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. 2019 Jan 15;20(1):25.
doi: 10.1186/s12891-019-2403-9.

Factors influencing disability in patients with chronic low back pain attending a tertiary hospital in sub-Saharan Africa

Marie Doualla  1   2   3 , Jeannine Aminde  4 , Leopold Ndemnge Aminde  1   5 , Fernando Kemta Lekpa  1   3 , Felix Mangan Kwedi  2   3 , Emmanuel Vubo Yenshu  6 , Alain Mefire Chichom  1
Affiliations

Factors influencing disability in patients with chronic low back pain attending a tertiary hospital in sub-Saharan Africa

Marie Doualla et al. BMC Musculoskelet Disord. .

Abstract

Background: Very little is known about the burden of chronic low back pain in Africa. This study aimed at assessing disability and associated factors in chronic low back patients in Cameroon.

Methods: We carried a hospital-based cross-sectional study including patients suffering from low back pain (LBP) of at least 12 weeks' duration. Disability was assessed using the Roland Morris Disability Questionnaire (RMDQ). RMDQ > 4 described persons with dysfunctional levels of disability. Multivariable linear regression was used to investigate factors associated with higher RMDQ scores hence greater disability. Variables investigated included; gender, age, marital status, employment status and type, smoking history, alcohol consumption, income, pain intensity, LBP duration, psychological wellbeing, sleep satisfaction, leg pain, numbness/paresthesia, bowel/bladder dysfunction symptoms (BBDS), body mass index (BMI), and days of work absence.

Results: A sample of 136 adults (64% female) with a mean age of 50.6 ± 12.2 years participated in the study. Median duration of LBP was 33 (25th - 75th percentile: 12-81) months. Mean RMDQ score was 12.8 ± 6. In multivariable linear regression, pain intensity (β = 0.07, p = 0.002), longer days of work absence (β = 0.15, p = 0.003) and BBDS (β =2.33, p = 0.029) were associated with greater disability. Factors such as consumption of alcohol (β = - 3.55, p = 0.005) and higher psychological wellbeing scores (β = - 0.10, p = 0.004) significantly contributed to less disability (lower RMDQ scores). Dysfunctional levels of disability were present in 88.1% of patients.

Conclusion: CLBP is associated with significant disability and this relationship is driven by several factors. Multidisciplinary management strategies especially those targeted to improve pain control, manage BBDS and improve psychological wellbeing could reduce disability and improve quality of life.

Keywords: Africa; Chronic low back pain; Disability.

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Conflict of interest statement

Authors’ information

Marie Doualla Bija: Associate Professor of Internal Medicine and Rheumatology, Faculty of Health Sciences, University of Buea, and Consultant Internist-Rheumatologist, Douala General Hospital, Cameroon.

Jeannine Aminde: Physician, Etoug-Ebe Baptist Hospital, Yaounde, and Faculty of Health Sciences, University of Buea, Cameroon.

Leopold Ndemnge Aminde: Physician and Doctoral candidate, Faculty of Medicine, School of Public Health, University of Queensland, Australia.

Fernando Kemta Lekpa: Consultant Internist-Rheumatologist, Douala General Hospital, and Lecturer, Faculty of Health Sciences, University of Buea, Cameroon.

Felix Mangan Kwedi: Consultant Internist-Rheumatologist, Douala General Hospital, and Lecturer, Faculty of Medicine & Pharmaceutical Sciences, University of Douala, Cameroon.

Emmanuel Vubo Yenshu: Professor of Sociology at the Department of Sociology & Anthropology, and Dean of the Faculty of Social and Management Sciences, University of Buea, Cameroon.

Alain Mefire Chichom: Associate Professor of Surgery and Head of Department of Surgery, Faculty of Health Sciences, University of Buea. Consultant General Surgeon, Gyneco-Obstetric and Paediatric Hospital Douala, Cameroon.

Ethics approval and consent to participate

All the patients read and signed an informed consent sheet. Research authorisations were obtained from the administration of Douala General Hospital. Ethical clearance was obtained from the Faculty of Health Sciences Institutional Ethical Review Board of the University of Buea, Cameroon.

Consent for publication

NA

Competing interests

All authors declare no conflict of interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Specific diagnoses of patients with CLBP. Legend: Bar chart showing the different aetiological diagnoses of patients with CLBP. The percentages next to the bars represent the proportion of each diagnosis in the cohort of patients.
Fig. 2
Fig. 2
Correlation between RMDQ scores and days of work loss. Legend: Scatter plot showing correlation between disability (RMDQ scores) and days of work loss. The many small circles represent the plotted values obtained for each of the variables while the line represents the best fit for the correlation between them.
Fig. 3
Fig. 3
Correlation between RMDQ scores and pain intensity. Legend: Scatter plot showing relationship between disability (RMDQ scores) and pain intensity scores measured with visual analogue scale (VAS).The many small circles represent the plotted values obtained for each of the variables while the line represents the best fit for the correlation between them.
Fig. 4
Fig. 4
Correlation between RMDQ scores and psychological wellbeing. Legend: Scatter plot showing correlation between disability (RMDQ scores) and psychological wellbeing scores. The many small circles represent the plotted values obtained for each of the variables while the line represents the best fit for the correlation between them.
Fig. 5
Fig. 5
RMDQ score variation between alcohol consumers and non-consumers. Legend: Box plots showing differences in disability (RMDQ scores) by alcohol consumption status. The horizontal line in the box represents the median RMDQ score, while the lower and upper edges of the boxes represent the 25th and 75th percentiles (and interquartile range being the difference between them).The tip of the extended vertical lines on either sides of the boxes refer to the minimum and maximum RMDQ scores.
Fig. 6
Fig. 6
RMDQ score variation between persons with and without BBDS. Legend: Box plots showing differences in disability (RMDQ scores) in those with and without bowel/bladder dysfunction symptoms (BBDS). The horizontal line in the box represents the median RMDQ score, while the lower and upper edges of the boxes represent the 25th and 75th percentiles (and interquartile range being the difference between them).The tip of the extended vertical lines on either sides of the boxes refer to the minimum and maximum RMDQ scores.
See this image and copyright information in PMC

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