Abstract
Background: LBP Epidemiological studies have identified important causal and prognostic factors, but these frequently only identify a proportion of the variance, and new factors add little to these models. Recently, interest has increased in studying diseases over the lifecourse, a move accompanied by crucial conceptual and methodological developments. This has resulted in improvements in the understanding of conditions such as cardiovascular and respiratory disease.
Aim: To examine how conceptual frameworks from lifecourse epidemiology could enhance LBP research.
Method and Results: Concept 1: patterns over time, risk chains and accumulation. Simple ‘chains of risk’ have been studied, e.g. depression leading to LBP, but studies involving more risk factors in the chain are infrequent. Also, we have not examined how risk accumulation influences outcome, e.g. whether multiple episodes or duration of depression, throughout the lifecourse, better predicts LBP. One-year LBP trajectories have been described, but descriptions of longer-term patterns with associated transitions and turning points are lacking. Concept 2: influences and determinants of pathways. LBP studies commonly adjust for confounders, but factors modifying risk, or related to resilience or susceptibility to LBP, are rarely studied. Concept 3: timing of risk. Studies of critical or sensitive periods – crucial times of life which influence later health in life – are scarce in LBP research.
Conclusion: LBP researchers should develop hypotheses and models of how risks from different stages of life might interact and influence the onset, persistence and prognosis of LBP throughout the lifecourse. Adoption of concepts and methods from lifecourse epidemiology could facilitate this.
Correspondence should be addressed to SBPR at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE, England.
