1. 2014;17;217-226Awareness of the German Population of Common Available Guidelines of How to Cope with Lower Back Pain
   Observational Study
   Andreas Werber, MD, Monique Zimmermann-Stenzel, MSc, Babak Moradi, MD, Eva Neubauer, Dipl. Psych, and Marcus Schiltenwolf, MD.

BACKGROUND: Several countries developed guidelines in order to provide a systematic approach for treatment of (chronic) lower back pain. The risk of suffering from (chronic) lower back pain differs significantly within the general population. A serious lack of research exists concerning the risk factor “dysfunctional behavior of the subjects in terms of acute lower back pain.”

OBJECTIVE: The purpose of this study was to assess the knowledge of the German population regarding the availability of guidelines about managing lower back pain.

STUDY DESIGN: Prospective observational cohort study.

SETTING:  We interviewed 983 subjects by phone. The study population included 50 – 70-year-old men and women with German residency and sufficient language ability.

RESULTS: Of all the subjects, 70.2% claimed that they suffered at least once in their lifetime with lower back pain. Lower back pain with radiating symptoms occurred in 28.7%. Women were affected significantly more frequently compared to the epidemiological data. Of all the subjects with lower education, 82.9% suffered from lower back pain at least once in their lifetime compared to only 62.4% of people with university degrees. Education was also a protective factor for lower back pain with radiating pain. People who completed secondary modern school were 42% less likely to suffer from lower back pain than those who did not graduate. Knowing active rules of conduct occurred significantly more often at higher educational levels (i.e. all kinds of sports and exercises requiring physical strength, flexibility, power, agility, coordination, grace, balance and control, in particular stretching exercises) odds ratio = 7.78, physical activities odds ratio = 3.92, relaxation exercises odds ratio = 3.51).

LIMITATIONS: Data acquisition was performed by an external company and therefore provided only limited options for external validity. Furthermore data acquisition was restricted to 50 – 70-year-old patients, since this age group is at higher risk of suffering from lower back pain. A conclusion upon the knowledge of the whole population has to be drawn with caution, especially when considering the size of the study population. The life-time prevalence of lower back pain was assessed by interviewing patients about prior episodes of lower back pain. Slightly biased results may have occurred since the memory of prior episodes might result in too many or too few episodes.

CONCLUSION: The study revealed a lack of awareness of common available guidelines and an uneven distribution of existing knowledge throughout the population. Passive coping strategies like taking pain medication or ointment therapy were favored over active coping strategies like gymnastics, physical activities, and relaxation exercises. Respondents with a higher level of education suffered significantly less often from lower back pain and tended toward active treatment strategies. Respondents with lower levels of education more often demanded passive treatment strategies. The general population, especially those with lower education, is not sufficiently aware of behavioral strategies for managing lower back pain as proposed in available guidelines.