INTRODUCTIONLow lower back pain (LBP) may be the most typical musculoskeletal issue that
brings ...

1. Economic burden of low back pain on patients seen at the
outpatient physiotherapy clinics of secondary and tertiary
health institutions in Ibadan.
INTRODUCTION
Low lower back pain (LBP) may be the most typical musculoskeletal issue that
brings patients for the hospital. (1) The idea is typically accompanied by
painful limitation of movement, often relying on physical activities
and postures and also could also always be connected along with referred pain. (2) in the
United States, LBP features reached epidemic proportions along with represents a
significant threat to the public wellness associated with its citizens. (3)
The recurrence with the situation will be common. Your lifetime prevalence
is more than 70% inside industrialized countries, with peak prevalence between
ages 35 along with 55. (4) Throughout Nigeria, your prevalence associated with LBP among
hospital
workers had been reported to be 46%, using the highest prevalence (69%)
recorded amongst nursing staff, accompanied by secretaries/administrative
staff (55%) as well as cleaners/aids (47%). heavy physical work (45%), poor
posture (20%) along with prolonged standing or perhaps sitting (20%) were your most
frequent activities associated together with LBP amongst these workers. (5) Some
studies have discovered the actual prevalence associated with LBP to be secure over several
years. (4,6,7) in Germany, the actual prevalence involving LBP was discovered to be stable
over any decade. (6) The Actual higher number of patients together with recurrent pain makes
it challenging to distinguish between prevalence of acute and also chronic LBP.
The economic burden of the disease may end up being the sum of all costs associated

2. with that condition which would certainly not well be incurred if that
disease failed to exist. (8) However, given the many categories associated with costs
that has for you to be considered (direct, indirect and also intangible), it could be
challenging to completely estimate the economic burden associated with an illness as data
is frequently not necessarily available. intangible expenses are generally rarely included when
estimating the cost-effective burden regarding an illness simply because of the general
societal uneasiness regarding putting a monetary value upon these aspects of a
disease. (8)
LBP is a costly situation to the society throughout regards to work
absenteeism, health treatment utilization, and disability benefits. Previous
estimates with the total annual expense regarding LBP in the United States Associated With America
have
ranged coming from $20-$50billion. (10) According to Shekelle et al., (9) the
direct as well as indirect expenses of low back pain, are usually estimated from $60 billion
annually within the United States.
A closer evaluation regarding the cost-effective burden involving LBP reveals that will it
is the many typical reason behind activity limitations in individuals under
the chronilogical get older of 45, (11) the second most frequent complaint heard in
physician's offices, (12) the third leading trigger with regard to surgery, and
the fifth most frequent cause pertaining to hospitalization. (13) Hemmila (14) found
that with regards to one-third with the immediate expenses (health treatment utilization) of
LBP has been allocated to complementary therapies as well as that sick leaves accounted
for 55 % of the total cost.
LBP will be the priciest benign issue inside industrialized

3. countries plus it is the primary cause regarding disability that will affects
people less than 45 years. Pertaining To these older as compared to 45 years, it is the
third leading trigger associated with disability. (15) The idea results in significant
restrictions on actions involving day-to-day living and participation, such as
inability for you to work. (10) Furthermore, the economic as well as societal impact of
LBP appears being huge. People with LBP incur millions of dollars
in medical expenditure annually inside the United States. (10) This
economic burden will be regarding certain concern throughout developing countries where
there tend to be currently limitations throughout well being care delivery and funds are
directed in the actual direction of epidemics like human immunodeficiency virus/Acquired
Immune Deficiency syndrome. (16)
Methods
The study protocol had been approved by the School regarding Ibadan/
University college Hospital (UI/UCH) joint Institutional Review
Committee. Contributors pertaining to this research had been most consenting patients with
mechanical LBP who were receiving physiotherapy with an outpatient basis
from Ring road State Hospital, along with university School Hospital, each in
Ibadan. That They were individuals that are not on the health insurance scheme
at the period of the actual study.
The rationale and also procedure associated with the research was explained to always be able to
each
participant and his/her informed consent has been obtained. The Actual Roland Morris
LBP Disability Questionnaire has been accustomed to assess how LBP affected the

4. participants' power to manage inside everyday routine in terms of
physical disability. Your questionnaire is composed of twenty-four items
(17) and it has verified evidence of psychometric properties associated with construct
validity (r = 0.89), and test-retest reliability (r = 0.80). (12) That
http://www.healthgrades.com/symptoms/pain is
scored through just summing up the items circled around the questionnaire by
the participant. It features a minimal score regarding 0 along along with a maximum score involving
24.
A self-developed questionnaire (Economic Burden of LBP questionnaire
with component questions/items adapted via details obtained from
literature around the socioeconomic impact associated with LBP) was used to assess the
economic burden of LBP regarding this study. The Particular questionnaire features 43 items
and can be split up into three sections; Section A New features 13 objects on
socio-demographic details associated with participants; Section B offers 14 objects on
the immediate expenses involving care; Section C provides 16 products around the indirect costs
of care. This specific self-developed questionnaire was assessed with regard to content
validity by simply a specialist panel committee consisting associated with five
physiotherapists well-informed inside the style along with development of
questionnaires. the instrument ended up being then pretested about 15 patients with
low again pain. Your patients were built along with a clear understanding of every one involving the
items
in the actual self-developed questionnaire.
DATA ANALYSIS
Forty members completed the 2 questionnaires which were
self-administered. Descriptive figures of mean, normal deviation
and percentages had been utilized to summarize the data obtained. Inferential

5. statistics involving independent t-test had been accustomed to compare the economical cost
of LBP between male as well as female patients. Any chi square method was utilized to
test the actual association between economic price involving care and additionally the physical
disability in the patients along with LBP. level involving significance was set at
0.05.
RESULTS
A total involving forty individuals together with LBP receiving physiotherapy in
secondary along with tertiary health institutions within Ibadan participated in
this cross-sectional study. Your majority (62.5%) with the participants
were male. The Particular age bracket of participants ranged via 30 to end up being able to 80
years. A
large percentage (87.5%) in the members had been forty along with over (table
1). Respondents with main education and learning accounted for that highest (50%)
number involving respondents. The Actual vast majority (97.5%) in the individuals were
married. Traders accounted for the greatest percentage (42.5%) of
workers involved within this study. Nearly half (47.5%) of the respondents
reported the duration of oncoming of reduced lower again pain was lower than a
year, although 10.0% reported a new duration associated with more than 5 years.
The estimated annual economic expense was averaged at 139,156.25 [+ or
-] 77,091.16 naira together with direct expenses (114,661.25 [+ or perhaps -] 74,230.53
naira) accounting regarding 82.4% (table 4). Concerning 60.10% with the immediate costs
was attributed in order to physiotherapy (68,875.20 [+ or perhaps -] 53,988.52 naira)
followed by the cost associated with physician's visit (27009.00 [+ or even -]

6. 13314.95 naira). The Particular price associated with medications was the smallest amount of
(2796.33 [+ or even -]
903.70 naira) (table 2). the estimated typical annual indirect cost was
24,495.00 [+ or even -] 16,837.13 naira. The Actual estimated typical annual cost of
transportation associated with respondents has been 17,772.00 [+ as well as -] 13,526.12 naira.
Only 27.5% with the respondents were accompanied towards the hospital with regard to their
treatment. Your estimated average cost involving transportation involving accompanying
persons has been 12938.18 [+ or -] 9331.78 naira for each year. only three
respondents had compensated helpers whose average price ended up being estimated with 34,000
[+ or even -] 19,287.30 naira annually. Your typical annual price regarding meals
outside the residence ended up being 9738.46 [+ or perhaps -] 4850.69 naira annually (table 3).
Two-fifths of the individuals reported that they did not spend a few money on
meals away from home. Your average loss of work hrs per hospital
visit had been estimated from 10.25 [+ or -] 6.75 hours for each month.
The imply immediate price involving treatment for that male respondents was
109,594.80 [+ or even =] 54,340.00 naira while those of the females was
123,105.33 [+ or =] 49,210.54 naira. the imply indirect price associated with care for
the male respondents had been 24,902.40 [+ as well as =] 975.00 naira while that of
the females has been 23,816.00 [+ or =] 908.12 naira. Right now there had been no
significant difference (p = 0.60) in the all round economic burden associated with low
back pain between male and also female contributors on this research (table 5).
There would always be a significant association ([chi square] = 37.87; p =
0.04) in between respondents' disability scores as well as the economic costs
of LBP (table 6).

7. DISCUSSION
The economic burden of your disease is the summary of most costs
associated with that condition. This kind of means that the responsibility of the disease
cannot be obtained if which issue will not occur within the very first place.
The economic burden of a disease could further end up being split up into various
categories, these categories consist of direct cost, indirect cost and
intangible cost. However, in this study, the actual immediate along with indirect costs
of treatment had been summed up because the economic burden. The Particular average annual
economic price involving care obtained on this study is enormous relative to the
earning capacity involving an average Nigerian. That appears there is no
comparable published information on the economic burden of low lower again pain within the
Nigerian environment hence comparison are just in any position to be produced along with studies
from
other parts of your world. People using LBP incur millions of dollars
in medical expenditure annually in the United States. (10) The Actual findings
of Williams et al. (18) which indirect costs contribute 85 % in the total
costs involving LBP does not offer the findings with the present study. Within this
study, indirect price contributed 26%. This kind of could be explained through the
fact which the majority of your contributors bore all the expenses involving the
direct and also indirect expenses unlike what obtains in developed countries
where healthcare will be borne mainly through the government and insurance
companies. This specific research didn't include members whose expenses are
borne by simply medical insurance companies.
The ratio of direct costs for you to indirect costs associated with care obtained from

8. this research (3:1) supports previous findings that direct expense often
contributes mainly to the economic costs involving disease. (8,9,10) Coming From a
Finnish research reported throughout 2002, almost one third with the direct back pain
costs within well being treatment utilization had been spent on complementary therapies
and sick leaves which usually accounted with regard to 55% in the total costs. (14)
Physiotherapy visits had been a major contributor for the direct price associated with care
in this research then physician visits. This could be much like the
findings in Lafuma et al., (19) exactly where physical therapy contributed the
most (41.6%) to the immediate price of treatment accompanied by physicians'
fees (23.9%).
Indirect expenses or productivity losses are the labour earnings that
are forgone as becoming a results of a detrimental health outcome. the decreased
productivity may be described as a result of illness, death, aspect effects, as well as time
spent receiving treatment. Indirect expenses include lost earnings and
productivity of both patients and the members of the family who be careful of
them. Regarding a few diseases which usually bring about premature death, the indirect
cost is the loss in possible wages along with benefits. Throughout this study,
indirect cost of treatment included the price of transportation for you to keep
appointments, price associated with transportation of the accompanied person, expense of
meals outside the house, and in addition the price involving paid help. the estimate of
indirect cost obtained via this research might be restricted through the fact that
only a new minority of the individuals expended price upon meals for
accompanied persons, compensated assist and had meals away from house. The
small sample sized participants within this research can be identified as a
limitation involving this study. more studies are generally recommended to become able to discover

9. the
economic expenses involving LBP upon a larger population.
A closer evaluation of the economical burden regarding LBP reveals that will it
is probably the particular most common reason behind activity limitation in individuals under
the age of 45. (11) LBP will become the most costly benign situation in
industrialized countries also it will become the primary cause associated with disability
that affects individuals less than 45 many years as well as for anyone older when compared with 45
years, it will end up being the third leading cause associated with disability. (15) That results in
significant restriction upon actions involving every http://ergonomics4u.tumblr.com/ day living along
with on
participation, like inability for you to work. (10) in this study, many of
the participants had high scores about the Rolland Morris back Pain
Disability Questionnaire; this may be explained coming from findings of
previous studies exactly where LBP has been identified as among your leading
causes associated with disability. There would end up being a significant association although
between
disability and also economic burden involving LBP based about the results involving this
study. This kind of locating will be similar to that of Becker et al., (20) exactly where a

10. significant association was discovered in between disability and also economic cost
of LBP.
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(3.) Deyo RA. low back again pain. The main treatment challenge. Spine 1996;
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(4.) Van Tulder, Becker A, Bekkering et al. European guidelines for
the management of acute nonspecific lower back pain inside primary care.
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(5.) Omokhodion FO, Umar US, Ogunnowo BE. low Lower Back Again Pain within a
Nigerian University Or College Journal involving Occupational Medicine 2000; 53: 287-289.
(6.) Huppe A, Muller K, Raspe H. Can Be the particular occurrence of lower back again pain in
Germany decreasing? European Journal of the Public Wellness 2007; 17(3):
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11. (7.) Ihleback C, Eriksen. Are Generally the particular myths regarding low lumbar pain alive in
general Norwegian Population? Scand J Public health 2003; 31: 395-398.
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12. patients throughout Finnish general practice. Spine 2002; 27(6): 647-653.
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psychosocial risk aspects inside the growth and development of chronic reduced back pain
disability. Spine 1995; 20: 2702-2709.
(16.) Walker BF, Muller R, Grant WD. Lower back pain throughout Australian
adults. Wellness provider utilization and also care seeking. J Manipulative
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(17.) Rolland M, Morris R. The research of the all-natural reputation back
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(18.) William JH, money JK, Kristina SB. Implications regarding physical
activity inside the population along with reduced again pain. American Journal of
Lifestyle as well as Medicine 2009; 3(1): 63-70.
(19.) Lafuma A, Fagnani F, Vautravers P. Management and cost of
care for lower lower again pain throughout main care options in France. Pharmaco
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13. ADESOLA C ODOLE
ADERONKE A New AKINPELU
BABATUNDE A New ADEKANLA
OLATUNJI B OBISANYA
Department involving Physiotherapy, University regarding Medicine, College of
Ibadan, Ibadan.
Correspondence: Adesola C. Odole, Department involving Physiotherapy,
College associated with Medicine, School involving Ibadan, Ibadan * Email
adesola_odole@yahoo.com
Table 1. Socio-demographic characteristics associated with participants
Characteristics Absolutely No %
Sex
Male 25 62.5
Female 15 37.5
Age team (years)
30-40 5 12.5

14. 40-50 13 32.5
50-60 11 27.5
60-70 9 22.5
70 along with above two 5
Marital Status
Married 39 97.5
Single 0 0
Widowed 1 2.5
Cohabiting 0 0
Occupation
Banking 5 12.5
Trading 17 42.5
Teaching three 7.5
Safety 2 5
Farming two 5
Driving A Car 2 5
Estate management one 2.5
business 4 10
Civil support two 5
Engineering two 5
Level involving Education
School 5 12.5
post secondary 4 10

15. Secondary three 7.5
Technical 2 5
Teacher Grade II 3 7.5
Certificate
Main 20 50
Incomplete Secondary 1 2.5
Education
Simply No Formal Training 2 5
Table 2. direct price associated with proper care of lower again pain
Annual price (naira)
Sex n % Imply SD %
Physician's Visit
Male 25 62.5 29169.6 13254.25
Female 15 37.5 23408 13057.05
Total 40 100 27009 13314.95 23.56
Physiotherapy Visit
M 25 62.5 75426 68875.2
F 15 37.5 86344 62650.55
Total 40 100 68875.2 53988.52 63

16. Diagnostic Test
M 25 62.5 3782 1521.85
F 15 37.5 2893.33 787.6
Total 40 100 3448.75 1355.64 3
Topical Creams/Gels/Sprays
M 2 50 7488 2661.5
F 15 37.5 7160 2627.62
Total 40 100 7365 2649.2 6.4
Supportive Devices
M two 50 3500 0
F two 50 3750 353.55
Total 4 one hundred 3625 250 3.12
Medications
M 0 0 0 0
F 15 100 2796.33 903.7
Total 15 2796.33 903.7 0.92
Overall 114661.25 74230.53 100
Table 3. Indirect expense of proper care of reduced back pain
Annual price (naira)

17. n mean SD
Transportation
Respondent 40 17772 13526.12
Accompanying individual 11 12938.18 9331.78
Meals Outside Residence 13 9738.46 4850.69
Paid helps 3 34000 19287.3
Total 24495 16837.13
Hours lost per 10.25 6.75
hospital visit
Table 4. Economic expenses associated with lower back pain
Economic
Costs (Naira) mean SD %
Direct 114661.25 74230.53 82.4
Indirect 24495 16837.13 17.6
Total 139156.25 77091.16 100
Table 5. Comparison among economic expenses regarding male and
female patients using lower again pain
Economic Burden Male Female p value
Direct costs 109594.8 123105.33 0.549
Indirect expenses 24902.4 23816 0.862

18. Overall costs 134497.2 146921.33 0.598
Table 6. Association among Respondents'
Disability Scores and also Economic Burden regarding Care
Chi-square
Economic expenses Disability worth p value
Indirect costs 24.48 0.02 *
Direct expenses 23.07 0.05 *
Overall costs 37.87 0.04 *
* Significant with p 0.05