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. 2020 Jan;29(1):275-287.
doi: 10.1007/s11136-019-02302-w. Epub 2019 Sep 17.

The longitudinal relationships between pain severity and disability versus health-related quality of life and costs among chronic low back pain patients

E N Mutubuki  1 , Y Beljon  2 , E T Maas  2   3 , F J P M Huygen  4 , R W J G Ostelo  2   5 , M W van Tulder  2   6 , J M van Dongen  2
Affiliations

The longitudinal relationships between pain severity and disability versus health-related quality of life and costs among chronic low back pain patients

E N Mutubuki et al. Qual Life Res. 2020 Jan.

Abstract

Purpose: Previous studies found higher levels of pain severity and disability to be associated with higher costs and lower health-related quality of life. However, these findings were based on cross-sectional data and little is known about the longitudinal relationships between pain severity and disability versus health-related quality of life and costs among chronic low back pain patients. This study aims to cover this knowledge gap by exploring these longitudinal relationships in a consecutive cohort.

Methods: Data of 6316 chronic low back pain patients were used. Measurements took place at 3, 6, 9, and 12 months. Pain severity (Numeric pain rating scale; range: 0-100), disability (Oswestry disability index; range: 0-100), health-related quality of life (EQ-5D-3L: range: 0-1), societal and healthcare costs (cost questionnaire) were measured. Using linear generalized estimating equation analyses, longitudinal relationships were explored between: (1) pain severity and health-related quality of life, (2) disability and health-related quality of life, (3) pain severity and societal costs, (4) disability and societal costs, (5) pain severity and healthcare costs, and (6) disability and healthcare costs.

Results: Higher pain and disability levels were statistically significantly related with poorer health-related quality of life (pain intensity: - 0.0041; 95% CI - 0.0043 to - 0.0039; disability: - 0.0096; 95% CI - 0.0099 to - 0.0093), higher societal costs (pain intensity: 7; 95% CI 5 to 8; disability: 23; 95% CI 20 to 27) and higher healthcare costs (pain intensity: 3; 95% CI 2 to 4; disability: 9; 95% CI 7 to 11).

Conclusion: Pain and disability were longitudinally related to health-related quality of life, societal costs, and healthcare costs. Disability had a stronger association with all outcomes compared to pain.

Keywords: Disability; Health-related quality of life; Longitudinal analysis; Low back pain; Pain; Societal costs.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Flowchart of missing data at each follow-up moment
See this image and copyright information in PMC

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