The Course of Low Back Pain From Adolescence to Adulthood

Eight-Year Follow-up of 9600 Twins

Lise Hestbaek, DC, PhD; Charlotte Leboeuf-Yde, DC, MPH, PhD; Kirsten Ohm Kyvik, MD, PhD; Claus Manniche, Dr. Med Sci


Spine. 2006;31(4):468-472. 

In This Article


Description of Cohort

In 1994, the overall response rate was 84%, of which 98% answered the LBP questions, resulting in 9,569 participants. Of those 9,569 individuals, 71% responded in 2002. Ninety-six percent of these answered the question regarding number of days with LBP, leaving 6,540 individuals for longitudinal analyses, i.e., 68% of the optimal study sample.

The mean age of this part of the cohort was 17.37 years (SD = 3.14 years; range, 12-22 years) in 1994 and the male/female ratio was 43:57. The prevalence of LBP in relation to age group and gender is shown in Table 1 for both 1994 and 2002.

Table 1 shows that the 1-year prevalence of LBP increases for the youngest group and decreases for the older groups, whereas the prevalence of persistent LBP increases for all age groups, although this increase is not significant for the oldest group.


Cross-tabulation of LBP-ever with LBP-days showed an unacceptable response (No to Have you ever had trouble with the lower part of your back? and more than zero to How many days have you altogether had trouble with the lower part of your back during the past year?) in 1.4% of cases in 1994, and 0.3% of cases in 2002. We considered this to be an acceptable level of invalid answers (logical errors). As for long-term recall, 35% of those reporting having had LBP in 1994 claimed never to have experienced LBP in 2002. However, this variable was only used for validation purposes in this study.


Comparisons between responders (n = 6,540) and nonresponders (n = 3,029) at follow-up in 2002 demonstrate similar age (responders: mean age = 17.00; SD = 3.13; range, 12-22; nonresponders: mean age = 17.37 years; SD = 3.14 years; range, 12-22 years) and a similar distribution of persistent LBP in 1994 (6%; range, 6%-7%; and 6%; range, 5%-7%, for responders and nonresponders, respectively, P = 0.262). However, there is a significant overrepresentation of females (57%; range, 55%-58%; vs. 39%; range, 37%-41%; P< 0.001) at follow-up and likewise, subjects with LBP-year in 1994 are overrepresented among responders in 2002 (35%; range, 34%-37%; vs. 29%; range, 28%-31%; P < 0.001).

Transition in LBP Status

The most stable group, as seen in Table 2 , is the pain-free group with 69% remaining pain-free from baseline to follow-up. Among the subjects with persistent LBP at baseline, there is a disproportionately large proportion of subjects with persistent LBP in 2002 (26% vs. 9% for those with none or nonpersistent LBP at baseline) and likewise a relatively small proportion being pain free in 2002 (33% vs. 63% for those with none or nonpersistent LBP at baseline).

LBP in Adolescence as a Predictor for Persistent LBP in Adulthood

Odds ratios stratified for age indicate no difference between ages. Thus, results are not presented stratified. Likewise, there is no gender difference. To illustrate this, odds ratios are presented both raw and adjusted for age and gender in Table 3 .

Table 3 shows a significant increase in the probability of getting LBP-year as well as persistent LBP at follow-up in case of LBP in adolescence. Thus, LBP in adolescence is a significant risk factor for LBP in adulthood. Furthermore, the risk increases with increasing duration of LBP in adolescence.


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