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Chiropr Man Therap. 2018 Dec 11;26:51. doi: 10.1186/s12998-018-0220-0. eCollection 2018.

Are frequent measurements in back pain research harmful? Two comparisons of back pain in groups with or without frequent follow-up.

Author information

1Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark.
2Dept. of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
Private Chiropractic Practice, Copenhagen, Denmark.



Frequent measures are becoming increasingly used to evaluate the course of spinal pain. However, it is not known whether this type of continuous follow-up in itself has implications for people's experience of pain. Therefore this article examines a potential impact of frequent follow-up using SMS reporting on the report of pain, based on results from two previous studies of spinal pain.


We examined two sets of cohorts, where each set was comparable in all other aspects, but one cohort in each set had been followed with weekly SMS-questions about the presence of spinal pain for 6 years and 1 year, respectively, whereas the other cohort had not answered any questions for research purposes before. At the end of the follow-up period, two cohorts, consisting of pupils from 5th and 6th grade, completed the Young Spine Questionnaire about spinal pain, one cohort in 2010 and the other in 2014. The other set of cohorts, consisting of low back pain patients in primary care, completed an extensive questionnaire about their back pain (2011 to 2013).


In both sets of cohorts there was a statistically significant difference in pain intensity with the pupils/patients who had been subject to frequent follow-up over long periods of time reporting lower intensity of pain. Other differences were small and not statistically significant.


Since the data were not optimally suited for the purpose of these analyses, the results should obviously be interpreted with caution, but they do not support a theory about increased attention leading to increased awareness, which in turn will lead to increased pain. On the contrary, participants reported lower levels of pain when belonging to the samples that had been subject to frequent follow-up by SMS-track over long periods of time.


Back pain; Frequent measures; Monitoring; Neck pain; Pain intensity

Conflict of interest statement

Cohort 1a: Prior to the study, the parents to the involved students received a letter including information about the project. Participation did not require parental consent, but the parents were informed that they could initially, or at any time later, decline their child’s participation. This form of passive consent was reviewed by the Regional Committee for Health Research Ethics with the rest of the project protocol. The conclusion was that the project was acceptable according to Danish legislation and did not require formal approval because all tests were non-invasive and there were no physical intervention involved [16]. The study was approved by the Danish Data Protection Agency (J-no. 2010-41-5147). Cohort 1b: Ethics committee approval was obtained before the start of the project (ID S20080047) and it was approved by the Danish Data Protection Agency (J-no. 2008-41-2240). Since this was not a randomized controlled clinical trial, the study is not suitable for registration in any of the clinical trial registers. All parents or guardians provided informed written consent for the family to participate in the study. In relation to children, all participation was voluntary; children could at any time withdraw from the whole project or from any part of it. Cohort 2: The local ethics committee found that the study did not need approval, since there was no intervention involved, which is in line with Danish law [16]. Documentation is available upon request. The project was approved by the Danish Data Protection Agency (J-no. 2004-41-4763 and J-no. 2010-41-5163). At the initial consultation, the patient was given oral and written information about the prospective study, an invitation to participate and a baseline questionnaire, including a consent form. Thus, written consent was given by returning the questionnaire.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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