title: Exploring Factors Influencing Low Back Pain in People With Nondysvascular Lower Limb Amputation: A National Survey.
abstract: BACKGROUND
  Chronic low back pain (LBP) is a common musculoskeletal impairment in people with lower limb amputation. Given the multifactorial nature of LBP, exploring the factors influencing the presence and intensity of LBP is warranted.
  
  
  OBJECTIVE
  To investigate which physical, personal, and amputee-specific factors predicted the presence and intensity of LBP in persons with nondysvascular transfemoral amputation (TFA) and transtibial amputation (TTA).
  
  
  METHODS
  A retrospective cross-sectional survey.
  
  
  METHODS
  A national random sample of people with nondysvascular TFA and TTA.
  
  
  METHODS
  Participants (N = 526) with unilateral TFA and TTA due to nondysvascular etiology (ie, trauma, tumors, and congenital causes) and a minimum prosthesis use of 1 year since amputation were invited to participate in the survey. The data from 208 participants (43.4% response rate) were used for multivariate regression analysis.
  Personal (ie, age, body mass, gender, work status, and presence of comorbid conditions), amputee-specific (ie, level of amputation, years of prosthesis use, presence of phantom-limb pain, residual-limb problems, and nonamputated limb pain), and physical factors (ie, pain-provoking postures including standing, bending, lifting, walking, sitting, sit-to-stand, and climbing stairs).
  LBP presence and intensity.
  
  
  RESULTS
  A multivariate logistic regression model showed that the presence of 2 or more comorbid conditions (prevalence odds ratio [POR] = 4.34, P = .01), residual-limb problems (POR = 3.76, P < .01), and phantom-limb pain (POR = 2.46, P = .01) influenced the presence of LBP. Given the high LBP prevalence (63%) in the study, there is a tendency for overestimation of POR, and the results must be interpreted with caution. In those with LBP, the presence of residual-limb problems (β = 0.21, P = .01) and experiencing LBP symptoms during sit-to-stand task (β = 0.22, P = .03) were positively associated with LBP intensity, whereas being employed demonstrated a negative association (β = -0.18, P = .03) in the multivariate linear regression model.
  
  
  CONCLUSIONS
  Rehabilitation professionals should be cognizant of the influence that comorbid conditions, residual-limb problems, and phantom pain have on the presence of LBP in people with nondysvascular lower limb amputation. Further prospective studies could investigate the underlying causal mechanisms of LBP.
  
  
  METHODS
  II.
authors.affiliation: Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Wellington, 23 Mein St., PO Box 7343, Wellington 6021, New Zealand(∗). Electronic address: hemakumar.devan@otago.ac.nz.
authors.forename: Hemakumar
authors.initials: H
authors.lastname: Devan
authors.affiliation: Division of Physiotherapy Education, University of Nottingham, Nottingham, United Kingdom(†).
authors.forename: Paul
authors.initials: P
authors.lastname: Hendrick
authors.affiliation: Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand(‡).
authors.forename: Leigh
authors.initials: L
authors.lastname: Hale
authors.affiliation: School of Sport & Recreation, Auckland University of Technology, Auckland, New Zealand(§).
authors.forename: Allan
authors.initials: A
authors.lastname: Carman
authors.affiliation: Discipline of Prosthetics and Orthotics, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia(‖).
authors.forename: Michael P
authors.initials: MP
authors.lastname: Dillon
authors.affiliation: Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand(¶).
authors.forename: Daniel Cury
authors.initials: DC
authors.lastname: Ribeiro
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000671:Amputation, Surgical / Q000379:methods*; D000674:Amputees / Q000534:rehabilitation*; D059350:Chronic Pain / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D003430:Cross-Sectional Studies; D005260:Female; D005269:Femur / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007866:Leg / Q000601:surgery; D016015:Logistic Models; D017116:Low Back Pain / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010147:Pain Measurement; D010591:Phantom Limb / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires; D013977:Tibia / Q000601:surgery; D055815:Young Adult