Low Back Pain in Adolescents Is Quality of Life Poorer in Those Seeking Medical Attention?

Study Design. Paired case-control study. Objective. To assess health-related quality of life (HRQOL) and disability in adolescents with low back pain (LBP) referred to a hospital and compare it with adolescents with and without LBP from the general population. Summary of Background Data. Recent studies show that the effect of LBP on HRQOL of adolescents from the general population is insignificant. Poorer HRQOL is attributed to those soliciting specialized medical attention. No study has evaluated HRQOL in adolescents with LBP who seek specialized attention. Methods. All consecutive adolescents with nonspecific LBP referred to a hospital outpatient clinic (cases-patients) between January 2006 and October 2007 were compared to two control groups: adolescents with LBP and adolescents without LBP from a representative sample of students. Two controls from each group were randomly paired with each case by city of residence, sex, and age. Cases and controls completed the same self-administered questionnaires, including a generic quality-of-life (KIDSCREEN-52) and two LBP-specific (Roland-Morris Disability Questionnaire, Hannover Functional Ability Questionnaire) instruments. A group of teenagers with juvenile idiopathic arthritis completing the same questionnaire was used as external reference. The sample was calculated to detect a difference of more than 4.68 units in KIDSCREEN scores. Comparisons were made using t tests and effect size estimation. Results. Patients (n = 76) had more frequent (P = 0.005) and intense (P < 0.001) LBP than adolescents with LBP in the general population (n = 152) and a poorer score on the Roland-Morris (5.5 vs. 4.3, P = .023) and Hanover (4.5 vs. 3.5, P = 0.032) questionnaires. Nonetheless, in all KIDSCREEN dimensions, patient scores and scores of adolescents with juvenile idiopathic arthritis were similar or better than those of the general adolescent population with or without LBP (n = 152). Conclusion. Adolescents with LBP seeking specialized medical attention have better HRQOL than symptomatic peers from the general population but report worse clinical and functional status.