: BACKGROUND
  Low back pain (LBP) is the world's leading cause of disability and yet poorly understood. Cross-national comparisons may motivate hypotheses about outcomes being condition-specific or related to cultural differences and can inform whether observations from one country may be generalised to another. This analysis of data from three cohort studies explored whether characteristics and outcomes differed between LBP patients visiting chiropractors in Sweden, Denmark and the UK.
  
  
  METHODS
  LBP patients completed a baseline questionnaire and were followed up after 3, 5, 12 and 26 weeks. Outcomes were LBP intensity (0-10 scales) and LBP frequency (0-7 days the previous week). Cohort differences were tested in mixed models accounting for repeated measures. It was investigated if any differences were explained by different baseline characteristics, and interaction terms between baseline factors and nations tested if strength of prognostic factors differed across countries.
  
  
  RESULTS
  The study sample consisted of 262, 947 and 453 patients from Sweden, Denmark and the UK respectively. Patient characteristics were largely similar across cohorts although some statistically significant differences were observed. The clinical course followed almost identical patterns across nations and small observed differences were not present after adjusting for baseline factors. The associations of LBP intensity and episode duration with outcome differed in strength between countries.
  
  
  CONCLUSIONS
  Chiropractic patients with low back pain had similar characteristics and clinical course across three Northern European countries. It is unlikely that culture have substantially different impacts on the course of LBP in these countries and the results support knowledge transfer between the investigated countries.
authors.affiliation: The Nordic Institute for Chiropractic and Clinical Biomechanics, Odense, Denmark. a.kongsted@nikkb.dk.|Departments of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense, M, Denmark. a.kongsted@nikkb.dk.
authors.forename: Alice
authors.initials: A
authors.lastname: Kongsted
authors.affiliation: Anglo-European College of Chiropractic, Bournemouth, UK.
authors.forename: Laura
authors.initials: L
authors.lastname: Davies
authors.affiliation: Institutet för Miljömedicin, Karolinska Institutet, Stockholm, Sweden.|Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
authors.forename: Iben
authors.initials: I
authors.lastname: Axen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D038622:Internationality; D008137:Longitudinal Studies; D017116:Low Back Pain / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D008297:Male; D026882:Manipulation, Chiropractic / Q000639:trends*; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods / Q000639:trends; D011446:Prospective Studies; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult