Incidence and risk factors for first-time incident low back pain: a systematic review and meta-analysis

Background context: Great effort has been made toward limiting low back pain (LBP). Recent focus has included factors involved with secondary and tertiary prevention, with less attention given to primary prevention.

Purpose: This review provided a current estimate of the incidence of LBP and risk factors associated with either first-time LBP or transition to LBP from a baseline of a pain-free state.

Study design: A systematic review and meta-analyses were performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Patient sample: Studies included subjects aged 18 years or older, from longitudinal, observational, cohort designs that included baseline risk factors to an outcome of either first-time LBP or transition to LBP from a baseline of a pain-free state.

Outcome measures: Risk factors and incidence rates were reported using descriptive analysis and the PRISMA guidelines.

Methods: Electronic search strategies in PubMed, CINAHL/SPORTDiscus, and Cochrane Central Register of Controlled Trials were combined with a hand search to identify articles for inclusion. Studies were classified based on the population studied (community vs. occupational based) and type of LBP outcome (first ever vs. transition from a baseline pain-free state).

Results: A total of 41 studies were included for review. Meta-analytical incidence rates for first-time LBP and transition to pain from a pain-free state were similar (∼25%), regardless of community or occupational populations. Risk factors for first-time LBP or transition to LBP from a baseline of a pain-free state were psychosocial and physically related. No consistent risk factor emerged as predictive of first-time LBP, although prior LBP was a consistent predictor of future incident LBP. Significant heterogeneity was found across studies in most models, which limits these findings.

Conclusions: The results of this study suggest that incidence of LBP is similar in community and occupational settings regardless of LBP definition. There were multiple diverse physical and psychosocial risk factors for first-time LBP. A history of LBP was the most consistent risk factor for transition to LBP from a baseline of a pain-free state.