Quality of life in patients with chronic low back pain at Moi Teaching and Referral Hospital, Eldoret

Abstract

Background: Chronic low back pain is pain lasting longer than 12 weeks even after an initial injury or underlying cause has been treated. Previous findings have shown a high degree of co-morbid psychopathology in chronic back pain. Doing Quality of life assessment in chronic back pain promotes holistic care by appreciation of the patient's physical, psychological and social-environmental experiences. Objectives: To determine the quality of life and the relationship between sociodemographic, psychopathological and socio-environmental factors and quality of life in patients with chronic low back pain at the orthopedic spine clinic of Moi Teaching and Referral Hospital, Eldoret. Methods: Cross-sectional, descriptive study using sociodemographic and WHOQOLBREF Questionnaires on consenting new adult patients that attended the orthopedic and spine out-patient clinic at Moi Teaching and Referral hospital (MTRH) presenting with chronic back pain, duration over 3 months. Three hundred and eighteen patients were consecutively sampled from January 2018 to December 2019 and data analyzed using computer software. Categorical demographic data was analyzed using frequency and percentages. Socio-demographic factors that were significant in the bivariate analysis were further analyzed by multivariate linear regression with statistical significance set at p-value of <0.05. Continuous data from the WHOQOL-BREF facet and domain scores was summarized with descriptive statistics including frequency, mean, and standard deviation. Results: Seventy percent of participants were females while thirty percent were males. The mean Quality of life score for the 4 domains was 50.56(SD=9.55). On a scale of 1-5, the mean score of the Overall Quality of life facet was 2.42 (SD =0.80) while that of the general health facet was 2.31 (SD=0.69). The psychological domain had the highest number of patients with poor scores at n=69. The scores for the physical, psychological, social relationships and environmental health domains were 38.60, 55.47, 58.11 and 50.05 respectively. Older age (46-65) was significantly associated with lower mean QOL at 49.4(SD=9.2) p<0.001 compared to younger age groups. This age bracket also reported low physical and psychological health domain scores (mean 36.97 and 54.62, p<0.0016 respectively). Patients with a higher income level reported a higher psychological domain score (mean 56.75, p<0.0076). Higher level of education was significantly associated with high mean QOL (p<0.022). In the multivariate analysis, older age and lower income level were significantly associated with lower QOL. Conclusion: Patients with chronic back pain have a reduced quality of life. Older age, low level of income and low level of education were significantly associated with low quality of life in patients with chronic back pain at the MTRH orthopaedic outpatient clinic. There is a subset of patients with psychological impairment; and poor social and environmental health domain scores in patients presenting with chronic back pain at MTRH orthopaedic clinic. Recommendations: A multidisciplinary approach to treatment of this condition by stratification of patients with psychological risk factors and then applying an integrative biopsychosocial approach by consulting mental health practitioners.