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Abstract

  1. Top of page
  2. Abstract
  3. 1. Introduction
  4. 2. Methods
  5. 3. Results
  6. 4. Discussion
  7. References
  8. Supporting Information

Background

Recent studies have indicated that low back pain (LBP) is common already in adolescence, but only few studies have evaluated the factors that determine LBP-related health care use at this age.

Methods

The study population included 1987 adolescents aged 18 from the Oulu Back Study, a subcohort of the 1986 Northern Finland Birth Cohort. We used logistic regression to evaluate whether enabling resources, need factors, personal health habits or psychological problems are associated with seeking health care for LBP, among adolescents reporting LBP during the last year.

Results

Of the 1987 respondents, 50% of the females and 42% of the males reported having had LBP during the previous year. Of the 921 respondents with LBP, 89 (16%) females, and 59 (16%) males had consulted a health care professional. In both genders, pain intensity was strongly associated with seeking care [visual analogue scale (VAS) 8–10 vs. VAS 0–3; males: OR 16.6, 95% CI 3.8–72.5, females: OR 18.8 95% CI 6.3–56.1]. In addition, LBP-related daily activity limitations (impairment index 4–6 vs. 0 OR 15.7 95% CI 1.7–142.5) were associated with care seeking among males. Student status was also associated with care seeking among males (OR 2.34 95% CI 1.02–5.36).

Conclusions

Approximately one out of six adolescents with LBP seeks medical care. Intensity of pain and daily activity limitations appear to be the main determinants of seeking care for LBP in adolescence.

1. Introduction

  1. Top of page
  2. Abstract
  3. 1. Introduction
  4. 2. Methods
  5. 3. Results
  6. 4. Discussion
  7. References
  8. Supporting Information

Low back pain (LBP) is common already in adolescence (Olsen et al., 1992; Burton et al., 1996; Taimela et al., 1997; Harreby et al., 1999; Vikat et al., 2000; Hakala et al., 2002). Both the prevalence (Olsen et al., 1992; Burton et al., 1996; Taimela et al., 1997; Vikat et al., 2000; Hakala et al., 2002) and severity of LBP (Taimela et al., 1997) are age dependent in this stage of life. One-year prevalence estimates range from 7% to 51% from the age of 12 to 18 (Olsen et al., 1992; Burton et al., 1996; Taimela et al., 1997; Harreby et al., 1999; Hakala et al., 2002). However, only 7% to 16% of adolescents seek medical care for LBP (Olsen et al., 1992; Burton et al., 1996; Harreby et al., 1999).

What's already known about this topic?
  • It is known that low back pain (LBP) is common already in adolescence.
  • Both the prevalence and severity of LBP are age dependent in this stage of life.
  • However, only 7% to 16% of adolescents seek medical care for LBP, and only few studies have evaluated the determinants of care-seeking behaviour among adolescents.
What does this study add?
  • We found out that one out of six adolescents with LBP seeks medical care.
  • Intensity of pain and daily activity limitations appear to be the main determinants of seeking care for LBP in adolescence.

Only few studies have evaluated the determinants of care-seeking behaviour among adolescents. Among Italian adolescents with musculoskeletal (MS) pain, the most important factors associated with medical care seeking were pain intensity, pain lasting over 3 months, injury, interruption or absence of physical activity and localization in the spine and knee (Masiero et al., 2010). Among 12- to 16-year-old Dutch adolescents with chronic pain, participation in lower vocational training programmes, intensity of pain and female gender were the most significant predictors of physician's consultation (Perquin et al., 2000). According to a Canadian study on adolescent health care utilization for any cause, female gender, higher age, single-parent family status, lower self-rated health, higher limitations to daily activities, higher distress, social activity, obesity and smoking are associated with higher rates of physician visits (Vingilis et al., 2007). In addition, rural area residence (DeVoe et al., 2009) and emotional problems (Angel and Angel, 1996) have been shown to have an impact on the decision to seek medical care among children and adolescents.

In an earlier study of a birth cohort, we analysed care seeking due to MS pain at the age of 16. The results showed that sports club membership and other health disorders are associated with seeking care for any MS pain among both genders. In addition, a high level of physical activity and low self-rated health were associated with care seeking among females. Being physically inactive decreased the likelihood of seeking care for pain among females (Paananen et al., 2011). Unfortunately, we had no information on the intensity and frequency of MS pains in the earlier study.

This study investigated factors that associate with seeking care for LBP among adolescents at the age of 18. We used Andersen's model of health care use as a conceptual framework (Andersen and Newman, 1973; Andersen, 1995). We applied an adapted model that assumes that both patient-related factors and health care system impact on care seeking and includes four major categories of determinants: (1) enabling resources consisting of family and community characteristics, (2) need factors referring to perceived and evaluated illness, (3) personal health habits including factors related to lifestyle and (4) psychological factors. Our hypothesis was that disease-related factors (intensity of LBP, duration of LBP and LBP-related limitations to daily activities) are the strongest determinants of care seeking due to LBP.

2. Methods

  1. Top of page
  2. Abstract
  3. 1. Introduction
  4. 2. Methods
  5. 3. Results
  6. 4. Discussion
  7. References
  8. Supporting Information

2.1 Study population

The study population belongs to the 1986 Northern Finland Birth Cohort (NFBC 1986), which includes data from birth onwards on children with expected date of birth in Northern Finland between 1 July 1985 and 30 June 1986 (n = 9479). The current study population (Oulu Back Study, OBS) is a subcohort of the NFBC 1986, and consists of all cohort members living within 100 km from the city of Oulu (n = 2969). The data were collected between September 2003 and June 2004 when the cohort members were on average 18 years old. The OBS adolescents received a postal questionnaire that included items on LBP, lifestyle, body weight and height, and psychological problems. The response rate was 67% (1987 adolescents out of 2969). The study protocol was approved by the institutional Ethics Committee of Oulu University Hospital. All participants provided informed written consent.

2.2 Outcome variable

The outcome variable was defined as the need to consult a physician for LBP in the past year. The question concerning LBP was ‘Have you suffered from low back pain (1) during the past year? (2) during the past month? (3) during the past week? (4) today?’ Adolescents who did not report LBP during the past year were excluded from the analysis. The need to consult a physician was elicited using the question ‘Have you visited a physician because of your LBP? The answer options were ‘no’ and ‘yes’. The reference group of the analysis comprised adolescents who had experienced LBP but not visited a physician.

2.3 Enabling resources

Enabling resources include the following determinants: membership of a sports club, own educational status, father's socio-economic position and place of residence. Membership of a sports club was considered an enabling resource, as participating in competitive sports in Finland usually requires sports insurance. It was elicited by the question ‘Do you currently take part in any sports activity?’ The response alternatives were ‘no’ and ‘yes’. The question concerning own educational status was ‘What is your current life situation? (1) student at high school, (2) student at a vocational institution, (3) student somewhere else, (4) I have a full-time job, (5) I have some other kind of employment, (6) I am unemployed, (7) I am on maternity leave or parental leave, and (8) Due to other reasons I am not a student, and am not working’. The adolescents were categorized into two groups according to the results: (1) students, (2) others. The data of parents’ self-reported occupational position was collected when cohort members were 16 years old. Father's occupational position was primarily used as an indicator of the family's socio-economic position and categorized into the following groups: (1) higher clerical employees, (2) self-employed, (3) lower clerical employees, (4) manual workers and (5) students, pensioners, unemployed or unknown. We obtained information on place of residence from the Population Register Centre. Place of residence was categorized by the definition of the National Rural Program into four groups: (1) urban areas, (2) urban-adjacent areas, (3) rural heartland areas and (4) remote areas (Keränen et al., 2000).

2.4 Need factors

Need factors include the following determinants: intensity of LBP, duration of LBP and limitations to daily activities caused by LBP. Intensity of LBP was assessed using a 10-point numerical rating scale, where ‘0’ indicated no pain at all and ‘10’ the worst imaginable pain. The adolescents were categorized into three groups according to their answers: (1) visual analogue scale(VAS) from 0 to 3 (reference group), (2) VAS from 4 to 7 and (3) VAS from 8 to 10. Duration of LBP was assessed by asking ‘How many days of LBP did you suffer during the last year?’ According to the responses, the adolescents were categorized into three groups: (1) from 0 to 7 days (reference group), (2) from 8 to 30 days and (3) over 30 days. The level of physical impairment caused by LBP was elicited by asking ‘Has LBP caused you inconvenience during the following activities (1) sitting for 5–10 minutes, (2) standing for 5–10 minutes, (3) walking for 5–10 minutes, (4) lifting/carrying heavy objects, (5) exercising and (6) lying on a bed.’ The response alternatives were ‘no’ and ‘yes’. We formulated an impairment index, in which the total score was the sum of limitations. Adolescents were categorized into three groups: (1) reference group (score 0), (2) some LBP-related limitations to daily activities (score 1–3) and (3) LBP-related limitations to daily activities (score 4–6).

2.5 Personal health habits

Personal health habits included the following determinants: physical activity level, smoking, sitting time outside school hours and obesity level. Adolescents were classified into three groups according to their participation in brisk physical activity outside school hours: (1) active (4 or more hours of physical activity per week), (2) moderately active (2 to 3 h of physical activity per week) and (3) inactive (1 h or less of physical activity per week). The term ‘brisk’ was defined as physical activity causing at least some sweating or shortage of breath. The question concerning smoking was ‘Do you currently smoke?’ Adolescents were categorized into three groups according to their current smoking frequency: (1) smoking 5 to 7 days per week, (2) smoking 4 days or less per week and (3) no smoking at all. Sitting time was elicited by the question ‘On average how many hours per day you spend doing the following activities: (1) watching TV, (2) reading books or magazines, (3) playing/working on a computer or playing video games, (4) sitting in a motor vehicle and (5) doing other sedentary activities’. The average sitting time per day was the sum of the time spent sitting with various activities, and was divided into three categories: (1) 8 h or more per day, (2) 4.1–7.9 h per day, and (3) 4 h or less per day. Body weight and height were also elicited in the questionnaire. Body mass index (BMI) was calculated as weight (kg)/height2 (m2), and categorized as either (1) normal weight (BMI 25 or less) or (2) overweight (BMI over 25).

2.6 Psychological factors

Psychological factors included the following determinants: trait anxiety and distress. Trait anxiety was assessed through the Trait Anxiety Inventory (Spielberger et al., 1970), which consisted of six statements such as ‘I always look positively and optimistically to the future’, and ‘If anything can go wrong, in my case it will’. There were four response options to each statement: (1) does not describe me at all, (2) describes me a little, (3) describes me fairly well and (4) describes me very well. Responses were scored individually under each statement, using a 4-point Likert scale (1-2-3-4), where ‘1’ indicated the response option with the least anxiety and ‘4’ the highest anxiety. The final anxiety score was the sum of these scores, and was used to categorize adolescents into two groups: (1) low anxiety (score from 6 to 11) or (2) moderate to high anxiety (score from 12 to 24). Psychological distress was assessed using the short version of the General Health Questionnaire (GHQ12; Goldberg, 1972). The GHQ12 evaluated whether the respondent had experienced a particular symptom or behaviour recently, which differed from how they usually feel (Goldberg et al., 1997). The GHQ-12 consisted of 12 questions, such as ‘Have you recently been able to concentrate on what you are doing or lost much sleep over worry?’ In order to assess the discrepancy between recent state and usual state, each item was rated on a 4-point scale: (1) better than usual, (2) same as usual, (3) less than usual, (4) much less than usual. We used a bimodal scoring method (0-0-1-1), thus the GHQ12 gave a maximum score of 12. A score of 4 or more was chosen to indicate psychosocial distress (Goldberg et al., 1998), and the adolescents were categorized into two groups: (1) no distress (score from 0 to 3) and (2) distress (score from 4 to 12).

2.7 Statistical analyses

Logistic regression analyses were used to evaluate the associations between determinants and care seeking for LBP among the subjects. We performed all analyses on males and females separately, and in three phases: (1) We calculated the crude odds ratios (OR) and their 95% confidence intervals (95% CI) for each variable; (2) we grouped the explanatory variables into four categories (enabling resources, need factors, personal health habits, psychological factors), and carried out a logistic regression model separately for each category; (3) we entered all variables with p-values (Wald's test) of <0.20 in the second phase into a final logistic regression model at the same time. All analyses were performed using SPSS for Windows version 19.0 (SPSS Inc., Chicago, IL, USA).

3. Results

  1. Top of page
  2. Abstract
  3. 1. Introduction
  4. 2. Methods
  5. 3. Results
  6. 4. Discussion
  7. References
  8. Supporting Information

3.1 Characteristics of adolescents

Among the study cohort members, the most common parents’ occupational class was manual workers (29%), followed by higher clerical employees (24%). Most of the adolescents were students (50%). The majority of them lived in either urban areas (48%) or urban-adjacent areas (28%).

Among the subjects with LBP, most of the adolescents were students (males: 50%, females: 50%), and the most common parents’ occupational class was manual workers (males: 28%, females: 29%), followed by higher clerical employees (males: 25%, females 22%). The majority of adolescents with LBP lived in either urban areas (males: 47%, females: 48%), or urban-adjacent areas (males: 29%, females: 26%; Supporting Information Tables S1 and S2).

3.2 LBP and care seeking

Of the 1987 respondents, 378 (42%) males and 543 (50%) females reported LBP during the previous year. Of those with LBP during the past year, 89 females (16%) and 59 males (16%) had consulted a physician for their LBP.

3.3 Factors associated with care seeking

Among females, in the univariate analyses (Table 1), the duration of LBP (over 30 days OR 3.0; 95% CI 1.7–5.4), intensity of LBP (VAS from 4 to 7 OR 6.9; 95% CI 2.7–17.7; VAS from 8 to 10 OR 27.1; 95% CI 9.8–75.1), LBP-related limitations to daily activities (impairment index from 1 to 3 OR 3.6; 95% CI 1.3–10.1, impairment index from 4 to 6 OR 6.7; 95% CI 2.1–21.1) and long periods spent sitting (8 h or more OR 3.3; 95% CI 1.5–7.6) were associated with seeking care for LBP. Among males, sports club membership (OR 2.6; 95% CI 1.4–4.6), student status (OR 2.0; 95% CI 1.1–3.8), duration of LBP (8–30 days OR 3.8; 95% CI 1.8–8.1, over 30 days OR 6.3; 95% CI 2.9–13.8), intensity of LBP (VAS from 4 to 7 OR 12.8; 95% CI 3.8–42.5, VAS from 8 to 10 OR 42.0; 95% CI 11.7–151.3) and LBP-related limitations to daily activities (impairment index from 1 to 3 OR 8.9; 95% CI 2.1–37.5, impairment index from 4 to 6 OR 25.0; 95% CI 5.5–114.0) were associated with medical care seeking (Table 2).

Table 1. The crude and adjusted odds ratios (OR) with their 95% confidence intervals (CI) in females, from logistic regression for health care use according to enabling resources, need factors, personal health habits and psychological factors
FemalesCrude OR (95% CI)Adjusteda OR (95% CI)
  1. a

    Adjusted for father's occupational class/position, intensity of LBP, impairment index and sitting time outside school hours.

Enabling resources  
Being an active member in a sports club  
No1.00 
Yes0.80 (0.35–1.84) 
Own socio-economic position  
Others1.00 
Students0.96 (0.59–1.54) 
Place of residence  
Remote area1.00 
Rural heartland area1.40 (0.56–3.49) 
Urban-adjacent area1.24 (0.54–2.83) 
Urban area1.09 (0.50–2.38) 
Father's occupational class/position  
Students, pensioned citizens, unemployed, unknown1.001.00
Manual workers0.65 (0.25–1.70)0.91 (0.32–2.65)
Lower clerical employees0.43 (0.15–1.22)0.55 (0.17–1.75)
Self-employed0.29 (0.09–0.99)0.35 (0.09–1.33)
Higher clerical employees0.37 (0.13–1.03)0.57 (0.18–1.80)
Need  
Duration of LBP  
0–7 days1.00 
8–30 days1.39 (0.78–2.50) 
More than 30 days2.98 (1.66–5.35) 
Intensity of LBP  
VAS 0–31.001.00
VAS 4–76.94 (2.72–17.71)5.75 (2.19–15.04)
VAS 8–1027.12 (9.79–75.13)18.81 (6.30–56.14)
Impairment index  
01.001.00
1–33.56 (1.26–10.07)1.59 (0.53–4.80)
4–66.67 (2.10–21.11)2.12 (0.60–7.54)
Personal health habits  
Physical activity level  
Inactive0.81 (0.46–1.41) 
Moderately active1.00 
Active1.00 (0.57–1.77) 
Sitting time outside school hours, h/day  
≤41.001.00
4.1–7.92.14 (0.90–5.12)1.99 (0.75–5.32)
≥83.33 (1.46–7.62)2.4 (0.94–6.12)
Smoking, days per week  
Not at all1.00 
≤41.04 (0.57–1.88) 
5–71.35 (0.80–2.27) 
Obesity level  
Normal weight1.00 
Overweight/obesity0.86 (0.42–1.75) 
Psychological factors  
Trait anxiety  
Low1.00 
Moderate + high1.18 (0.73–1.91) 
Distress, GHQ12 index  
No distress1.00 
Distress0.85 (0.52–1.39) 
Table 2. The crude and adjusted odds ratios (OR) with their 95% confidence intervals (CI) in males, from logistic regression for health care use according to enabling resources, need factors, personal health habits, and psychological factors
MalesCrude OR (95% CI)Adjusted ORa (95% CI)
  1. a

    Adjusted for sports club membership, own socio-economic position, father's occupational class/position, duration of LBP, intensity of LBP and impairment index.

Enabling resources  
Being an active member in a sports club  
No1.001.00
Yes2.55 (1.40–4.64)1.61 (0.71–3.70)
Own socio-economic position  
Others1.001.00
Students2.00 (1.06–3.77)2.34 (1.02–5.36)
Place of residence  
Remote area1.00 
Rural heartland area0.54 (0.14–2.07) 
Urban-adjacent area0.99 (0.36–2.73) 
Urban area1.30 (0.50–3.35) 
Father's occupational class/position  
Students, pensioned citizens, unemployed, unknown1.001.00
Manual workers0.60 (0.17–2.09)0.99 (0.17–5.63)
Lower clerical employees0.21 (0.05–0.90)0.21 (0.03–1.60)
Self-employed0.69 (0.17–2.82)1.17 (0.18–7.85)
Higher clerical employees0.69 (0.20–2.40)1.65 (0.28–9.87)
Need  
Duration of LBP  
0–7 days1.001.00
8–30 days3.78 (1.77–8.07)1.68 (0.64–4.29)
More than 30 days6.27 (2.85–13.79)2.12 (0.79–5.66)
Intensity of LBP  
VAS 0–31.001.00
VAS 4–712.77 (3.84–42.48)6.56 (1.76–24.45)
VAS 8–1042.00 (11.66–151.31)16.62 (3.81–72.46)
Impairment index  
01.001.00
1–38.85 (2.09–37.52)8.75 (1.09–70.28)
4–625.03 (5.50–113.96)15.69 (1.73–142.53)
Personal health habits  
Physical activity level  
Inactive0.80 (0.34–1.89) 
Moderately active1.00 
Active1.69 (0.83–3.44) 
Sitting time outside school hours, h/day  
≤41.00 
4.1–7.90.60 (0.26–1.39) 
≥80.72 (0.33–1.55) 
Smoking, days per week  
Not at all1.00 
≤40.85 (0.39–1.82) 
5–70.75 (0.39–1.44) 
Obesity level  
Normal weight1.00 
Overweight/obesity0.62 (0.29–1.32) 
Psychological factors  
Trait anxiety  
Low1.00 
Moderate + high1.48 (0.81–2.70) 
Distress, GHQ12 index  
No distress  
Distress1.32 (0.64–2.73) 

The final multivariate model included all variables with p-values (Wald's test) of <0.200 in the second phase. Among females, the final model included father's occupational class/position, intensity of LBP, the impairment index and sitting time outside school hours. Among males, the final model included sports club membership, own educational status, father's occupational class/position, duration of LBP, intensity of LBP and the impairment index.

In the final multivariate model of the determinants of medical care seeking due to LBP, out of all the included variables, intensity of pain was most strongly associated with care seeking in both genders (VAS from 4 to 7, males: OR 6.6; 95% CI 1.8–24.5 and females: OR 5.8; 95% CI 2.2–15.0; VAS from 8 to 10, males: OR 16.6; 95% 3.8–72.5 and females: OR 18.8; 95% CI 6.3–56.1; Fig. 1, Tables 1 and 2). In addition, limitations to daily activities caused by LBP were associated with seeking care for LBP among males (impairment index from 1 to 3 OR 8.8; 95% CI 1.1–70.3; impairment index from 4 to 6 OR 15.7; 95% CI 1.7–142.5; Fig. 2, Tables 1 and 2). Student status was also associated with care seeking among males (student status vs. others OR 2.3 95% CI 1.0–5.4).

figure

Figure 1. Proportion (%) of adolescents seeking medical care for LBP according to pain intensity in VAS.

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figure

Figure 2. Proportion (%) of adolescents seeking medical care for LBP according to LBP-related limitations to daily activities.

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4. Discussion

  1. Top of page
  2. Abstract
  3. 1. Introduction
  4. 2. Methods
  5. 3. Results
  6. 4. Discussion
  7. References
  8. Supporting Information

4.1 Main findings

In our study, relatively small proportion of adolescents with LBP sought medical care for pain. Moderate or high pain intensity was most strongly associated with medical care seeking among both genders. In addition, limitations to daily activities due to LBP and student status were associated with care seeking among males.

4.2 Strengths and weaknesses of the study

A major strength of our study is that it was based on a large birth cohort. Another was that we used the previously published Andersen's model of health care use as a framework (Andersen and Newman, 1973; Andersen, 1995). We collected a wide spectrum of data regarding LBP, health behaviour and psychosocial well-being and took a large scale of potential explaining factors into account. Despite numerous studies on LBP in adolescence, care-seeking behaviour among LBP sufferers is insufficiently understood. To our knowledge, this is the first study investigating the determinants of care seeking among adolescents with LBP.

One limitation of this study is that the outcome measure, as well as the explaining factors, was based on self-reported data. Obviously, the use of medical records would have led to a more reliable estimation of care seeking for LBP. However, self-reported care-seeking rates correspond well with data from medical records (Picavet et al., 2008). Unfortunately, we could not differentiate separately those with more than one visit to a physician during the past year. Their risk profile of health care use could be distinct from those with only one physician's visit. Moreover, pain-related factors, such as pain intensity, are clearly subjective in nature. Another source of bias might be the potentially selective participation in the study, although the response rate, 67%, must be considered reasonably high. However, the OBS has proved to be a representative sample of the original cohort (unpublished data). Finally, as our study was cross-sectional in design, the directionality of the observed associations remains unclear, although it is in our opinion more likely that symptoms determine health care utilization than vice versa.

4.3 Some differences compared to previous studies

In the current study, the 1-year prevalence of LBP was 46%, which compares well with previous studies (Leboeuf-Yde and Kyvik, 1998; Harreby et al., 1999; Sjolie, 2002; Sjolie, 2004; Skoffer and Foldspang, 2008). The differences in the 1-year prevalence estimates of LBP between different studies (Olsen et al., 1992; Burton et al., 1996; Taimela et al., 1997) are most likely due to differences in the definition of LBP and the age of the study population. Previous results have shown that the likelihood of LBP increases with age (Balague et al., 1994; Burton et al., 1996; Taimela et al., 1997; Harreby et al., 1999; Hakala et al., 2002). In our study, LBP was more common among females (50%) than males (42%), which is also in line with earlier studies (Vikat et al., 2000; Hakala et al., 2002). The care-seeking rate of LBP was 16% in the current study, i.e., almost identical to that of previous studies (Burton et al., 1996; Harreby et al., 1999). However, in contrast to some other studies, we did not find differences in the care-seeking rates between genders (Perquin et al., 2000; Vingilis et al., 2007).

In our study, pain intensity associated strongly with care seeking due to LBP. Previous studies have also reported this association between pain intensity and care seeking among adolescents (Perquin et al., 2000; Roth-Isigkeit et al., 2005; Masiero et al., 2010). Perquin et al. reported that intensity of pain is a strong predictor of consultation among adolescents with chronic pain (Perquin et al., 2000).

In the present study, limitations to daily activities caused by LBP were associated with care seeking among males. Previous studies among adults have also reported an association between care seeking and physical impairment caused by LBP (Hillman et al., 1996; Cote et al., 2001; Jacob et al., 2003; Mortimer et al., 2003; IJzelenberg and Burdorf, 2004; Walker et al., 2004). Among females, limitations to daily activities due to LBP were significantly associated with care seeking in univariate analyses only, while among males, the association remained significant after adjustments. The gender-specific difference may be due to the fact that males are more physically active and hence more prone to inconvenience due to pain.

Previous studies of adults have reported controversial results on the association between economic situation and seeking care for LBP or MS pain (Hagen et al., 2000; Cote et al., 2001; Molano et al., 2001; Mortimer et al., 2003). Some claim that a lower level of education increases the likelihood of care seeking among adults (Hagen et al., 2000; Cote et al., 2001), although one Dutch study found that education was not significantly associated with care seeking (Molano et al., 2001). In the current study, parents’ socio-economic position was not associated with care seeking, while adolescents’ own socio-economic position was associated with care seeking among males. However, we have no explanation as to why male students were more likely to seek care. In a previous study, Dutch adolescents in lower vocational training programmes consulted a physician almost twice as often as those pursuing higher levels of education (Perquin et al., 2000).

In a previous study among adolescents with pain, health care utilization was predicted by longer duration of pain, rather than by frequency of pain (Roth-Isigkeit et al., 2005). Among adults, it appears that duration of pain is a determinant of care seeking for LBP and MS pain (Hillman et al., 1996; Hagen et al., 2000; IJzelenberg and Burdorf, 2004). In our study, among both genders, the duration of LBP was significantly associated with care seeking only in the univariate analyses. This may be due to the fact that the intensity and duration of pain have a high degree of collinearity. Previous studies among adults have shown collinearity between the intensity of pain and the duration of pain (Demmelmaier et al., 2008), and the intensity of pain and LBP-related limitations to daily activities (Gronblad et al., 1996; Demmelmaier et al., 2008).

We found no health behaviour factor (smoking, physical activity level, sitting time, overweight) to be associated with care seeking for LBP. In line with our study, lifestyle factors (high body weight, smoking and physical exercise) did not affect care seeking for LBP among Swedish adults (Mortimer et al., 2003). In contrast, however, a Dutch study of adults showed that high BMI is associated with visiting a general practitioner for LBP (IJzelenberg and Burdorf, 2004).

Psychological distress was positively associated with an increased likelihood of visiting a physician among Canadian adolescents between the ages of 12 and 19 (Vingilis et al., 2007). Similarly, mental distress was associated with care seeking for MS pain among Norwegian adults (Hagen et al., 2000). However, we found no association between care seeking and psychological distress or trait anxiety.

4.4 Meaning of the study and remaining issues

It is important to know the proportions of adolescents seeking care for LBP, and to understand the factors that determine their use of health care since visiting a health care provider has societal implications by contributing to the cost of health care. Consultation obviously indicates a clinically more relevant problem than merely reporting pain, as more severe or disabling pain appears more often to result in seeking care. This study suggests that the characteristics of pain, i.e., pain intensity and limitations to daily activities are decisive factors in seeking care for LBP in adolescence. Future studies are needed to clarify further the determinants of health care use among the adolescents who visit a physician several times because of LBP.

References

  1. Top of page
  2. Abstract
  3. 1. Introduction
  4. 2. Methods
  5. 3. Results
  6. 4. Discussion
  7. References
  8. Supporting Information
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Supporting Information

  1. Top of page
  2. Abstract
  3. 1. Introduction
  4. 2. Methods
  5. 3. Results
  6. 4. Discussion
  7. References
  8. Supporting Information
FilenameFormatSizeDescription
ejp178-sup-001-tblS1.doc51K Table S1. Numbers of females who reported low back pain, with percentages of pain subjects consulting a doctor with the low back pain.
ejp178-sup-002-tblS2.doc50K Table S2. Numbers of males who reported low back pain, with percentages of pain subjects consulting a doctor with the low back pain.

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