title: Obesity is associated with more disability at presentation and after treatment in low back pain but not in neck pain: findings from the OIOC registry.
abstract: BACKGROUND
  The influence on the treatment response in patients with low back pain (LBP) and neck pain (NP) is unknown. The aim of the study was to investigate the influence of body weight in patients with low back pain (LBP) and neck pain (NP) on baseline and end of treatment disability.
  
  
  METHODS
  Cross-sectional analysis of baseline factors. Longitudinal analysis of prospectively collected patient information at an outpatient physical therapy registry (data from June 2010 to December 2012). WHO-BMI classification was used: underweight, lean, overweight, obesity class I, obesity class II and III. The influence of body weight and a predefined set of confounders was analyzed by multiple regression models.
  
  
  RESULTS
  In LBP, disability increased with increasing BMI [lean = reference, obesity class I Beta 5.41 (95 % CI 0.75; 10.07), obesity class II-III Beta 7.58 (95 % CI 2.13; 13.03)]. Compared to lean patients, disability after treatment improved in overweight subjects [Beta -3.90 (95 % CI -7.4; -0.41)] but not in subjects with obesity class II-III [Beta 3.43 (95 % CI -3.81; 10.68)]. There were insufficient patients in the sample with severe obesity and therefore this trend has to be confirmed. The likelihood for meaningful important change (MID) was similar in all BMI subgroups. For patients with NP, BMI was not associated with baseline disability, and did not predict end of treatment disability or the likelihood of a MID. These findings must be interpreted with caution as BMI subgroups did not meet the required sample size.
  
  
  CONCLUSIONS
  Overweight and obesity are associated with higher levels of disability before treatment in LBP patients, but not in NP. In severely obese patients class II-III with LBP the rate of MID was lowest indicating that these patients experienced the least treatment response compared to the other groups. Further studies should address the impact of severe obesity on the prognosis of LBP. In patients with LBP, severe obesity may be an important factor to consider during the physical therapy treatment. In particular, combined treatment strategies combining weight management, cardiovascular fitness, and low back pain rehabilitation should be investigated.
authors.affiliation: Horten Centre for Patient Oriented Research and Knowledge Transfer, Department of Internal Medicine, Zurich University, University Hospital Zurich, Pestalozzistrasse 24, CH-8032, Zurich, Switzerland. Maria.Wertli@insel.ch.|NYU Hospital for Joint Diseases, Occupational and Industrial Orthopaedic Center (OIOC), New York University, 63 Downing Street, New York, NY, 10014, USA. Maria.Wertli@insel.ch.|Division of General Internal Medicine, Bern University Hospital, Bern University, Freiburgstrasse 8, CH-3010, Bern, Switzerland. Maria.Wertli@insel.ch.
authors.forename: Maria M
authors.initials: MM
authors.lastname: Wertli
authors.affiliation: Horten Centre for Patient Oriented Research and Knowledge Transfer, Department of Internal Medicine, Zurich University, University Hospital Zurich, Pestalozzistrasse 24, CH-8032, Zurich, Switzerland.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Held
authors.affiliation: NYU Hospital for Joint Diseases, Occupational and Industrial Orthopaedic Center (OIOC), New York University, 63 Downing Street, New York, NY, 10014, USA.
authors.forename: Marco
authors.initials: M
authors.lastname: Campello
authors.affiliation: NYU Hospital for Joint Diseases, Occupational and Industrial Orthopaedic Center (OIOC), New York University, 63 Downing Street, New York, NY, 10014, USA.
authors.forename: Shira
authors.initials: S
authors.lastname: Schecter Weiner
mesh_terms: D000328:Adult; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D009765:Obesity / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D010147:Pain Measurement; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index; D013557:Switzerland; D016896:Treatment Outcome