Low back pain, quality of life and function in people with incomplete spinal cord injury in USA, UK and Greece

Abstract

BACKGROUND: Pain is a common consequence of Spinal Cord Injury (SCI). While research into pain in SCI is vast, examining musculoskeletal pain (MSKP) and low back pain (LBP) are limited. This thesis aims to investigate these categories of pain in incomplete SCI (iSCI). The experience of pain is known to affect quality of life (QoL) and function. The impact of the experience of pain, particularly of LBP, on both the QoL and function are examined in this research. While research in similar fields is predominantly conducted in single nation populations this research is set out to study three different nations. METHOD: The following were part of this study: • A systematic literature review on the prevalence on chronic back pain (BP), LBP and MSKP in SCI. • A translation, and preliminary validation, into Greek of the Spinal Cord Independence Measure (SCIM version III). • A cross-national survey conducted in the USA, UK and Greece. Questionnaires included the short-form McGill Pain questionnaire (SF-MPQ), EQ-5D and the SCIM III. They were collected either online or via post and 219 questionnaires were analysed. RESULTS: The papers included in the systematic literature review were considerably heterogeneous not allowing meta-analysis to be made. 95% confidence intervals (CI) for the total number of participants in the studies were used. Among people with pain the prevalence of chronic MSKP (CMSKP) was 49% (95%CI 44%, 55%), of chronic BP (CBP) was 47% (95%CI 43%, 50%) and chronic LBP (CLBP) was 49% (95%CI 44%, 55%). GR-SCIM III maintains its unidimensionality and has acceptable internal consistency (α=0.78). Concurrent/criterion validity for the two cross-examined subscales were strong for “self-care” (ρ=-0.78) and moderate for “mobility” (ρ=-0.58). Unidimensionality was also confirmed for the English version of SCIM III, which had accepted internal consistency (α=0.79) and strong concurrent/criterion validity for “self-care” (ρ=-0.75) and moderate for “mobility” (ρ=-0.45). The survey results showed that the prevalence of current LBP is 67.9% (95%CI 61%, 73%) and of MSKP is 38.8% (95%CI 32%, 45%). LBP was of moderate intensity and most commonly described as “aching”. People who report pain, LBP or MSKP reported worse QoL. The impact of LBP on QoL was greater than that of pain in general or MSKP. The increased intensity of LBP correlated with worse function. Among the three participating countries, people from the UK had the worst experience of pain and LBP, classified themselves with the worst health status and reported the worst functional independence. CONCLUSION: This study offers the first systematic review on CLBP, CBP and CMSKP in SCI. It is unique in using SCIM III by self-report and into Greek. The results show that LBP is highly present in iSCI affecting both QoL and function. Both the GR-SCIM III and the SCIM III are reliable for use, however studies are needed to examine further their psychometric properties. The findings of the study fit with features of the currently used patients’ rehabilitation models.