FUNCTIONAL OUTCOMES
Chronic low back pain:
Relevance of functional outcomes
Functionality is the main consideration when evaluating the efficacy of chronic low back pain
treatments. There is no one validated or perfect tool for measuring functionality, but clinicians can
use any of a number of questionnaires in daily clinical practice
Concepción Pérez MD PhD
Elena Rojo MD
Dolores Ochoa PhD MD
Manuel Muñoz MD
Noelia Sánchez
Pain Clinic and
Clinical Pharmacology
Department, Hospital
Universitario de la
Princesa, Madrid, Spain
Chronic low back pain (cLBP) has a high
life-time prevalence. Overall,the annual
prevalence of cLBP has been reported to range from
15% to 45%,with a point prevalence of 30%. 1
Furthermore, as the population ages over the
coming decades, the number of individuals with
cLBP is likely to increase substantially. 1 Other
research has evaluated the prevalence and incidence
in different ways, determining the prevalence and
incidence estimates based on routinely collected
data, which ranged from 1.4–20.0% and 0.024–7.0%,
respectively. 2 Findings have shown risk factors
include gender and belonging to certain subgroups
such as the elderly. 2
The economic cost is high; for example, in
a Swedish study, the indirect costs due to lost
productivity were sizeable and accounted for 84%
of the total cost. 3 The largest proportion of direct
medical costs were for physical therapy (17%) and
inpatient services (17%), followed by pharmacy (13%)
and primary care (13%). 4 Among studies providing
estimates of total costs, indirect costs resulting from
lost work productivity represented most of the
overall costs. Assuming that US direct cost estimates
of $12.2 to $90.6 billion represent only 14.5% of total
costs, the total US costs attributable could be
estimated at $84.1 to $624.8 billion. 4
In addition to this, cLBP has been the primary
cause of disability globally since 1990, and the years
lived with disability caused by cLBP have increased
by more than 50% since then. 5 The causes might be
different, but population growth and ageing are
crucial factors in this increase. Disability is higher
in working age groups, and social isolation of elders
can occur due to functional decline. 6–8
In a recent study, pain and disability were
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