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The association between sleep quality, low back pain and disability: A prospective study in routine practice

Last updated: 06-02-2020

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The association between sleep quality, low back pain and disability: A prospective study in routine practice

European Journal of Pain
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Original Article
The association between sleep quality, low back pain and disability: A prospective study in routine practice
Authors
Kovacs Back Pain Unit, HLA-Moncloa University Hospital, Madrid, Spain
Spanish Back Pain Research Network, Palma de Mallorca, Spain
Correspondence
Spanish Back Pain Research Network, Palma de Mallorca, Spain
Institute of Biomedicine (IBIOMED), University of León, Spain
University of the Basque Country, León, Spain
Spanish Back Pain Research Network, Palma de Mallorca, Spain
ClinicalBiostatisticsUnit, Puerta de Hierro University Hospital, Instituto de Investigación Puerta de Hierro (IDIPHIM), Madrid, Spain
Spanish Back Pain Research Network, Palma de Mallorca, Spain
Servicio de Cirugía Ortopédica y Traumatología, Complejo Asistencial Universitario de León (CAULE), León, Spain
Spanish Back Pain Research Network, Palma de Mallorca, Spain
Servicio de Cirugía Ortopédica y Traumatología, Complejo Asistencial Universitario de León (CAULE), León, Spain
Spanish Back Pain Research Network, Palma de Mallorca, Spain
Aliviam – Majorca PainClinic, Palma de Mallorca, Spain
Spanish Back Pain Research Network, Palma de Mallorca, Spain
Servicio de Rehabilitación, Hospital Ramón y Cajal, IRICYS, Universidad de Alcalá, Madrid, Spain
Spanish Back Pain Research Network, Palma de Mallorca, Spain
Servicio de Reumatología, Hospital Clínic, Barcelona, Spain
Spanish Back Pain Research Network, Palma de Mallorca, Spain
Servicio de Traumatología, Patología de Columna, Fundación Jiménez Díaz, Madrid, Spain
Spanish Back Pain Research Network, Palma de Mallorca, Spain
Unidad del Dolor, Hospital MateuOrfila, Mahón, Spain
Spanish Back Pain Research Network, Palma de Mallorca, Spain
FisysFisioterapia, Laredo, Cantabria, Spain
Spanish Back Pain Research Network, Palma de Mallorca, Spain
Centro de Salud Alburquerque, La Codosera, Badajoz, Spain
Spanish Back Pain Research Network, Palma de Mallorca, Spain
Policlínica FISIOMED, Salamanca, Spain
Spanish Back Pain Research Network, Palma de Mallorca, Spain
Departamento de Psicología Básica, Evolutiva y de la Educación, Universidad Autónoma de Barcelona, Bellaterra, Spain
Spanish Back Pain Research Network, Palma de Mallorca, Spain
Escuela Universitaria Ciencias de la Salud, Universidad de León, Ponferrada, Spain
Spanish Back Pain Research Network, Palma de Mallorca, Spain
Departamento de Fisiología, Universidad de El País Vasco (UPV/EHU), Leioa, Vizcaya, Spain
N. Burgos-Alonso,
Spanish Back Pain Research Network, Palma de Mallorca, Spain
Departamento de Medicina Preventiva y Salud Pública, Universidad de El País Vasco (UPV/EHU), Leioa, Vizcaya, Spain
Spanish Back Pain Research Network, Palma de Mallorca, Spain
Escuela Universitaria Ciencias de la Salud, Universidad de León, Ponferrada, Spain
Spanish Back Pain Research Network, Palma de Mallorca, Spain
Servicio de Cirugía Ortopédica y Traumatología, Fundación Jiménez Díaz, Madrid, Spain
Spanish Back Pain Research Network, Palma de Mallorca, Spain
Unidad de Bioestadística Clínica, Hospital Ramón y Cajal, IRICYS, Madrid, Spain
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Funding Information
Funding sources
This study was funded by the Spanish Back Pain Research Network, a Spanish not-for-profit organization, which specializes in neck and back pain research. The funding institution had no role in the design and conduction of the study; data collection; management, analysis and interpretation of the data; preparation, review and approval of the manuscript; or the decision to submit the article for publication.
Conflicts of interest
No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this article. The authors do not have any financial or personal relationships with third parties that could influence this work inappropriately. The authors have no conflicts of interest to report.
Abstract
Background
The objective of this study was to estimate the association between sleep quality (SQ) and improvements in low back pain (LBP) and disability, among patients treated for LBP in routine practice.
Methods
This prospective cohort study included 461 subacute and chronic LBP patients treated in 11 specialized centres, 14 primary care centres and eight physical therapy practices across 12 Spanish regions. LBP, leg pain, disability, catastrophizing, depression and SQ were assessed through validated questionnaires upon recruitment and 3 months later. Logistic regression models were developed to assess: (1) the association between the baseline score for SQ and improvements in LBP and disability at 3 months, and (2) the association between improvement in SQ and improvements in LBP and disability during the follow-up period.
Results
Seventy-three per cent of patients were subacute. Median scores at baseline were four points for both pain and disability, as assessed with a visual analog scale and the Roland-Morris Questionnaire, respectively. Regression models showed (OR [95% CI]) that baseline SQ was not associated with improvements in LBP (0.99 [0.94; 1.06]) or in disability (0.99 [0.93; 1.05]), although associations existed between ‘improvement in SQ’ and ‘improvement in LBP’ (4.34 [2.21; 8.51]), and ‘improvement in SQ’ and ‘improvement in disability’ (4.60 [2.29; 9.27]).
Conclusions
Improvement in SQ is associated with improvements in LBP and in disability at 3-month follow-up, suggesting that they may reflect or be influenced by common factors. However, baseline SQ does not predict improvements in pain or disability.
Significance
In clinical practice, sleep quality, low back pain and disability are associated. However, sleep quality at baseline does not predict improvement in pain and disability.


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