It is unknown whether the built environment influences recovery from low back pain (LBP). Objective: To investigate whether neighbourhood walkability influences the recovery from LBP after adjusting for genetics and shared environmental factors. Study group: We conducted a longitudinal analysis of adult twins with LBP from the Washington State Twin Registry (average follow-up: 1.7 years). Methods: Walkability, assessed using the valid and reliable Walkscore®, was our exposure. Recovery from LBP (i.e., pain free for 3 months) at follow-up was our outcome. Multivariate logistic regression analyses were performed for the total sample (n = 1,299 twins) and for twin pairs discordant for recovery at follow-up (within-pair analysis, n = 240 twins), stratified by zygosity (dizygotic (DZ) twins, n = 138; monozygotic twins (MZ), n = 102). Results: 384 (29.6%) twins had recovered from LBP at follow-up. The total sample analysis showed no association between walkability and recovery from LBP (OR = 0.99, 95%CI: 0.99-1.00, n = 1,250 twins). There was also no association between walkability and recovery from LBP after controlling for genetics and shared environmental factors in the within-pair twin analysis of all twins (OR = 0.99, 95% CI: 0.98-1.02, n = 240 twins), DZ twins (OR = 0.99, 95% CI: 0.97-1.01, n = 138) and MZ twins (OR = 0.99; 95%CI: 0.98-1.02, n = 102). Conclusions: People with LBP who live in an environment that supports physical activity are not more likely to recover from LBP than those who live in an environment where it is more difficult to be active. Because these results did not change after adjusting for genetic and shared environmental confounding, we are more confident in these findings.
Zadro JR, Gill D, Pinheiro MB, Duncan GE, Ferreira M, Ferreira PH. Does it matter where you live? The effect of neighbourhood walkability on recovery from low back pain. Int Public Health J. 2022;14(1):61-68.