Rheumatology International

, Volume 39, Issue 10, pp 1663–1679 | Cite as

Health-care utilisation for low back pain: a systematic review and meta-analysis of population-based observational studies

  • Getahun Kebede BeyeraEmail author
  • Jane O’Brien
  • Steven Campbell
Systematic Review


Low back pain (LBP) is a major public health problem globally, resulting in a significant personal and societal burden. However, little is known about health-care utilisation for optimal management of LBP. The aim of this systematic review and meta-analysis was to determine the prevalence rate of health-care utilisation for LBP. The electronic databases MEDLINE, EMBASE via Ovid, CINAHL, and Scopus were searched for peer-reviewed articles published in English before March 2018. Meta-analysis was performed using Stata version 14 software. The reported summary statistics including the pooled prevalence rate of health-care utilisation were calculated using a random-effects model. Of 5801 identified records, 20 met the inclusion criteria and were reviewed. The prevalence rate of health-care utilisation for LBP varied regionally, the pooled prevalence rate was 67%, 95% confidence interval (CI) 50–84 in the USA, 47%, 95% CI 39–56 in the UK and 48%, 95% CI 33–63 in Europe. General practitioners, chiropractors and physical therapists were health-care providers commonly engaged in the management of LBP patients, while medication treatment, exercise, massage therapy and spinal manipulation were common prescriptions. A range of factors influencing the decision to seek and use health-care for LBP were also identified. Despite LBP being a common public health problem, a significant proportion of people with the pain fail to use health-care. It is apparent from this review that there is possibly skewed data, as the evidence to date is largely from developed countries. Therefore, it is warranted that future studies investigate the epidemiology of health-care utilisation for LBP in developing countries.


Low back pain Health-care utilisation Population-based observational studies Systematic review Meta-analysis 


Author contributions

All authors contributed to the formation of the research question. GKB conducted the search. GKB and JO’B extracted the data and SC revised the data. All authors contributed to the preparation and review of the manuscript.


This study did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors have no conflict of interests to declare.

Ethical approval

Because this study was a systematic review and meta-analysis, ethical approval was not required.

Supplementary material

296_2019_4430_MOESM1_ESM.docx (36 kb)
Supplementary material 1 (DOCX 35 kb)


  1. 1.
    Buchbinder R, van Tulder M, Öberg B et al (2018) Low back pain: a call for action. Lancet 391(10137):2384–2388Google Scholar
  2. 2.
    Joergensen AC, Hestbaek L, Andersen PK, Andersen A-MN (2019) Epidemiology of spinal pain in children: a study within the Danish National Birth Cohort. Eur J Pediatr 178(5):695–706Google Scholar
  3. 3.
    Doualla M, Aminde J, Aminde LN et al (2019) Factors influencing disability in patients with chronic low back pain attending a tertiary hospital in sub-Saharan Africa. BMC Musculoskelet Disord 20(1):25Google Scholar
  4. 4.
    Bento TPF, dos Santos Genebra CV, Maciel NM et al (2019) Low back pain and some associated factors: is there any difference between genders? Braz J Phys Ther. Google Scholar
  5. 5.
    Vos T, Flaxman AD, Naghavi M et al (2013) Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380(9859):2163–2196Google Scholar
  6. 6.
    Hartvigsen J, Hancock MJ, Kongsted A et al (2018) What low back pain is and why we need to pay attention. Lancet 391(10137):2356–2367Google Scholar
  7. 7.
    Hurwitz EL, Randhawa K, Yu H, Côté P, Haldeman S (2018) The Global Spine Care Initiative: a summary of the global burden of low back and neck pain studies. Eur Spine J 27(6):796–801Google Scholar
  8. 8.
    Murray CJ, Vos T, Lozano R et al (2012) Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380(9859):2197–2223Google Scholar
  9. 9.
    Gore M, Sadosky A, Stacey BR, Tai K-S, Leslie D (2012) The burden of chronic low back pain: clinical comorbidities, treatment patterns, and health care costs in usual care settings. Spine 37(11):E668–E677Google Scholar
  10. 10.
    Balagué F, Mannion AF, Pellisé F, Cedraschi C (2012) Non-specific low back pain. Lancet 379(9814):482–491Google Scholar
  11. 11.
    Hoy D, Brooks P, Blyth F, Buchbinder R (2010) The epidemiology of low back pain. Best Pract Res Clin Rheumatol 24(6):769–781Google Scholar
  12. 12.
    United Nations (2006) World population prospects: the 2006 revision. United Nations, New YorkGoogle Scholar
  13. 13.
    Hoy D, March L, Brooks P et al (2014) The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis 73(6):968–974Google Scholar
  14. 14.
    Adamson J, Hunt K, Nazareth I (2011) The influence of socio-demographic characteristics on consultation for back pain—a review of the literature. Fam Pract 28(2):163–171Google Scholar
  15. 15.
    Woodhouse A, Pape K, Romundstad PR, Vasseljen O (2016) Health care contact following a new incident neck or low back pain episode in the general population; the HUNT study. BMC Health Serv Res 16:81Google Scholar
  16. 16.
    Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097Google Scholar
  17. 17.
    Maher C, Underwood M, Buchbinder R (2017) Non-specific low back pain. Lancet 389(10070):736–747Google Scholar
  18. 18.
    de Vet HC, Heymans MW, Dunn KM et al (2002) Episodes of low back pain: a proposal for uniform definitions to be used in research. Spine 27(21):2409–2416Google Scholar
  19. 19.
    Hoy D, Brooks P, Woolf A et al (2012) Assessing risk of bias in prevalence studies: modification of an existing tool and evidence of interrater agreement. J Clin Epidemiol 65(9):934–939Google Scholar
  20. 20.
    The Joanna Briggs Institute (2014) Joanna Briggs Institute Reviewers’ manual, 2014th edn. Australia The Joanna Briggs Institute, AdelaideGoogle Scholar
  21. 21.
    Buchan HA, Duggan A, Hargreaves J, Scott IA, Slawomirski L (2016) Health care variation: time to act. Med J Aust 205(S10):S30–S33Google Scholar
  22. 22.
    Traeger AC, Buchbinder R, Elshaug AG, Croft PR, Maher CG (2019) Care for low back pain: can health systems deliver? Bull World Health Organ 97(6):423–433Google Scholar
  23. 23.
    Kent PM, Keating JL (2005) The epidemiology of low back pain in primary care. Chiropract Osteopat 13(1):13Google Scholar
  24. 24.
    Huedo-Medina TB, Sánchez-Meca J, Marín-Martínez F, Botella J (2006) Assessing heterogeneity in meta-analysis: q statistic or I2 index? Psychol Methods 11(2):193–206Google Scholar
  25. 25.
    Carey TS, Evans AT, Hadler NM et al (1996) Acute severe low back pain: a population-based study of prevalence and care-seeking. Spine 21(3):339–344Google Scholar
  26. 26.
    Côté P, Baldwin ML, Johnson WG (2005) Early patterns of care for occupational back pain. Spine 30(5):581–587Google Scholar
  27. 27.
    Deyo RA, Tsui-Wu Y-J (1987) Descriptive epidemiology of low-back pain and its related medical care in the United States. Spine 12(3):264–268Google Scholar
  28. 28.
    Merlino LA, Rosecrance JC, Anton D, Cook TM (2003) Symptoms of musculoskeletal disorders among apprentice construction workers. Appl Occup Environ Hyg 18(1):57–64Google Scholar
  29. 29.
    Carey T, Freburger JK, Holmes GM et al (2009) A long way to go: practice patterns and evidence in chronic low back pain care. Spine 34(7):718Google Scholar
  30. 30.
    Carey T, Evans A, Hadler N et al (1995) Care-seeking among individuals with chronic low back pain. Spine 20(3):312–317Google Scholar
  31. 31.
    Walsh K, Cruddas M, Coggon D (1992) Low back pain in eight areas of Britain. J Epidemiol Community Health 46(3):227–230Google Scholar
  32. 32.
    Waxman R, Tennant A, Helliwell P (1998) Community survey of factors associated with consultation for low back pain. BMJ 317(7172):1564–1567Google Scholar
  33. 33.
    Macfarlane GJ, Beasley M, Jones EA et al (2012) The prevalence and management of low back pain across adulthood: results from a population-based cross-sectional study (the MUSICIAN study). Pain (03043959) 153(1):27–32Google Scholar
  34. 34.
    Ijzelenberg W, Burdorf A (2004) Impact of musculoskeletal co-morbidity of neck and upper extremities on healthcare utilisation and sickness absence for low back pain. Occup Environ Med 61(10):806–810Google Scholar
  35. 35.
    Ijzelenberg W, Burdorf A (2004) Patterns of care for low back pain in a working population. Spine 29(12):1362–1368Google Scholar
  36. 36.
    Alexopoulos EC, Tanagra D, Konstantinou E, Burdorf A (2006) Musculoskeletal disorders in shipyard industry: prevalence, health care use, and absenteeism. BMC Musculoskelet Disord 7(1):88Google Scholar
  37. 37.
    Alexopoulos EC, Tanagra D, Detorakis I et al (2011) Knee and low back complaints in professional hospital nurses: occurrence, chronicity, care seeking and absenteeism. Work 38(4):329–335Google Scholar
  38. 38.
    Mannion AF, Wieser S, Elfering A (2013) Association between beliefs and care-seeking behavior for low back pain. Spine 38(12):1016–1025Google Scholar
  39. 39.
    Szpalski M, Nordin M, Skovron M, Melot C, Cukier D (1995) Health care utilization for low back pain in Belgium: influence of sociocultural factors and health beliefs. Spine 20(4):431–442Google Scholar
  40. 40.
    O’Sullivan D, Cunningham C, Blake C (2009) Low back pain among Irish farmers. Occup Med 59(1):59–61Google Scholar
  41. 41.
    Jacob T, Zeev A, Epstein L (2003) Low back pain—a community-based study of care-seeking and therapeutic effectiveness. Disabil Rehabil 25(2):67–76Google Scholar
  42. 42.
    Walker BF, Muller R, Grant WD (2004) Low back pain in Australian adults: health provider utilization and care seeking. J Manip Physiol Ther 27(5):327–335Google Scholar
  43. 43.
    Ono R, Yamazaki S, Takegami M et al (2015) Patient-reported disability in the general Japanese population was associated with medical care visits for low back pain, regardless of pain intensity. J Orthop Sci 20(4):742–749Google Scholar
  44. 44.
    Karahan A, Kav S, Abbasoglu A, Dogan N (2009) Low back pain: prevalence and associated risk factors among hospital staff. J Adv Nurs 65(3):516–524Google Scholar
  45. 45.
    Paul NS, Vicki KL, Pierre C, Linda CJ, David CJ (2015) Is low back pain associated with worse health-related quality of life 6 months later? Eur Spine J 24(3):458–466Google Scholar
  46. 46.
    Strudwick K, McPhee M, Bell A, Martin-Khan M, Russell T (2018) Best practice management of low back pain in the emergency department (part 1 of the musculoskeletal injuries rapid review series). Emerg Med Australas 30(1):18–35Google Scholar
  47. 47.
    Geurts JW, Willems PC, Kallewaard J-W, van Kleef M, Dirksen C (2018) The impact of chronic discogenic low back pain: costs and patients’ burden. Pain Res Manag. Google Scholar
  48. 48.
    Sadosky AB, DiBonaventura M, Cappelleri JC, Ebata N, Fujii K (2015) The association between lower back pain and health status, work productivity, and health care resource use in Japan. J Pain Res 8:119–130Google Scholar
  49. 49.
    Misiak B, Snarska KK (2014) Quality of life of patients with back pain. J Neurol Neurosurg Nurs 3(3):97–144Google Scholar
  50. 50.
    Sezgin M, Hasanefendioğlu EZ, Sungur MA et al (2015) Sleep quality in patients with chronic low back pain: a cross-sectional study assessing its relations with pain, functional status and quality of life. J Back Musculoskelet Rehabil 28(3):433–441Google Scholar
  51. 51.
    Zamanzadeh V, Ahmadi F, Foolady M, Behshid M, Irajpoor A (2017) The health seeking behaviors and perceptions of iranian patient with osteoarthritis about pain management: a qualitative study. J Caring Sci 6(1):81–93Google Scholar
  52. 52.
    Mikkelsson M (2012) Do we know enough about the health care use of adolescents with low back pain? Eur J Pain 16(10):1343–1344Google Scholar
  53. 53.
    Pagán JA, Pauly MV (2006) Community-level uninsurance and the unmet medical needs of insured and uninsured adults. Health Serv Res 41(3p1):788–803Google Scholar
  54. 54.
    Brezzi M, Luongo P (2016) Regional disparities in access to health care: a multilevel analysis in selected OECD countries. OECD regional development working papers 2016/04, ParisGoogle Scholar
  55. 55.
    Zhu D, Guo N, Wang J, Nicholas S, Chen L (2017) Socioeconomic inequalities of outpatient and inpatient service utilization in China: personal and regional perspectives. Int J Equity Health 16(1):210Google Scholar
  56. 56.
    Bier JD, Kamper SJ, Verhagen AP, Maher CG, Williams CM (2017) Patient nonadherence to guideline-recommended care in acute low back pain. Arch Phys Med Rehabil 98(12):2416–2421Google Scholar
  57. 57.
    Plénet A, Gourmelen J, Chastang J-F et al (2010) Seeking care for lower back pain in the French population aged from 30 to 69: the results of the 2002–2003 Decennale Sante survey. Ann Phys Rehabil Med 53(4):224–238Google Scholar
  58. 58.
    Picavet HSJ, Struijs JN, Westert GP (2008) Utilization of health resources due to low back pain: survey and registered data compared. Spine 33(4):436–444Google Scholar
  59. 59.
    Becker A, Held H, Redaelli M et al (2010) Low back pain in primary care: costs of care and prediction of future health care utilization. Spine 35(18):1714–1720Google Scholar
  60. 60.
    Namiranian K, Norris EJ, Jolissaint JG, Patel JB, Lombardi CM (2018) Impact of multidisciplinary spine conferences on surgical planning and perioperative care in elective lumbar spine surgeries. Asian Spine J 12(5):854–861Google Scholar
  61. 61.
    Harris SA, Rampersaud YR (2016) The importance of identifying and modifying unemployment predictor variables in the evolution of a novel model of care for low back pain in the general population. Spine J 16(1):16–22Google Scholar
  62. 62.
    Kirby ER, Broom AF, Adams J, Sibbritt DW, Refshauge KM (2014) A qualitative study of influences on older women’s practitioner choices for back pain care. BMC Health Serv Res 14(1):131Google Scholar
  63. 63.
    Koes BW, van Tulder M, Lin C-WC et al (2010) An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J 19(12):2075–2094Google Scholar
  64. 64.
    Freburger JK, Holmes GM, Agans RP et al (2009) The rising prevalence of chronic low back pain. Arch Intern Med 169(3):251–258Google Scholar
  65. 65.
    Kinge JM, Knudsen AK, Skirbekk V, Vollset SE (2015) Musculoskeletal disorders in Norway: prevalence of chronicity and use of primary and specialist health care services. BMC Musculoskelet Disord 16(1):75Google Scholar
  66. 66.
    Noll M, de Avelar IS, Lehnen GC, Vieira MF (2016) Back pain prevalence and its associated factors in Brazilian athletes from public high schools: a cross-sectional study. PLoS One 11(3):e0150542Google Scholar
  67. 67.
    Meucci RD, Fassa AG, Faria NMX (2015) Prevalence of chronic low back pain: systematic review. Rev Saude Publica 49:73Google Scholar
  68. 68.
    Yang H, Haldeman S, Lu M-L, Baker D (2016) Low back pain prevalence and related workplace psychosocial risk factors: a study using data from the 2010 National Health Interview Survey. J Manipul Physiol Ther 39(7):459–472Google Scholar
  69. 69.
    Garg A, Kapellusch JM, Hegmann KT et al (2014) The NIOSH lifting equation and low-back pain, part 2: association with seeking care in the Backworks prospective cohort study. Hum Factors 56(1):44–57Google Scholar
  70. 70.
    Sanders C, Donovan J, Dieppe P (2004) Unmet need for joint replacement: a qualitative investigation of barriers to treatment among individuals with severe pain and disability of the hip and knee. Rheumatology 43(3):353–357Google Scholar
  71. 71.
    Walters K, Iliffe S, Orrell M (2001) An exploration of help-seeking behaviour in older people with unmet needs. Fam Pract 18(3):277–282Google Scholar
  72. 72.
    Vlaeyen JW, Linton SJ (2000) Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain 85(3):317–332Google Scholar
  73. 73.
    Keedy NH, Keffala VJ, Altmaier EM, Chen JJ (2014) Health locus of control and self-efficacy predict back pain rehabilitation outcomes. Iowa Orthop J 34:158–165Google Scholar
  74. 74.
    Vasseljen O, Woodhouse A, Bjørngaard JH, Leivseth L (2013) Natural course of acute neck and low back pain in the general population: the HUNT study. Pain 154(8):1237–1244Google Scholar
  75. 75.
    Lim K-L, Jacobs P, Klarenbach S (2006) A population-based analysis of healthcare utilization of persons with back disorders: results from the Canadian Community Health Survey 2000–2001. Spine 31(2):212–218Google Scholar
  76. 76.
    Tsuji T, Matsudaira K, Sato H, Vietri J (2016) The impact of depression among chronic low back pain patients in Japan. BMC Musculoskelet Disord 17(1):447Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.School of Nursing, College of Health and MedicineUniversity of TasmaniaLauncestonAustralia
  2. 2.Institute of Public Health, College of Medicine and Health SciencesUniversity of GondarGondarEthiopia

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