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The Global Spine Care Initiative: a systematic review of individual and community-based burden of spinal disorders in rural populations in low- and middle-income communities

European Spine Journal volume 27, pages 802–815 (2018)Cite this article

Abstract

Purpose

The purpose of this review was to synthesize literature on the burden of spinal disorders in rural communities to inform the Global Spine Care Initiative care pathway and model of care for their application in medically underserved areas and low- and middle-income countries.

Methods

A systematic review was conducted. Inclusion criteria included all age groups with nonspecific low back pain, neck pain, and associated disorders, nonspecific thoracic spinal pain, musculoskeletal chest pain, radiculopathy, or spinal stenosis. Study designs included observational study design (case-control, cross-sectional, cohort, ecologic, qualitative) or review or meta-analysis. After study selection, studies with low or moderate risk of bias were qualitatively synthesized.

Results

Of 1150 potentially relevant articles, 43 were eligible and included in the review. All 10 low and 18 moderate risk of bias studies were cross-sectional, 14 of which included rural residents only. All studies included estimates of low back pain prevalence, one included neck pain and one reported estimates for spinal disorders other than back or neck pain. The prevalence of low back pain appears greater among females and in those with less education, psychological factors (stress, anxiety, depression), and alcohol consumers. The literature is inconsistent as to whether back pain is more common in rural or urban areas. High risk of bias in many studies, lack of data on disability and other burden measures and few studies on conditions other than back and neck pain preclude a more comprehensive assessment of the individual and community-based burden of spinal disorders in less-developed communities.

Conclusion

We identified few high-quality studies that may inform patients, providers, policymakers, and other stakeholders about spinal disorders and their burden on individuals and communities in most rural places of the developing world. These findings should be a call to action to devote resources for high-quality research to fill these knowledge gaps in medically underserved areas and low and middle-income countries.

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References

  1. Woolf AD (2000) The bone and joint decade 2000–2010. Ann Rheum Dis 59:81–82. https://doi.org/10.1136/ard.59.2.81

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  2. Hoy D, March L, Brooks P, Blyth F, Woolf A, Bain C, Williams G, Smith E, Vos T, Barendregt J, Murray C, Burstein R, Buchbinder R (2014) The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. https://doi.org/10.1136/annrheumdis-2013-204428

    Article  PubMed  Google Scholar 

  3. Shearer HM, Carroll LJ, Wong JJ, Cote P, Varatharajan S, Southerst D, Sutton DA, Randhawa KA, Yu H, Mior SA, van der Velde GM, Nordin MC, Stupar M, Taylor-Vaisey AL (2015) Are psychological interventions effective for the management of neck pain and whiplash-associated disorders? A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Spine J . https://doi.org/10.1016/j.spinee.2015.08.011

    Article  PubMed  Google Scholar 

  4. Côté P, Wong JJ, Sutton D, Shearer HM, Mior S, Randhawa K, Ameis A, Carroll LJ, Nordin M, Yu H, Lindsay GM, Southerst D, Varatharajan S, Jacobs C, Stupar M, Taylor-Vaisey A, van der Velde G, Gross DP, Brison RJ, Paulden M, Ammendolia C, David Cassidy J, Loisel P, Marshall S, Bohay RN, Stapleton J, Lacerte M, Krahn M, Salhany R (2016) Management of neck pain and associated disorders: a clinical practice guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Eur Spine J. https://doi.org/10.1007/s00586-016-4467-7

    Article  PubMed  Google Scholar 

  5. Aas RW, Tuntland H, Holte KA, Roe C, Lund T, Marklund S, Moller A (2011) Workplace interventions for neck pain in workers. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD008160.pub2

    Article  PubMed  Google Scholar 

  6. Lehmann TR, Spratt KF, Lehmann KK (1993) Predicting long-term disability in low back injured workers presenting to a spine consultant. Spine 18:1103–1112

    CAS  Article  Google Scholar 

  7. Andersson GBJ (1999) Epidemiological features of chronic low-back pain. Lancet 354:581–585. https://doi.org/10.1016/S0140-6736(99)01312-4

    CAS  Article  PubMed  Google Scholar 

  8. Dionne CE, Koepsell TD, Von Korff M, Deyo RA, Barlow WE, Checkoway H (1997) Predicting long-term functional limitations among back pain patients in primary care settings. J Clin Epidemiol 50:31–43. https://doi.org/10.1016/S0895-4356(96)00313-7

    CAS  Article  PubMed  Google Scholar 

  9. Vos T et al (2016) Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet (London, England) 388:1545–1602. https://doi.org/10.1016/s0140-6736(16)31678-6

    Article  Google Scholar 

  10. Kassebaum et al (2016) Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet (London, England) 388:1603–1658. https://doi.org/10.1016/s0140-6736(16)31460-x

    Article  Google Scholar 

  11. Hoy D, Brooks P, Blyth F, Buchbinder R (2010) The Epidemiology of low back pain. Best Pract Res Clin Rheumatol 24:769–781. https://doi.org/10.1016/j.berh.2010.10.002

    CAS  Article  PubMed  Google Scholar 

  12. Global Spine Care Initiative. https://www.globalspinecareinitiative.org/. Accessed 10 Nov 2016

  13. McGowan J, Sampson M, Salzwedel DM, Cogo E, Foerster V, Lefebvre C (2016) PRESS peer review of electronic search strategies: 2015 guideline statement. J Clin Epidemiol 75:40–46. https://doi.org/10.1016/j.jclinepi.2016.01.021

    Article  PubMed  Google Scholar 

  14. Hart LG, Larson EH, Lishner DM (2005) Rural definitions for health policy and research. Am J Public Health 95:1149–1155. https://doi.org/10.2105/ajph.2004.042432

    Article  PubMed  PubMed Central  Google Scholar 

  15. Hoy D, Brooks P, Woolf A, Blyth F, March L, Bain C, Baker P, Smith E, Buchbinder R (2012) Assessing risk of bias in prevalence studies: modification of an existing tool and evidence of interrater agreement. J Clin Epidemiol 65:934–939. https://doi.org/10.1016/j.jclinepi.2011.11.014

    Article  PubMed  Google Scholar 

  16. Vandenbroucke JvE E, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, Poole C, Schlesselman JJ, Egger M (2007) Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. PLOS Med 4:e297

    Article  Google Scholar 

  17. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet (London, England) 370:1453–1457

    Article  Google Scholar 

  18. Slavin RE (1995) Best evidence synthesis: an intelligent alternative to meta-analysis. J Clin Epidemiol 48:9–18

    CAS  Article  Google Scholar 

  19. Barrero LH, Hsu YH, Terwedow H, Perry MJ, Dennerlein JT, Brain JD, Xu X (2006) Prevalence and physical determinants of low back pain in a rural Chinese population. Spine 31:2728–2734. https://doi.org/10.1097/01.brs.0000244583.35982.ea

    Article  PubMed  Google Scholar 

  20. Dhillon HK, Mohd Zaki Nik Mahmood N, Singh H (2007) Documentation of self-care actions taken for somatic complaints by postmenopausal Malay women living in Kelantan Malaysia. Maturitas 58:241–248. https://doi.org/10.1016/j.maturitas.2007.08.011

    Article  PubMed  Google Scholar 

  21. Meziat Filho N, Silva GA (2011) Disability pension from back pain among social security beneficiaries, Brazil. Rev Saude Publica 45:494–502

    Article  Google Scholar 

  22. Geere JA, Hunter PR, Jagals P (2010) Domestic water carrying and its implications for health: a review and mixed methods pilot study in Limpopo Province, South Africa. Environ Health Glob Access Sci Source 9:52. https://doi.org/10.1186/1476-069x-9-52

    Article  Google Scholar 

  23. Inbaraj LR, Haebar OJ, Saj F, Dawson S, Paul P, Prabhakar AK, Mohan VR, Alex RG (2013) Prevalence of musculoskeletal disorders among brick kiln workers in rural Southern India. Indian J Occup Environ Med 17:71–75. https://doi.org/10.4103/0019-5278.123170

    Article  PubMed  PubMed Central  Google Scholar 

  24. Kshetri DB, Smith WC (2011) Self-reported health problems, healthcare utilisation and unmet healthcare needs of elderly men and women in an urban municipality and a rural area of Bhaktapur District of Nepal. Aging Male 14:127–131. https://doi.org/10.3109/13685538.2010.502272

    Article  PubMed  Google Scholar 

  25. Naidoo S, Kromhout H, London L, Naidoo RN, Burdorf A (2009) Musculoskeletal pain in women working in small-scale agriculture in South Africa. Am J Ind Med 52:202–209. https://doi.org/10.1002/ajim.20662

    CAS  Article  PubMed  Google Scholar 

  26. Obregon-Ponce A, Iraheta I, Garcia-Ferrer H, Mejia B, Garcia-Kutzbach A (2012) Prevalence of musculoskeletal diseases in Guatemala, Central America: the COPCORD study of 2 populations. J Clin Rheumatol Pract Rep Rheum Musculoskelet Dis 18:170–174. https://doi.org/10.1097/RHU.0b013e3182583803

    Article  Google Scholar 

  27. Omokhodion FO (2002) Low back pain in a rural community in South West Nigeria. West Afr J Med 21:87–90

    PubMed  Google Scholar 

  28. Onwuekwe IO, Ezeala Adikaibe B, Ekenze SO (2012) Neurological disease burden in two semi-urban communities in South East Nigeria. Niger J Med J Natl Assoc Resid Dr Niger 21:317–319

    CAS  Google Scholar 

  29. Pradhan A (2004) Backache prevalence among groups with long and normal working day. Kathmandu Univ Med J 2:119–123

    CAS  Google Scholar 

  30. Prakash S, Manjunatha S, Shashikala C (2010) Morbidity patterns among rice mill workers: a cross sectional study. Indian J Occup Environ Med 14:91–93. https://doi.org/10.4103/0019-5278.75696

    Article  PubMed  PubMed Central  Google Scholar 

  31. Puntumetakul R, Yodchaisarn W, Emasithi A, Keawduangdee P, Chatchawan U, Yamauchi J (2015) Prevalence and individual risk factors associated with clinical lumbar instability in rice farmers with low back pain. Patient Preference Adherence 9:1–7. https://doi.org/10.2147/ppa.s73412

    Article  PubMed  Google Scholar 

  32. Rana A, Wahlin A, Streatfield P, Kabir Z (2009) Association of bone and joint diseases with health-related quality of life among older people: a population-based cross-sectional study in rural Bangladesh. Ageing Soc 29:727–743. https://doi.org/10.1017/S0144686X09008411

    Article  Google Scholar 

  33. Tella BA, Akinbo SR, Asafa SA, Gbiri CA (2013) Prevalence and impacts of low back pain among peasant farmers in south-west Nigeria. Int J Occup Med Environ Health 26:621–627. https://doi.org/10.2478/s13382-013-0135-x

    Article  PubMed  Google Scholar 

  34. Davatchi F, Tehrani Banihashemi AT, Gholami J, Faezi ST, Forouzanfar MH, Salesi M, Karimifar M, Essalatmanesh K, Barghamdi M, Noorolahzadeh E, Dahaghin S, Rasker JJ (2009) The prevalence of musculoskeletal complaints in a rural area in Iran: a WHO-ILAR COPCORD study (stage 1, rural study) in Iran. Clin Rheumatol 28:1267–1274. https://doi.org/10.1007/s10067-009-1234-8

    Article  PubMed  Google Scholar 

  35. Liu X, Wang L, Stallones L, Wheeler KK, Zhao W, Smith GA, Xiang H (2012) Back pain among farmers in a northern area of China. Spine 37:508–514. https://doi.org/10.1097/BRS.0b013e318221e83f

    Article  PubMed  PubMed Central  Google Scholar 

  36. Meksawi S, Tangtrakulwanich B, Chongsuvivatwong V (2012) Musculoskeletal problems and ergonomic risk assessment in rubber tappers: a community-based study in southern Thailand. Int J Ind Ergon 42:129–135. https://doi.org/10.1016/j.ergon.2011.08.006

    Article  Google Scholar 

  37. Santos LR, Assunção AA, Lima Ede P (2014) Back pain in adults living in quilombola territories of Bahia, Northeastern Brazil. Rev Saude Publica 48:750–757

    Article  Google Scholar 

  38. Taechasubamorn P, Nopkesorn T, Pannarunothai S (2011) Prevalence of low back pain among rice farmers in a rural community in Thailand. J Med Assoc Thail 94:616–621

    Google Scholar 

  39. Mahajan A, Jasrotia DS, Manhas AS, Jamwal SS (2003) Prevalence of major rheumatic disorders in Jammu. JK Sci 5:63–66

    Google Scholar 

  40. Miszkurka M, Haddad S, Langlois EV, Freeman EE, Kouanda S, Zunzunegui MV (2012) Heavy burden of non-communicable diseases at early age and gender disparities in an adult population of Burkina Faso: World Health Survey. BMC Public Health 12:24. https://doi.org/10.1186/1471-2458-12-24

    Article  PubMed  PubMed Central  Google Scholar 

  41. Mohseni-Bandpei MA, Fakhri M, Ahmad-Shirvani M, Bagheri-Nessami M, Khalilian AR, Shayesteh-Azar M, Mohseni-Bandpei H (2009) Low back pain in 1,100 Iranian pregnant women: prevalence and risk factors. Spine J 9:795–801. https://doi.org/10.1016/j.spinee.2009.05.012

    Article  PubMed  Google Scholar 

  42. Rodriguez-Amado J, Peláez-Ballestas I, Sanin LH, Esquivel-Valerio JA, Burgos-Vargas R, Perez-Barbosa L, Riega-Torres J, Garza-Elizondo MA (2011) Epidemiology of rheumatic diseases. A community-based study in urban and rural populations in the state of Nuevo Leon, Mexico. J Rheumatol Suppl 86:9–14. https://doi.org/10.3899/jrheum.100952

    Article  PubMed  Google Scholar 

  43. Sabbah I, Vuitton DA, Droubi N, Sabbah S, Mercier M (2007) Morbidity and associated factors in rural and urban populations of South Lebanon: a cross-sectional community-based study of self-reported health in 2000. Trop Med Int Health 12:907–919

    Article  Google Scholar 

  44. Omokhodion FO, Umar US, Ogunnowo BE (2000) Prevalence of low back pain among staff in a rural hospital in Nigeria. Occup Med (Lond) 50:107–110

    CAS  Article  Google Scholar 

  45. Chopra A, Patil J, Billempelly V, Relwani J, Tandle HS (2001) Prevalence of rheumatic diseases in a rural population in western India: a WHO-ILAR COPCORD Study. J Assoc Physicians India 49:240–246

    CAS  PubMed  Google Scholar 

  46. Birabi BN, Dienye PO, Ndukwu GU (2012) Prevalence of low back pain among peasant farmers in a rural community in South South Nigeria. Rural Remote Health 12:1920

    CAS  PubMed  Google Scholar 

  47. Akinpelu A, Odole A, Odejide A (2009) Prevalence and pattern of musculoskeletal pain in a rural community in Southwestern Nigeria. Internet J Epidemiol 8(2)

  48. Ahmed M, Haq SA, Islam N, Banik SK, Alam MN (2014) Burden of rheumatic diseases in a rural community of Bangladesh. J Med 15:125–130

    Google Scholar 

  49. Hoy D, Toole MJ, Morgan D, Morgan C (2003) Low back pain in rural Tibet. Lancet (London, England) 361:225–226. https://doi.org/10.1016/s0140-6736(03)12254-4

    Article  Google Scholar 

  50. Durlov S, Chakrabarty S, Chatterjee A, Das T, Dev S, Gangopadhyay S, Haldar P, Maity SG, Sarkar K, Sahu S (2014) Prevalence of low back pain among handloom weavers in West Bengal, India. Int J Occup Environ Health 20:333–339. https://doi.org/10.1179/2049396714y.0000000082

    Article  PubMed  PubMed Central  Google Scholar 

  51. Abegunde KA, Owoaje ET (2013) Health problems and associated risk factors in selected urban and rural elderly population groups of South-West Nigeria. Ann Afr Med 12:90–97. https://doi.org/10.4103/1596-3519.112398

    Article  PubMed  Google Scholar 

  52. Zeng QY, Darmawan J, Xiao ZY, Chen SB, Chen R, Lin K, Wigley R, Chen SL, Zhang NZ (2005) Risk factors associated with rheumatic complaints: a WHO-ILAR COPCORD study in Shantou, Southeast China. J Rheumatol 32:920–927

    PubMed  Google Scholar 

  53. Yiengprugsawan V, Harley D, Seubsman SA, Sleigh AC (2012) Physical and mental health among caregivers: findings from a cross-sectional study of Open University students in Thailand. BMC Public Health 12:1111. https://doi.org/10.1186/1471-2458-12-1111

    Article  PubMed  PubMed Central  Google Scholar 

  54. Wang S, Kou C, Liu Y, Li B, Tao Y, D’Arcy C, Shi J, Wu Y, Liu J, Zhu Y, Yu Y (2015) Rural-urban differences in the prevalence of chronic disease in northeast China. Asia Pac J Public Health Asia Pac Acad Consort Public Health 27:394–406. https://doi.org/10.1177/1010539514551200

    Article  Google Scholar 

  55. Prista A, Balague F, Nordin M, Skovron ML (2004) Low back pain in Mozambican adolescents. Eur Spine J 13:341–345. https://doi.org/10.1007/s00586-004-0683-7

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  56. Mwaka ES, Munabi IG, Buwembo W, Kukkiriza J, Ochieng J (2014) Musculoskeletal pain and school bag use: a cross-sectional study among Ugandan pupils. BMC Res Notes 7:222. https://doi.org/10.1186/1756-0500-7-222

    Article  PubMed  PubMed Central  Google Scholar 

  57. Haq SA, Darmawan J, Islam MN, Uddin MZ, Das BB, Rahman F, Chowdhury MA, Alam MN, Mahmud TA, Chowdhury MR, Tahir M (2005) Prevalence of rheumatic diseases and associated outcomes in rural and urban communities in Bangladesh: a COPCORD study. J Rheumatol 32:348–353

    PubMed  Google Scholar 

  58. Swami HM, Bhatia V, Dutt R (2002) A Community based study of the morbidity profile among the elderly in Chandigarh, India. Bahrain Med Bull 24:13–16

    Google Scholar 

  59. Stewart Williams J, Ng N, Peltzer K, Yawson A, Biritwum R, Maximova T, Wu F, Arokiasamy P, Kowal P, Chatterji S (2015) Risk factors and disability associated with low back pain in older adults in low- and middle-income countries. results from the WHO Study on Global AGEing and Adult Health (SAGE). PLoS One 10:e0127880. https://doi.org/10.1371/journal.pone.0127880

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  60. El-Sayed AM, Hadley C, Tessema F, Tegegn A, Cowan JA Jr, Galea S (2010) Back and neck pain and psychopathology in rural sub-Saharan Africa: evidence from the Gilgel Gibe Growth and Development Study, Ethiopia. Spine (Phila Pa 1976) 35:684–689. https://doi.org/10.1097/BRS.0b013e3181b4926e

    Article  Google Scholar 

  61. Hassan M, Haq SA, Choudhury MR, Islam N, Das A, Banik G, Mondal MT, Ali R (2012) Patterns of nonarticular rheumatism in a rural area of Bangladesh. J Med 13:165–169

    Article  Google Scholar 

  62. Jackson T, Thomas S, Stabile V, Han X, Shotwell M, McQueen K (2015) Prevalence of chronic pain in low-income and middle-income countries: a systematic review and meta-analysis. Lancet (London, England) 385(Suppl 2):S10. https://doi.org/10.1016/s0140-6736(15)60805-4

    Article  Google Scholar 

  63. Moher D, Pham B, Lawson ML, Klassen TP (2003) The inclusion of reports of randomised trials published in languages other than English in systematic reviews. Health Technol Assess (Winchester, England) 7(41):1–90

    CAS  Google Scholar 

  64. Morrison A, Polisena J, Husereau D, et al (2012) The effect of English-language restriction on systematic review-based meta-analyses: a systematic review of empirical studies. Int J Technol Assess Health Care 28(2):138–144

    Google Scholar 

  65. Carlson BA (1985) The potential of national household survey programmes for monitoring and evaluating primary healthcare in developing countries. World Health Stat Q 38:38–64

    CAS  PubMed  Google Scholar 

  66. Kroeger A (1983) Health interview surveys in developing countries: a review of the methods and results. Int J Epidemiol 12:465–481

    CAS  Article  Google Scholar 

  67. Cory S, Ussery-Hall A, Griffin-Blake S, Easton A, Vigeant J, Balluz L, Garvin W, Greenlund K (2010) Prevalence of selected risk behaviors and chronic diseases and conditions-steps communities, United States, 2006–2007. Morb Mortal Wkly Rep Surveill Summ (Washington, DC: 2002) 59:1–37

    Google Scholar 

  68. Sen A (2002) Health: perception versus observation. BMJ (Clinical research ed) 324:860–861

    Article  Google Scholar 

  69. Johnston DW, Propper C, Shields MA (2009) Comparing subjective and objective measures of health: evidence from hypertension for the income/health gradient. J Health Econ 28:540–552. https://doi.org/10.1016/j.jhealeco.2009.02.010

    Article  PubMed  Google Scholar 

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Acknowledgements

We thank Leslie Verville for her contributions to this paper.

Author information

Affiliations

  1. Office of Public Health Studies, University of Hawai`i, Mānoa, Honolulu, HI, USA

    Eric L. Hurwitz

  2. Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada

    Kristi Randhawa, Hainan Yu, Leslie Verville & Pierre Côté

  3. UOIT-CMCC Centre for Disability Prevention and Rehabilitation, Toronto, Canada

    Kristi Randhawa & Pierre Côté

  4. Rehabilitation Centre, San Cristobal Clinic, Santiago Spine Group, Santiago, Chile

    Paola Torres

  5. Department of Sports Science and Clinical Biomechanics, University of Southern Denmark and Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark

    Jan Hartvigsen

  6. Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, USA

    Scott Haldeman

  7. Department of Neurology, University of California, Irvine, CA, USA

    Scott Haldeman

  8. World Spine Care, Santa Ana, CA, USA

    Scott Haldeman

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  1. Eric L. Hurwitz
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Correspondence to Eric L. Hurwitz.

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Funding

The Global Spine Care Initiative and this study were funded by Grants from the Skoll Foundation and NCMIC Foundation. World Spine Care provided financial management for this project. The funders had no role in study design, analysis, or preparation of this paper.

Conflict of interest

EH declares he is a consultant for: RAND Corporation; EBSCO Information Services; Southern California University of Health Sciences; Western University of Health Sciences. Data and Safety Monitoring Committee Chair, Palmer Center for Chiropractic Research. Research Committee Co-chair, World Spine Care. KR declares funding to UOIT from Skoll Foundation, NCMIC Foundation through World Spine Care. PT declares no COI. HY declares funding to UOIT from Skoll Foundation, NCMIC Foundation through World Spine Care. LV declares funding to UOIT from Skoll Foundation and NCMIC Foundation through World Spine Care. JH declares his research group has extensive funding from Danish public funding agencies, the European Union, and Danish charities. PC is funded by a Canada Research Chair in Disability Prevention and Rehabilitation at the University of Ontario Institute of Technology, and declares funding to UOIT from Skoll Foundation, NCMIC Foundation through World Spine Care. Canadian Institutes of Health Research Canada. Research Chair Ontario Ministry of Finance. Financial Services Commission of Ontario. Ontario Trillium Foundation, ELIB Mitac. Fond de Recherche and Sante du Quebec. SH declares funding to UOIT from Skoll Foundation, NCMIC Foundation through World Spine Care. Clinical Policy Advisory Board and stock holder, Palladian Health. Advisory Board, SpineHealth.com. Book Royalties, McGraw Hill. Travel expense reimbursement-CMCC Board.

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Hurwitz, E.L., Randhawa, K., Torres, P. et al. The Global Spine Care Initiative: a systematic review of individual and community-based burden of spinal disorders in rural populations in low- and middle-income communities. Eur Spine J 27, 802–815 (2018). https://doi.org/10.1007/s00586-017-5393-z

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Keywords

  • Spine
  • Neck pain
  • Back pain
  • Global burden of disease