Francisco M Kovacs1,2, Jesús Seco3,4, Ana Royuela3,5, Andrés Barriga3,6, Javier Zamora3,7,8,9. 1. Unidad de la Espalda Kovacs, Hospital Universitario HLA-Moncloa. 81, Avda. Valladolid, 28008, Madrid, Spain. fmkovacs@kovacs.org. 2. Spanish Back Pain Research Network, Madrid, Spain. fmkovacs@kovacs.org. 3. Spanish Back Pain Research Network, Madrid, Spain. 4. Institute of Biomedicine (IBIOMED), University of León, University of the Basque Country, Campus Universitario, 24071, León, Spain. 5. Clinical Biostatistics Unit, Puerta de Hierro University Hospital, Instituto de Investigación Puerta de Hierro (IDIPHIM), Madrid, Spain. 6. Orthopedic Surgery Department, National Hospital for Paraplegics, University Castilla-La Mancha, Finca La Peraleda s/n, 45071, Toledo, Spain. 7. Unidad de Bioestadística Clínica, Hospital Ramón y Cajal, IRYCIS, Ctra. Colmenar Km 9.1, 28034, Madrid, Spain. 8. Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK. 9. CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain.
Abstract
STUDY DESIGN: Cross-sectional study. OBJECTIVES: To determine the prevalence of, and factors associated with, spinal pain among wheelchair users. SETTING: Four Spanish hospitals specialized in providing care for wheelchair users. METHODS: Persons who had used a wheelchair for a median (IRQ) of 10 (5;19) years, 27% of them due to reasons other than spinal cord injury, were recruited consecutively (n = 750). Data on 43 demographic, psychosocial, ergonomic, and clinical variables were collected, and analyzed. Main outcome measures were: point prevalence of neck (NP), thoracic (TP), low back pain (LBP), and pain at any spinal level (PASL); and factors associated with them. RESULTS: Point prevalence was 56% for NP, 54% for TP, 45% for LBP, and 76% for PSAL. PASL was associated with a lower quality of life (OR (95% CI) 0.91 (0.86; 0.97)). Multivariable regression models showed that the main factors associated with significant pain (≥1.5 VAS points) were: (a) For NP: cervical spinal injury and wheelchair seat cushion thickness, (b) For TP: thoracic spinal injury and sagittal index, (c) For LBP: thoracic or lumbar spinal injury, with some sensitivity remaining, (d) For PASL: being female, living alone, and using a non-power wheelchair. Discrimination (AUC) of these models ranged between 0.638 and 0.818. p-values in the Hosmer-Lemeshow test ranged between 0.420 and 0.701. CONCLUSIONS: Prevalence of spinal pain among wheelchair users is high. It is associated with a lower quality of life. Future studies should assess whether using a power wheelchair affects PASL, and if the thickness of seat cushion affects NP. SPONSORSHIP: Spanish Back Pain Research Network.
STUDY DESIGN: Cross-sectional study. OBJECTIVES: To determine the prevalence of, and factors associated with, spinal pain among wheelchair users. SETTING: Four Spanish hospitals specialized in providing care for wheelchair users. METHODS:Persons who had used a wheelchair for a median (IRQ) of 10 (5;19) years, 27% of them due to reasons other than spinal cord injury, were recruited consecutively (n = 750). Data on 43 demographic, psychosocial, ergonomic, and clinical variables were collected, and analyzed. Main outcome measures were: point prevalence of neck (NP), thoracic (TP), low back pain (LBP), and pain at any spinal level (PASL); and factors associated with them. RESULTS: Point prevalence was 56% for NP, 54% for TP, 45% for LBP, and 76% for PSAL. PASL was associated with a lower quality of life (OR (95% CI) 0.91 (0.86; 0.97)). Multivariable regression models showed that the main factors associated with significant pain (≥1.5 VAS points) were: (a) For NP: cervical spinal injury and wheelchair seat cushion thickness, (b) For TP: thoracic spinal injury and sagittal index, (c) For LBP: thoracic or lumbar spinal injury, with some sensitivity remaining, (d) For PASL: being female, living alone, and using a non-power wheelchair. Discrimination (AUC) of these models ranged between 0.638 and 0.818. p-values in the Hosmer-Lemeshow test ranged between 0.420 and 0.701. CONCLUSIONS: Prevalence of spinal pain among wheelchair users is high. It is associated with a lower quality of life. Future studies should assess whether using a power wheelchair affects PASL, and if the thickness of seat cushion affects NP. SPONSORSHIP: Spanish Back Pain Research Network.
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