Long-term outcomes of a large, prospective observational cohort of older adults with back pain

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The spine journal


BACKGROUND CONTEXT: Although back pain is common among older adults, there is relatively little research on the course of back pain in this age group.

PURPOSE: Our primary goals were to report 2-year outcomes of older adults initiating primary care for back pain and to examine the relative importance of patient factors versus medical interventions in predicting 2-year disability and pain.

STUDY DESIGN/SETTING: This study used a predictive model using data from a prospective, observational cohort from a primary care setting.

PATIENT SAMPLE: The study included patients aged ≥65 years at the time of new primary care visits for back pain.

OUTCOME MEASURES: Self-reported 2-year disability (Roland-Morris Disability Questionnaire [RDQ]) and back pain (0-10 numerical rating scale [NRS]).

METHODS: We developed our models using a machine learning least absolute shrinkage and selection operator approach. We evaluated the predictive value of baseline characteristics and the incremental value of interventions that occurred between 0 and 90 days, and the change in patient disability and pain from 0 to 90 days. Limitations included confounding by indication and unmeasured confounding.

RESULTS: Of 4,665 patients (89%) with follow-up, both RDQ (from mean 9.6 [95% confidence interval {CI} 9.4-9.7] to mean 8.3 [95% CI 8.0-8.5]) and back pain NRS (from mean 5.0 [95% CI 4.9-5.1] to mean 3.5 [95% CI 3.4-3.6]) scores improved slightly. Only 16% (15%-18%) reported no back pain-related disability or back pain at 2 years after initial visits. Regression model parameters explained 40% of the variation (R

CONCLUSIONS: Baseline patient factors were more important than early interventions in explaining disability and pain after 2 years.

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