F M Kovacs1,2, J Seco2,3,4, A Royuela2,5, J N Betegon2,6, S Sánchez-Herráez2,6, M Meli2,7, M E Martínez Rodríguez2,8, M Núñez2,9, L Álvarez-Galovich2,10, J Moyá2,11, C Sánchez2,12, S Luna2,13, P Borrego2,14, J Moix2,15, V Rodríguez-Pérez2,16, J Torres-Unda2,17, N Burgos-Alonso2,18, I Gago-Fernández2,16, Y González-Rubio2,19, V Abraira2,20. 1. Kovacs Back Pain Unit, HLA-Moncloa University Hospital, Madrid, Spain. 2. Spanish Back Pain Research Network, Palma de Mallorca, Spain. 3. Institute of Biomedicine (IBIOMED), University of León, Spain. 4. University of the Basque Country, León, Spain. 5. ClinicalBiostatisticsUnit, Puerta de Hierro University Hospital, Instituto de Investigación Puerta de Hierro (IDIPHIM), Madrid, Spain. 6. Servicio de Cirugía Ortopédica y Traumatología, Complejo Asistencial Universitario de León (CAULE), León, Spain. 7. Aliviam - Majorca PainClinic, Palma de Mallorca, Spain. 8. Servicio de Rehabilitación, Hospital Ramón y Cajal, IRICYS, Universidad de Alcalá, Madrid, Spain. 9. Servicio de Reumatología, Hospital Clínic, Barcelona, Spain. 10. Servicio de Traumatología, Patología de Columna, Fundación Jiménez Díaz, Madrid, Spain. 11. Unidad del Dolor, Hospital MateuOrfila, Mahón, Spain. 12. FisysFisioterapia, Laredo, Cantabria, Spain. 13. Centro de Salud Alburquerque, La Codosera, Badajoz, Spain. 14. Policlínica FISIOMED, Salamanca, Spain. 15. Departamento de Psicología Básica, Evolutiva y de la Educación, Universidad Autónoma de Barcelona, Bellaterra, Spain. 16. Escuela Universitaria Ciencias de la Salud, Universidad de León, Ponferrada, Spain. 17. Departamento de Fisiología, Universidad de El País Vasco (UPV/EHU), Leioa, Vizcaya, Spain. 18. Departamento de Medicina Preventiva y Salud Pública, Universidad de El País Vasco (UPV/EHU), Leioa, Vizcaya, Spain. 19. Servicio de Cirugía Ortopédica y Traumatología, Fundación Jiménez Díaz, Madrid, Spain. 20. Unidad de Bioestadística Clínica, Hospital Ramón y Cajal, IRICYS, Madrid, Spain.
Abstract
BACKGROUND: The objective of this study was to estimate the association between sleep quality (SQ) and improvements in low back pain (LBP) and disability, among patients treated for LBP in routine practice. METHODS: This prospective cohort study included 461 subacute and chronic LBP patients treated in 11 specialized centres, 14 primary care centres and eight physical therapy practices across 12 Spanish regions. LBP, leg pain, disability, catastrophizing, depression and SQ were assessed through validated questionnaires upon recruitment and 3 months later. Logistic regression models were developed to assess: (1) the association between the baseline score for SQ and improvements in LBP and disability at 3 months, and (2) the association between improvement in SQ and improvements in LBP and disability during the follow-up period. RESULTS: Seventy-three per cent of patients were subacute. Median scores at baseline were four points for both pain and disability, as assessed with a visual analog scale and the Roland-Morris Questionnaire, respectively. Regression models showed (OR [95% CI]) that baseline SQ was not associated with improvements in LBP (0.99 [0.94; 1.06]) or in disability (0.99 [0.93; 1.05]), although associations existed between 'improvement in SQ' and 'improvement in LBP' (4.34 [2.21; 8.51]), and 'improvement in SQ' and 'improvement in disability' (4.60 [2.29; 9.27]). CONCLUSIONS: Improvement in SQ is associated with improvements in LBP and in disability at 3-month follow-up, suggesting that they may reflect or be influenced by common factors. However, baseline SQ does not predict improvements in pain or disability. SIGNIFICANCE: In clinical practice, sleep quality, low back pain and disability are associated. However, sleep quality at baseline does not predict improvement in pain and disability.
BACKGROUND: The objective of this study was to estimate the association between sleep quality (SQ) and improvements in low back pain (LBP) and disability, among patients treated for LBP in routine practice. METHODS: This prospective cohort study included 461 subacute and chronic LBP patients treated in 11 specialized centres, 14 primary care centres and eight physical therapy practices across 12 Spanish regions. LBP, leg pain, disability, catastrophizing, depression and SQ were assessed through validated questionnaires upon recruitment and 3 months later. Logistic regression models were developed to assess: (1) the association between the baseline score for SQ and improvements in LBP and disability at 3 months, and (2) the association between improvement in SQ and improvements in LBP and disability during the follow-up period. RESULTS: Seventy-three per cent of patients were subacute. Median scores at baseline were four points for both pain and disability, as assessed with a visual analog scale and the Roland-Morris Questionnaire, respectively. Regression models showed (OR [95% CI]) that baseline SQ was not associated with improvements in LBP (0.99 [0.94; 1.06]) or in disability (0.99 [0.93; 1.05]), although associations existed between 'improvement in SQ' and 'improvement in LBP' (4.34 [2.21; 8.51]), and 'improvement in SQ' and 'improvement in disability' (4.60 [2.29; 9.27]). CONCLUSIONS: Improvement in SQ is associated with improvements in LBP and in disability at 3-month follow-up, suggesting that they may reflect or be influenced by common factors. However, baseline SQ does not predict improvements in pain or disability. SIGNIFICANCE: In clinical practice, sleep quality, low back pain and disability are associated. However, sleep quality at baseline does not predict improvement in pain and disability.
Authors: K E Roberts; P R Beckenkamp; M L Ferreira; G E Duncan; L Calais-Ferreira; J M Gatt; P Ferreira Journal: Eur Spine J Date: 2022-10-08 Impact factor: 2.721
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