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Exploring factors influencing low back pain in people with non-dysvascular lower limb amputation: a national survey.

Exploring factors influencing low back pain in people with non-dysvascular lower limb amputation: a national survey.
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Devan H, Hendrick P, Hale L, Carman A, Dillon MP, Ribeiro DC,


Devan H, Hendrick P, Hale L, Carman A, Dillon MP, Ribeiro DC, (click to view)

Devan H, Hendrick P, Hale L, Carman A, Dillon MP, Ribeiro DC,

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PM & R : the journal of injury, function, and rehabilitation 2017 02 15() pii S1934-1482(17)30175-2
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 presence and intensity of low back pain (LBP) in persons with non-dysvascular transfemoral (TFA) and transtibial amputation (TTA).

DESIGN
A retrospective cross-sectional survey SETTING: A national random sample of people with non-dysvascular TFA and TTA.

PARTICIPANTS
Participants (N = 526) with unilateral TFA and TTA due to non-dysvascular aetiology (i.e. trauma, tumours, and congenital causes) and a minimum prosthesis usage of one 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.

METHODS
(Independent variables): Personal (i.e. age, body mass, gender, work status, and presence of comorbid conditions), amputee-specific (i.e. level of amputation, years of prosthesis use, presence of phantom limb pain, residual limb problems, and non-amputated limb pain), and physical factors (i.e. pain provoking postures including standing, bending, lifting, walking, sitting, sit-to-stand, and climbing stairs). Main outcome measures (Dependent variables): LBP presence and intensity.

RESULTS
A multivariate logistic regression model showed that the presence of two 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 (beta = 0.21, p = .01), and experiencing LBP symptoms during sit-to-stand task (beta = 0.22, p = .03) were positively associated with LBP intensity, while being employed demonstrated a negative association (beta = - 0.18, p = .03) in the multivariate linear regression model. CONCLUSIONS
Rehabilitation professionals should be cognisant of the influence that comorbid conditions, residual limb problems, and phantom pain have on the presence of LBP in people with non-dysvascular lower limb amputation. Further prospective studies could investigate the underlying causal mechanisms of LBP.

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