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A Consensus Approach Toward the Standardization of Back Pain Definitions for Use in Prevalence Studies

Dionne, Clermont E., PhD*†‡; Dunn, Kate M., PhD; Croft, Peter R., MD; Nachemson, Alf L.; Buchbinder, Rachelle; Walker, Bruce F.; Wyatt, Mary; Cassidy, J David; Rossignol, Michel; Leboeuf-Yde, Charlotte; Hartvigsen, Jan; Leino-Arjas, Päivi; Latza, Ute; Reis, Shmuel; Gil del Real, Maria Teresa; Kovacs, Francisco M.; Öberg, Birgitta; Cedraschi, Christine; Bouter, Lex M.; Koes, Bart W.; Picavet, H Susan J.; van Tulder, Maurits W.; Burton, Kim; Foster, Nadine E.; Macfarlane, Gary J.; Thomas, Elaine; Underwood, Martin; Waddell, Gordon; Shekelle, Paul; Volinn, Ernest; Von Korff, Michael

doi: 10.1097/BRS.0b013e31815e7f94
Health Services Research

Study Design. A modified Delphi study conducted with 28 experts in back pain research from 12 countries.

Objective. To identify standardized definitions of low back pain that could be consistently used by investigators in prevalence studies to provide comparable data.

Summary of Background Data. Differences in the definition of back pain prevalence in population studies lead to heterogeneity in study findings, and limitations or impossibilities in comparing or summarizing prevalence figures from different studies.

Methods. Back pain definitions were identified from 51 articles reporting population-based prevalence studies, and dissected into 77 items documenting 7 elements. These items were submitted to a panel of experts for rating and reduction, in 3 rounds (participation: 76%). Preliminary results were presented and discussed during the Amsterdam Forum VIII for Primary Care Research on Low Back Pain, compared with scientific evidence and confirmed and fine-tuned by the panel in a fourth round and the preparation of the current article.

Results. Two definitions were agreed on a minimal definition (with 1 question covering site of low back pain, symptoms observed, and time frame of the measure, and a second question on severity of low back pain) and an optimal definition that is made from the minimal definition and add-ons (covering frequency and duration of symptoms, an additional measure of severity, sciatica, and exclusions) that can be adapted to different needs.

Conclusion. These definitions provide standards that may improve future comparisons of low back pain prevalence figures by person, place and time characteristics, and offer opportunities for statistical summaries.

A modified Delphi study was conducted with 28 experts to identify standardized definitions of low back pain prevalence for use in epidemiological studies. Two definitions were agreed on minimal and optimal. These definitions provide standards that may improve the validity of future comparisons of low back pain prevalence figures and facilitate statistical summaries.

From the *Population Health Research Unit, (URESP) Research Centre of the Laval University Affiliated Hospital; †Department of Rehabilitation, Faculty of Medicine, Laval University, Québec, QC, Canada; and ‡Primary Care Musculoskeletal Research Centre, Primary Care Sciences, Keele University, Staffordshire, UK.

Acknowledgment date: April 19, 2007. Revision date: June 20, 2007. Acceptance date: June 25, 2007.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Clermont E. Dionne, PhD, Unité de recherche en santé des populations, Centre de recherche du CHA de Québec, Hôpital du Saint-Sacrement, 1050 chemin Ste-Foy, QC, Canada G1S 4L8; E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.