Predictors of Persistent Disability and Back Pain in Older Adults with a New Episode of Care for Back Pain
Rundell SD, Sherman KJ, Heagerty PJ, Mock CN, Dettori NJ, Comstock BA, Avins AL, Nedeljkovic SS, Nerenz DR, Jarvik JG. Predictors of Persistent Disability and Back Pain in Older Adults with a New Episode of Care for Back Pain. Pain Medicine 2017; 18(6):1049-1062.
Objective: To identify predictors of persistent disability and back pain in older adults.
Design: Prospective cohort study.
Setting: Back pain outcomes using longitudinal data registry.
Subjects: Five thousand two hundred twenty adults age 65 years and older with a new primary care visit for back pain.
Methods: Baseline measurements included: demographics, health, and back pain characteristics. We abstracted imaging findings from 348 radiology reports. The primary outcomes were the Roland-Morris Disability Questionnaire (RMDQ) and back pain intensity. We defined persistent disability as RMDQ of 4/24 or higher at both six and 12 months and persistent back pain as pain 3/10 or higher at both six and 12 months.
Results: There were 2,498 of 4,143 (60.3%) participants with persistent disability, and 2,099 of 4,144 (50.7%) had persistent back pain. Adjusted analyses showed the following characteristics most strongly predictive of persistent disability and persistent back pain: sex, race, worse baseline clinical characteristics of back pain, leg pain, back-related disability and duration of symptoms, smoking, anxiety symptoms, depressive symptoms, a history of falls, greater number of comorbidities, knee osteoarthritis, wide-spread pain syndromes, and an index diagnosis of lumbar spinal stenosis. Within the imaging data subset, central spinal stenosis was not associated with disability or pain.
Conclusion: We found that many predictors in older adults were similar to those for younger populations.
Medical Subject Headings
Aged; Aged, 80 and over; Back Pain; Cohort Studies; Disability Evaluation; Disabled Persons; Episode of Care; Female; Follow-Up Studies; Humans; Longitudinal Studies; Male; Pain Measurement; Predictive Value of Tests; Prospective Studies