Low back pain is a common health problem that most people experience at some point in their life. However, its burden is often considered trivial. The risk factors to develop low back pain is multifactorial and although some of these factors have been shown in previous studies, their associations remain poorly understood. Thinking of it, twin studies might clarify the role of genetics factors and personal behaviors, such as exposure to tobacco smoke, which are involved on the onset of low back pain. Objective: To investigate the association between personal behaviors, exposure to tobacco smoke, and genetic factors and the development of low back pain in adults twins, as well as pain-related disability. Methods: The sample of this study will be composed of adult twins from the Murcia Twin Registry, a community-based registry of twins from Spain. All the twins will answer questions about lifetime prevalence of low back pain, as well as exposure to tobacco smoke history, sleep quality, and engagement in leisure physical activity. Statistical analysis: Descriptive statistics will be conducted for all variables. Analyses will be performed separately for each variable in two stages: total sample analysis and within-pair twin case-control analysis. Frequencies of reported risk factors will be presented for twin pairs and separately for cases and controls. Findings for twin pairs will be first presented for pairs irrespective of their zygosity and subsequently separated according to the zygosity status (ie, mono- or dizygotic twin pairs). Analyses will be conducted using IBM SPSS software version 22.0 (IBM corporation, Somers, NY, USA).
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