Low Back Pain in Adults With Transfemoral Amputation: A Retrospective Population-Based Study.
Marianne Luetmer, Benjamin Mundell, Hilal Maradit Kremers and 3 others
PMID 30701681WHAT IT FOUND
Transfemoral amputation was associated with more low back pain visits in dysvascular amputation.
Early low back pain events were more likely in both amputation causes. Prosthesis findings were unclear.
Key findings
01Low back pain visit frequency was significantly higher only in dysvascular transfemoral amputation (RR 1.80, 95% CI 1.07-3.03); trauma/cancer frequency was not significant (RR 1.14, 95% CI 0.58-2.22).
02Within early follow-up, a low back pain event was more likely after transfemoral amputation: 2.4 fold increase within 2.5 years for dysvascular amputation and 3.6 times higher within 5 years for trauma/cancer amputation.
03Phantom limb pain was associated with a 90% higher likelihood of a low back pain event in either amputation cause.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only 96 adults with transfemoral amputation were studied, and the trauma/cancer group had 12 people, so subgroup findings are unstable. Median follow-up was 0.78 years for dysvascular amputation because mortality was high, so long-term low back pain patterns may not be captured. Low back pain was identified from physician records and codes, so people who did not seek care or did not report back pain were missed. The study could not distinguish acute, chronic, or nonspecific low back pain, and it did not capture radiculopathy. Prosthesis data did not include daily use, design, or fit, and apparent prosthesis benefits were confounded because healthier patients were more likely to receive a prosthesis. The Olmsted County population is less diverse, wealthier, and more highly educated than the general U.S. population.
Declared interests
No author conflict declaration appears in the supplied article text. The metadata lists NIH extramural and non-U.S. government research support.
The easy way to misread this
Do not conclude that prosthesis fitting reduces low back pain. The apparent protective association disappeared when people who died within the first 7 months (N=41) were removed. Patients needed to be healthy enough to receive a prosthesis.