Biopsychosocial factors and low back pain in military personnel with lower limb loss: the ADVANCE study
File(s)
Published version (online first)
Author(s)
Type
Journal Article
Abstract
Introduction Biopsychosocial factors influence low back pain (LBP) in the general population but may affect people with lower limb loss (LLL) differently. The first aim was to investigate the relationship between LBP, disability and injury status. We hypothesised that those with LLL (no lumbosacral injury) will have more LBP and functional disability than those with (i) non-lumbosacral and non-amputation trauma and (ii) a non-injured comparison group, but less LBP and functional disability than those with (iii) lumbosacral trauma. The second aim was to report the biopsychosocial factors of LBP for those with LLL (no lumbosacral injury), stratified by functional disability.
Methods Military and veteran personnel who did (‘exposed’, n=578) and did not (‘unexposed’, n=565) sustain combat trauma completed questionnaires for LBP severity, functional disability and biopsychosocial factors. The exposed group was subdivided into participants with lumbosacral injuries (exposed-lumbosacral (Exp-L)), those with LLL and no lumbosacral injuries (exposed-lower limb amputee (Exp-A)) and those with neither LLL nor lumbosacral injuries (exposed-non-lower limb amputee (Exp-NA)). LBP and functional disability were statistically compared for Exp-A versus unexposed, Exp-A versus Exp-L and Exp-A versus Exp-NA. Biopsychosocial factors were descriptively compared for Exp-A with and without functional disability.
Results Exp-A had worse LBP and functional disability than unexposed (both p<0.001), less LBP (p=0.02) and functional disability (p=0.001) than Exp-L, but no different from Exp-NA. Exp-A with functional disability experienced more LBP prior to LLL, higher body mass index, greater current opioid use, increased phantom and residuum pain and higher depression scores than those without.
Conclusion LBP and functional disability were significantly worse in participants with LLL (without comorbid lumbosacral combat injury) than controls, although LBP and functional disability scores were low. Biopsychosocial factors, comorbid non-amputation combat trauma (including lumbosacral), history of LBP, phantom and residuum pain are associated with greater functional disability in people with LLL.
Methods Military and veteran personnel who did (‘exposed’, n=578) and did not (‘unexposed’, n=565) sustain combat trauma completed questionnaires for LBP severity, functional disability and biopsychosocial factors. The exposed group was subdivided into participants with lumbosacral injuries (exposed-lumbosacral (Exp-L)), those with LLL and no lumbosacral injuries (exposed-lower limb amputee (Exp-A)) and those with neither LLL nor lumbosacral injuries (exposed-non-lower limb amputee (Exp-NA)). LBP and functional disability were statistically compared for Exp-A versus unexposed, Exp-A versus Exp-L and Exp-A versus Exp-NA. Biopsychosocial factors were descriptively compared for Exp-A with and without functional disability.
Results Exp-A had worse LBP and functional disability than unexposed (both p<0.001), less LBP (p=0.02) and functional disability (p=0.001) than Exp-L, but no different from Exp-NA. Exp-A with functional disability experienced more LBP prior to LLL, higher body mass index, greater current opioid use, increased phantom and residuum pain and higher depression scores than those without.
Conclusion LBP and functional disability were significantly worse in participants with LLL (without comorbid lumbosacral combat injury) than controls, although LBP and functional disability scores were low. Biopsychosocial factors, comorbid non-amputation combat trauma (including lumbosacral), history of LBP, phantom and residuum pain are associated with greater functional disability in people with LLL.
Date Issued
2025-06-20
Date Acceptance
2025-05-31
Citation
BMJ Military Health, 2025
ISSN
2633-3767
Publisher
BMJ Publishing Group
Journal / Book Title
BMJ Military Health
Copyright Statement
© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group. http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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Publication Status
Published online
Date Publish Online
2025-06-20