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

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.