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McNaughton DT, Roseen EJ, Patel S, Downie A, Øverås CK, Nim C, Harsted S, Jenkins H, Young JJ, Hartvigsen J, Wong JJ, Stone KL, Ensrud KE, Lee S, Cawthon PM, Fink HA. Long-term Trajectories of Low Back Pain in Older Men: A Prospective Cohort Study With 10-Year Analysis of the Osteoporotic Fractures in Men Study. J Gerontol A Biol Sci Med Sci 2024; 79:glae175. [PMID: 38995164 PMCID: PMC11333921 DOI: 10.1093/gerona/glae175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Indexed: 07/13/2024] Open
Abstract
Although low back pain (LBP) may persist or recur over time, few studies have evaluated the individual course of LBP over a long-term period, particularly among older adults. Based on data from the longitudinal Osteoporotic Fractures in Men (MrOS) Study, we aimed to identify and describe different LBP trajectories in older men and characterize members in each trajectory group. A total of 5 976 community-dwelling men (mean age = 74.2) enrolled at 6 U.S. sites were analyzed. Participants self-reported LBP (yes/no) every 4 months for a maximum of 10 years. Latent class growth modeling was performed to identify unique LBP trajectory groups that explained variation in the LBP data. The association of baseline characteristics with trajectory group membership was assessed using univariable and multivariable multinominal logistic regression. A 5-class solution was chosen; no/rare LBP (n = 2 442/40.9%), low frequency-stable LBP (n = 1 040/17.4%), low frequency-increasing LBP (n = 719/12%), moderate frequency-decreasing LBP (n = 745/12.5%), and high frequency-stable LBP (n = 1 030/17.2%). History of falls (OR = 1.52), history of LBP (OR = 6.37), higher physical impairment (OR = 1.51-2.85), and worse psychological function (OR = 1.41-1.62) at baseline were all associated with worse LBP trajectory groups in this sample of older men. These findings present an opportunity for targeted interventions and/or management to older men with worse or increasing LBP trajectories and associated modifiable risk factors to reduce the impact of LBP and improve quality of life.
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Affiliation(s)
- David T McNaughton
- College of Health Sciences, School of Medical, Health, and Applied Sciences, Central Queensland University, Brisbane, Queensland, Australia
- School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Eric J Roseen
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedision School of Medicine, Boston Medical Center, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Sheena Patel
- Research Institute, California Pacific Medical Center, San Francisco, California, USA
| | - Aron Downie
- Department of Chiropractic, Macquarie University, Sydney, New South Wales, Australia
| | - Cecilie K Øverås
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Casper Nim
- Spine Centre of Southern Denmark, University Hospital of Southern Denmark, Middelfart, Denmark
- Department of Sports Science and Clinical Biomechanics, Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
| | - Steen Harsted
- Spine Centre of Southern Denmark, University Hospital of Southern Denmark, Middelfart, Denmark
- Department of Sports Science and Clinical Biomechanics, Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
| | - Hazel Jenkins
- Department of Chiropractic, Macquarie University, Sydney, New South Wales, Australia
| | - James J Young
- Department of Sports Science and Clinical Biomechanics, Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, Odense, Denmark
| | - Jessica J Wong
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Canada
| | - Katie L Stone
- Research Institute, California Pacific Medical Center, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Kristine E Ensrud
- Division of Epidemiology and Community Health, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Soomi Lee
- Department of Human Development and Family Studies, Center for Healthy Aging, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Peggy M Cawthon
- Research Institute, California Pacific Medical Center, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Howard A Fink
- Division of Epidemiology and Community Health, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
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Weiser S, Mowery HC, Campello M, Chytas V, Cedraschi C. What do older adults want from spine care? BRAIN & SPINE 2024; 4:102844. [PMID: 38873530 PMCID: PMC11170354 DOI: 10.1016/j.bas.2024.102844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/24/2024] [Accepted: 05/27/2024] [Indexed: 06/15/2024]
Abstract
Introduction Older adults comprise a large portion of back pain (BP) sufferers but are under-represented in the literature. Patients over age 65 present with different clinical characteristics and psychosocial needs than younger patients. Therefore, recommended patient-centered outcomes for BP may not be relevant to older patients. Research question What treatment outcomes are most important to adults over 65 years of age? Materials and methods We queried older adults seeking treatment for BP using qualitative methods. Participants were asked about their goals and expectations of treatment in an audio-taped interview. Audiotapes were transcribed, coded and analyzed by the investigators. Using thematic analysis, main themes and constructs were extracted and interpreted by the investigators. From there we were able to generate hypotheses about what older patients want from spine treatment. Results For all participants, age played a role in their treatment goals as a moderator or motivator. They were most concerned with returning to usual activities and preventing further physical limitations to maintain independence. Goals that reflect important outcomes such as increasing walking tolerance and improving balance were of particular importance. Confidence in the provider acted as a facilitator of goals. Discussion and conclusion Unlike their younger cohorts, they did not emphasize work-related outcomes and pain relief. These findings can be tested in future quantitative studies and will help to develop protocols for outcomes assessment in older adults. This study is a first step towards understanding and improving the quality of care for older patients with back pain.
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Affiliation(s)
- Sherri Weiser
- New York University Grossman School of Medicine, 550 1st Ave, New York, NY, 10016, USA
| | - Hope C. Mowery
- New York University Langone Orthopedic Hospital, 63 Downing St, New York, NY, 10014, USA
| | - Marco Campello
- New York University Grossman School of Medicine, 550 1st Ave, New York, NY, 10016, USA
| | - Vasileios Chytas
- Department of Psychiatry, Service of Liaison Psychiatry and Crisis Intervention, Geneva University Hospitals, Geneva, Switzerland
| | - Christine Cedraschi
- Division of General Medical Rehabilitation, Geneva University Hospitals, 14 - CH, Geneva, 1211, Switzerland
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Knox PJ, Simon CB, Pohlig RT, Pugliese JM, Coyle PC, Sions JM, Hicks GE. Construct validity of movement-evoked pain operational definitions in older adults with chronic low back pain. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:985-992. [PMID: 36944266 PMCID: PMC10391587 DOI: 10.1093/pm/pnad034] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 03/03/2023] [Accepted: 03/09/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE Movement-evoked pain (MeP) may predispose the geriatric chronic low back pain (LBP) population to health decline. As there are differing operational definitions for MeP, the question remains as to whether these different definitions have similar associations with health outcomes in older adults with chronic LBP. DESIGN Cross-sectional analysis of an observational study. SETTING Clinical research laboratory. SUBJECTS 226 older adults with chronic LBP. METHODS This secondary analysis used baseline data from a prospective cohort study (n = 250). LBP intensity was collected before and after the repeated chair rise test, stair climbing test, and 6-minute walk test; MeP change scores (ie, sum of pretest pain subtracted from posttest pain) and aggregated posttest pain (ie, sum of posttest pain) variables were calculated. LBP-related disability and self-efficacy were measured by the Quebec Back Pain Disability Scale (QBPDS) and Low Back Activity Confidence Scale (LOBACS), respectively. Physical function was measured with the Health ABC Performance Battery. Robust regression with HC3 standard errors was used to evaluate adjusted associations between both MeP variables and disability, self-efficacy, and physical function. RESULTS Greater aggregated posttest MeP was independently associated with worse disability (b = 0.593, t = 2.913, P = .004), self-efficacy (b = -0.870, t = -3.110, P = .002), and physical function (b = -0.017, t = -2.007, P = .039). MeP change scores were not associated with any outcome (all P > .050). CONCLUSIONS Aggregate posttest MeP was linked to poorer health outcomes in older adults with chronic LBP, but MeP change scores were not. Future studies should consider that the construct validity of MeP paradigms partially depends on the chosen operational definition.
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Affiliation(s)
- Patrick J Knox
- Department of Physical Therapy, University of Delaware, Newark, DE 19713, United States
| | - Corey B Simon
- Department of Orthopaedic Surgery, Physical Therapy Division, Duke University, Durham, NC 27710, United States
| | - Ryan T Pohlig
- Department of Epidemiology, University of Delaware, Newark, DE 19713, United States
- Biostatistics Core, University of Delaware, Newark, DE 19713, United States
| | - Jenifer M Pugliese
- Department of Physical Therapy, University of Delaware, Newark, DE 19713, United States
| | - Peter C Coyle
- Department of Physical Therapy, University of Delaware, Newark, DE 19713, United States
| | - Jaclyn M Sions
- Department of Physical Therapy, University of Delaware, Newark, DE 19713, United States
| | - Gregory E Hicks
- Department of Physical Therapy, University of Delaware, Newark, DE 19713, United States
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The Intersection of Pain Outcomes and Social Isolation Among African Americans. J Racial Ethn Health Disparities 2021; 9:1905-1911. [PMID: 34506012 DOI: 10.1007/s40615-021-01128-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/21/2021] [Accepted: 08/04/2021] [Indexed: 10/20/2022]
Abstract
There is increasing evidence suggesting the influence social isolation has on health outcomes and mental well-being. Chronic medical conditions, such as pain, have been shown to impact social relationships and isolation among majority populations, but there is little evidence documenting this relationship among African Americans. To address this lack of scholarly work, the current study aimed to examine subjective and objective social isolation, pain interference with daily life, and problems with pain in a sample of African American adults 18 + years of age. Taken from the National Survey of American Life: Coping with Stress in the 21st Century (NSAL), results showed that participants who were objectively isolated from family only were more likely to have a chronic health problem that was associated with increased pain. Data further showed that those reporting subjective isolation from both family and friends experienced greater interference from pain than those who were not isolated from family and friends. Findings from this study acknowledge a larger issue that addresses the impact social isolation has on health, quality of life, and general well-being. Recognizing the influence of such may allow systems to acknowledge the determinants that perpetuate social isolation, while still recognizing the needs of marginalized groups.
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Teixeira LF, Diz JBM, Moreira BDS, Silva SLAD, Dias JMD, Pereira LSM, Dias RC. Attitudes and beliefs of older adults with acute low back pain: 12-month results from the Brazilian cohort back complaints in the elders. Musculoskeletal Care 2021; 20:279-289. [PMID: 34379352 DOI: 10.1002/msc.1583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 07/20/2021] [Accepted: 07/29/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Psychosocial factors have been identified as important predictors of onset, course and persistence of low back pain (LBP) in the general population. OBJECTIVE To identify factors associated with attitudes/beliefs in older adults with LBP throughout a 12-month follow-up. METHODS A longitudinal investigation was conducted with 500 participants aged ≥60 years reporting a new (acute) episode of nonspecific LBP. Data were obtained at baseline, 6-week, 3-, 6-, 9-, and 12-month interviews. The study variables were: [dependent] LBP-related attitudes/beliefs that were assessed by the Back Beliefs Questionnaire (BBQ); [independent] age; sex; LBP intensity 'at-the-present-time' of interview and 'over-the-past-week' before interview; LBP frequency; LBP-related treatments; disability; mobility; depressive symptoms; self-perceived recovery; expectation of pain improvement; and expectation for returning to activities. Data were analysed by multiple linear regression analysis. RESULTS At baseline, 85.7% of the participants were female, had mean age of 69.0 (6.3) years, mean BBQ score of 24.5 (6.5), and 79.6% reported pain complaints after an acute episode of LBP. After 12 months, participants maintained a mean BBQ score of 24.6 (6.6) and 63.3% still reported pain complaints after an acute episode of LBP at baseline. Multivariate analysis showed that disability, advancing age, poor expectation of pain improvement in 3 months, and mobility decline were significantly associated with worse BBQ scores during all follow-ups. CONCLUSION Ageing, hopelessness, and physical and functional impairment impact pain-related behaviours among older patients seeking healthcare due to acute LBP complaints. Their screening may assist in strategies to manage symptoms and prevent the persistence of pain.
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Affiliation(s)
- Luiza Faria Teixeira
- Department of Physical Therapy, Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Juliano Bergamaschine Mata Diz
- Department of Physical Therapy, Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Bruno de Souza Moreira
- Graduate Program in Public Health, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - João Marcos Domingues Dias
- Department of Physical Therapy, Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Leani Souza Máximo Pereira
- Department of Physical Therapy, Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Rosângela Corrêa Dias
- Department of Physical Therapy, Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Stensland M. Managing the Incurable: Older Pain Clinic Patients' Experiences of Managing Treatment-Resistant Chronic Low Back Pain. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2021; 64:405-422. [PMID: 33719939 DOI: 10.1080/01634372.2021.1898073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 02/26/2021] [Accepted: 02/28/2021] [Indexed: 06/12/2023]
Abstract
Chronic low back pain (CLBP) is a highly prevalent disabling condition among older adults, and treatment remains a challenge. Limited research has qualitatively examined late-life CLBP and its management. Study objective was to examine how older adults experience pain management approaches for CLBP. Guided by van Manen's phenomenological method, 21 pain clinic patients (66-83) completed semi-structured interviews. Under the main theme "Managing the incurable," four subthemes emerged: (a) A quest for relief; (b) Spinal procedures offer temporary relief yet ongoing disappointment; (c) The apprehension of medication (d) Making things work for me. Social work practice implications are discussed.
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Affiliation(s)
- Meredith Stensland
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center of San Antonio, San Antonio, Texas, USA
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7
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Geraghty AWA, Roberts LC, Stanford R, Hill JC, Yoganantham D, Little P, Foster NE, Hay EM, Yardley L. Exploring Patients' Experiences of Internet-Based Self-Management Support for Low Back Pain in Primary Care. PAIN MEDICINE 2021; 21:1806-1817. [PMID: 31841156 PMCID: PMC7553019 DOI: 10.1093/pm/pnz312] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objective We explored patients’ experiences of using Internet-based self-management support for low back pain (LBP) in primary care, with and without physiotherapist telephone guidance. Design Exploratory descriptive qualitative study using thematic analysis, nested within a randomized feasibility trial. Methods Patients with LBP who participated in a feasibility trial of the SupportBack Internet intervention (ISRCTN: 31034004) were invited to take part in semistructured telephone interviews after the three-month intervention period (a convenience sample from within the trial population). Fifteen participants took part (age range = 36–87 years, 66.7% female, characteristics representative of the trial population). Data were analyzed thematically. Results Analysis resulted in the development of six themes (subthemes in parentheses): Perceptions of SupportBack’s design (Clarity and ease of use, Variety and range of information provided, Need for specificity and flexibility), Engaging with the SupportBack intervention, Promoting positive thought processes (Reassurance, Awareness of self-management), Managing behavior with SupportBack (Motivation and goal setting, Using activity as a pain management strategy, Preferences for walking or gentle back exercises), Feeling supported by telephone physiotherapists (Provision of reassurances and clarity, Physiotherapists are motivating), Severity and comorbidity as barriers (Preexisting condition or severity acting as a barrier, Less useful for mild low back pain). Conclusions The Internet intervention SupportBack appeared to feasibly support self-management of LBP. Reassurance and ongoing support to implement behavioral changes were central to reported benefits. The addition of physiotherapist telephone support further enhanced the patient experience and the potential utility of the intervention.
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Affiliation(s)
- Adam W A Geraghty
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Lisa C Roberts
- School of Health Sciences, University of Southampton & University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Rosie Stanford
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Jonathan C Hill
- Arthritis Research UK Primary Care Centre, Institute for Primary Care and Health Sciences, Keele University, Newcastle, UK
| | - Dinesh Yoganantham
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Paul Little
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Nadine E Foster
- Arthritis Research UK Primary Care Centre, Institute for Primary Care and Health Sciences, Keele University, Newcastle, UK
| | - Elaine M Hay
- Arthritis Research UK Primary Care Centre, Institute for Primary Care and Health Sciences, Keele University, Newcastle, UK
| | - Lucy Yardley
- School of Psychological Science, University of Bristol, Bristol, UK.,Department of Psychology, University of Southampton, Southampton, UK
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8
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Svensson HK, Karlsson J, Sterner TR, Ahlner F, Skoog I, Erhag HF. Self-perceived functional ability and performance-based testing of physical function in older women with or without long-term back pain - results of the H70 study. BMC Geriatr 2021; 21:229. [PMID: 33827441 PMCID: PMC8028168 DOI: 10.1186/s12877-021-02177-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 03/25/2021] [Indexed: 11/18/2022] Open
Abstract
Background The proportion of older adults is increasing rapidly, and the majority are female. In 2050, the number of persons aged 60 years and over is estimated to reach 2.1 billion worldwide, constituting one-third of the total population of Europe. Long-term back pain is a disabling and common condition, primarily affecting older women. Although standardized functional evaluations are essential in the screening of older adults, self-rated activities of daily living capture a different aspect of the person’s ability in the context of his or her environment and social support system. This study aimed to describe how older women with or without long-term back pain self-rate their activities of daily living (ADL) and instrumental activities of daily living (IADL) in relation to their performance-based testing of physical function, including walking test, leg muscle strength, balance, and endurance. Method This study is part of the Gothenburg H70 Birth Cohort Studies in Sweden (H70 studies) and uses data from the 1944 birth cohort examined in 2015–16 at age 70. In the present study, only female participants were included in the analysis, and all cases of dementia (n = 17) and cases of acute and sub-acute back pain excluded (n = 181), leaving an effective sample of 446 female participants. Results Women with long-term back pain self-perceived their ADL and IADL as being as good as those without back pain, although they performed poorer in all performance-based tests and perceived themselves as less physically fit. Conclusion The discrepancy between self-perceived functional ability (ADL/IADL) and performance-based testing of functioning based on clinical tests calls for further investigation to incentivize person-centered care in older women with long-term back pain in municipal or emergency health-care settings.
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Affiliation(s)
- Hilda Kristin Svensson
- Academy of Health and Welfare and Centre of Research on Welfare, Health and Sport (CVHI), Halmstad University, Box 823, SE-301 18, Halmstad, Sweden. .,Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Box 457, SE-405 30, Gothenburg, Sweden.
| | - Jon Karlsson
- Institute of Clinical Sciences and Department of Orthopaedics at Sahlgrenska Academy, University of Gothenburg, Box 426, SE-405 30, Gothenburg, Sweden
| | - Therese Rydberg Sterner
- Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Box 430, SE-405 30, Gothenburg, Sweden.,Centre for Ageing and Health (AGECAP) at the University of Gothenburg, Wallinsgatan 6, SE-431 41, Mölndal, Sweden
| | - Felicia Ahlner
- Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Box 430, SE-405 30, Gothenburg, Sweden.,Centre for Ageing and Health (AGECAP) at the University of Gothenburg, Wallinsgatan 6, SE-431 41, Mölndal, Sweden
| | - Ingmar Skoog
- Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Box 430, SE-405 30, Gothenburg, Sweden.,Centre for Ageing and Health (AGECAP) at the University of Gothenburg, Wallinsgatan 6, SE-431 41, Mölndal, Sweden
| | - Hanna Falk Erhag
- Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Box 430, SE-405 30, Gothenburg, Sweden.,Centre for Ageing and Health (AGECAP) at the University of Gothenburg, Wallinsgatan 6, SE-431 41, Mölndal, Sweden
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9
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Sawicki P, Tałałaj M, Życińska K, Zgliczyński WS, Wierzba W. Comparison of the Characteristics of Back Pain in Women with Postmenopausal Osteoporosis with and without Vertebral Compression Fracture: A Retrospective Study at a Single Osteoporosis Center in Poland. Med Sci Monit 2021; 27:e929853. [PMID: 33597390 PMCID: PMC7901154 DOI: 10.12659/msm.929853] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background The incidence of unspecific back pain and osteoporotic vertebral compression fractures increases significantly with age. Considering the difficulties in the diagnosis of spontaneous osteoporotic vertebral fractures, this retrospective study aimed to compare the characteristics of back pain in women with postmenopausal osteoporosis with and without vertebral compression fractures. Material/Methods This study enrolled 334 women with postmenopausal osteoporosis; 150 had vertebral fractures, and 184 had no vertebral fractures. Densitometric vertebral fracture assessment and bone mineral density measurements in the central skeleton were performed for each patient. The participants completed a survey about features of their back pain. Results Patients with vertebral fractures had more severe back pain based on the numeric rating scale: 6.14 vs 4.33 (P<0.001, odds ratio [OR]=1.43, 95% confidence interval [CI]: 1.29–1.59). Among these individuals, back pain caused reduction in normal activity during the day (P<0.001, OR=4.68, 95% CI: 2.86–7.68), and pain occurred more often (P<0.001, OR=1.77, 95% CI: 1.47–2.13), lasted longer (P<0.001, OR=2.01, 95% CI: 1.65–2.46), predominantly occurred in the lumbar spine (P<0.001, OR=4.70, 95% CI: 1.96–11.29), and intensified during normal everyday activities (P<0.001). Based on these results, a new survey was created. It demonstrated a sensitivity of 70.67% and a specificity of 67.37% in predicting a current compression fracture. Conclusions Patients with vertebral compression fractures experience higher pain intensity and exhibit specific features of back pain. The new survey can be considered a supportive tool in assessing the possibility of vertebral compression fractures.
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Affiliation(s)
- Piotr Sawicki
- Department of Rheumatology, Systemic Connective Tissue Diseases and Rare Diseases, Central Clinical Hospital MSWiA in Warsaw, Warsaw, Poland
| | - Marek Tałałaj
- Department of Geriatrics, Internal Medicine and Metabolic Bone Diseases, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Katarzyna Życińska
- Department of Rheumatology, Systemic Connective Tissue Diseases and Rare Diseases, Central Clinical Hospital MSWiA in Warsaw, Warsaw, Poland.,Department of Family Medicine, Medical University of Warsaw, Warsaw, Poland
| | | | - Waldemar Wierzba
- Central Clinical Hospital MSWiA in Warsaw, Warsaw, Poland.,UHE Satellite Campus in Warsaw, University of Humanities and Economics in Łódź, Warsaw, Poland
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10
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Nayfe R, Chansard M, Hynan LS, Mortensen EM, Annaswamy T, Fraenkel L, Makris UE. Comparison of patient-reported outcomes measurement information system and legacy instruments in multiple domains among older veterans with chronic back pain. BMC Musculoskelet Disord 2020; 21:598. [PMID: 32900386 PMCID: PMC7487821 DOI: 10.1186/s12891-020-03587-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 08/13/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Chronic low back pain (cLBP) results in significant physical, psycho-social and socioeconomic burden. Identifying efficient and reliable patient reported outcome measures is critical for research and clinical purposes. The NIH's Patient Reported Outcomes Measurement Information System (PROMIS) instruments have not been compared to validated "legacy" instruments in older adults with cLBP. This study evaluates construct (convergent and discriminant) validity and time to complete (TTC) PROMIS as compared to legacy instruments. METHODS We enrolled older Veterans (age 60+) with cLBP with/without leg pain scheduled for lumbar epidural steroid injections. Subjects completed PROMIS computer adaptive test item banks and corresponding legacy instruments in the following domains: pain intensity, interference, and behavior; functional status; depression and anxiety; fatigue; sleep and social functioning. Convergent and discriminant validity between PROMIS and legacy instruments was evaluated using Spearman rank order correlations; Mann-Whitney U tests compared TTC. RESULTS Of the 71 Veterans recruited, the median (IQR) age was 67 (63-71) years old, 94% were men, 76% were White, 17% Black, and 96% were Non-Hispanic. Spearman correlations between PROMIS and legacy instruments showed moderate to very strong convergent validity in all domains (r = 0.4-1.0), except for social functioning and pain behavior (PROMIS Pain Behavior with Fear Avoidance Belief Questionnaire). The total median TTC for all PROMIS items was significantly shorter than legacy items, 8 min 50 s vs 29 min 14 s respectively, p < 0.001. CONCLUSIONS Given time efficiency of using PROMIS, along with strong construct validity, PROMIS instruments are a practical choice for measuring multidimensional PROs in older Veterans with cLBP for both research and clinical purposes.
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Affiliation(s)
- Rabih Nayfe
- Department of Internal Medicine, UT Southwestern (UTSW) Medical Center, Dallas, TX, USA
| | | | - Linda S Hynan
- Department of Population and Data Sciences, UTSW, Dallas, TX, USA
- Department of Psychiatry, UTSW, Dallas, TX, USA
| | - Eric M Mortensen
- Department of Population and Data Sciences, UTSW, Dallas, TX, USA
- Department of Medicine, University of Connecticut, Farmington, CT, USA
- Department of Medicine, VA North Texas Health Care System, Dallas, TX, USA
| | - Thiru Annaswamy
- Department of Physical Medicine & Rehabilitation, VA North Texas Health Care System, Dallas, TX, USA
| | - Liana Fraenkel
- Department of Medicine, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Una E Makris
- Department of Internal Medicine, UT Southwestern (UTSW) Medical Center, Dallas, TX, USA.
- Department of Population and Data Sciences, UTSW, Dallas, TX, USA.
- Department of Medicine, VA North Texas Health Care System, Dallas, TX, USA.
- Department of Internal Medicine, Division of Rheumatic Diseases, VA North Texas Health Care System, 4500 S Lancaster Rd., Dallas, TX, 75216, USA.
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Coetzee M, Giljam-Enright M, Morris LD. Rehabilitation needs in individuals with knee OA in rural Western Cape, South Africa: an exploratory qualitative study. Prim Health Care Res Dev 2020; 21:e7. [PMID: 32188525 PMCID: PMC7082714 DOI: 10.1017/s1463423620000043] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/16/2019] [Accepted: 01/02/2020] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Current clinical practice guidelines have suggested that each individual with knee osteoarthritis (OA) should receive three core treatments from their health care provider. These core treatments comprise of exercise, education and weight loss. Identification of the health care and rehabilitation needs of individuals with knee OA in rural areas are imperative for focusing service delivery in a specific context in order to empower the individual. The aim of this study was to explore the rehabilitation needs of individuals with knee OA living in rural Western Cape in order to identify the gaps in services offered and inform rehabilitation programmes in these settings. METHODS Semi-structured in-depth individual interviews were performed on 16 individuals with knee OA living in rural settings of the Western Cape, South Africa. A deductive data analysis approach was used and the needs of the individuals were identified and categorised for interpretation and comparison with the reported services received. FINDINGS The three major themes identified were 'I would like to know more', 'There's not much support from the clinic' and 'I don't feel myself anymore'. These themes relate to the lack of disease-specific education, barriers in the health systems and service delivery resulting in individuals lack of self-worth and poor mental wellbeing. The results revealed the integral relationship between health care systems, service delivery and the effect on patient wellbeing. CONCLUSION The rehabilitation needs of individuals with knee OA in rural areas advocates for addressing barriers in rural primary health care system such as adequate human resources, referral systems and continuity of care. This will allow for a comprehensive, person-centred and context-specific multidisciplinary approach focused on empowering individuals with knee OA through disease-specific education, improving functional participation and symptom management strategies. This could improve the social inclusion and mental wellbeing of individuals living with knee OA.
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Affiliation(s)
- Marisa Coetzee
- Senior Research Assistant and PhD Student, Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, University of Stellenbosch, Tygerberg7505, Republic of South Africa
| | - Marlie Giljam-Enright
- Lecturer and Clinical Educator, Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, University of Stellenbosch, Tygerberg7505, Republic of South Africa
| | - Linzette Deidre Morris
- Assistant Professor, Department of Physical Therapy & Rehabilitation Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
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Stensland M, Sanders S. Living a Life Full of Pain: Older Pain Clinic Patients' Experience of Living With Chronic Low Back Pain. QUALITATIVE HEALTH RESEARCH 2018; 28:1434-1448. [PMID: 29598770 DOI: 10.1177/1049732318765712] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Chronic low back pain (CLBP) is older adults' most common pain complaint and is associated with many physical and psychosocial consequences, which have been quantitatively examined. However, little research has qualitatively examined the experience itself of CLBP in later life. Study objective was to understand older adults' lived CLBP experience. Guided by van Manen's phenomenological method, 21 pain clinic patients aged 66 to 83 completed semistructured interviews. Under the main theme "living a life full of pain," results are reflected in four existential subthemes: (a) Corporeality: The pain is relentless and constantly monitored, (b) Temporality: To live with pain is to live by pacing day and night, (c) Relationality: Pain creates limits that can be tested or obeyed, and (d) Spatiality: Manipulating the space around me to accommodate the pain. Findings improve understanding of the patient experience of late life CLBP and highlights the importance of empathy and patient-centeredness when treating older adults.
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Older adult's experience of chronic low back pain and its implications on their daily life: Study protocol of a systematic review of qualitative research. Syst Rev 2018; 7:81. [PMID: 29793522 PMCID: PMC5968538 DOI: 10.1186/s13643-018-0742-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 05/09/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Of various chronic diseases, low back pain (LBP) is the most common and debilitating musculoskeletal condition among older adults aged 65 years or older. While more than 17 million older adults in the USA suffer from at least one episode of LBP annually, approximately six million of them experience chronic LBP that significantly affects their quality of life and physical function. Since many older adults with chronic LBP may also have comorbidities and are more sensitive to pain than younger counterparts, these older individuals may face unique age-related physical and psychosocial problems. While some qualitative research studies have investigated the life experiences of older adults with chronic LBP, no systematic review has integrated and synthesized the scientific knowledge regarding the influence of chronic LBP on the physical, psychological, and social aspects of lives in older adults. Without such information, it may result in unmet care needs and ineffective interventions for this vulnerable group. Therefore, the objective of this systematic review is to synthesize knowledge regarding older adults' experiences of living with chronic LBP and the implications on their daily lives. METHODS/DESIGN Candidate publications will be sought from databases: PubMed, CINAHL, and PsycINFO. Qualitative research studies will be included if they are related to the experiences of older adults with chronic LBP. Two independent reviewers will screen the titles, abstracts, and full-text articles for eligibility. The reference lists of the included studies will be checked for additional relevant studies. Forward citation tracking will be conducted. Meta-ethnography will be chosen to synthesize the data from the included studies. Specifically, the second-order concepts that are deemed to be translatable by two independent reviewers will be included and synthesized to capture the core of the idiomatic translations (i.e., a translation focusing on salient categories of meaning rather than the literal translation of words or phrases). DISCUSSION This systematic review of qualitative evidence will enable researchers to identify potential unmet care needs, as well as to facilitate the development of effective, appropriate, person-centered health care interventions targeting this group of individuals. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2018: CRD42018091292.
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Stensland ML, Sanders S. "It has changed my whole life": The systemic implications of chronic low back pain among older adults. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2018; 61:129-150. [PMID: 29336694 DOI: 10.1080/01634372.2018.1427169] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Chronic low back pain (CLBP) is the most common pain complaint among older adults. Despite its prevalence, very little research has qualitatively examined the diverse consequences of living with CLBP in later life. As part of a larger study aiming to understand the experience of CLBP among older adults, the objective of this manuscript is to understand how older adults experience CLBP and its impacts on the functioning of older adults. Guided by van Manen's phenomenological method, 23 semi-structured interviews with 21 pain clinic patients aged 66-83 were conducted. Through an iterative process assisted by NVivo 11 software, researchers used line-by-line thematic coding to identify main impacts of CLBP. Under the main theme "It has changed my whole life," results are reflected in six subthemes: (a) Pain damages sense of self; (b) trapped in a body that doesn't work anymore; (c) me, my partner, and my pain; (d) pain complicates family relationships; (e) painfully employed; and (f) feeling socially and recreationally repressed. This study improves our understanding of older pain clinic patients' experience of living with debilitating CLBP and offers direction for social work intervention in the context of multidisciplinary pain management.
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Affiliation(s)
| | - Sara Sanders
- a School of Social Work , University of Iowa , IA , USA
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Makris UE, Weinreich MA, Fraenkel L, Han L, Leo-Summers L, Gill TM. Restricting Back Pain and Subsequent Disability in Activities of Daily Living Among Community-Living Older Adults. J Aging Health 2017; 30:1482-1494. [PMID: 28863724 DOI: 10.1177/0898264317721555] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To evaluate the relationship between back pain severe enough to restrict activity (restricting back pain) and subsequent disability in essential (e) and instrumental (i) activities of daily living (ADL) among community-living older adults. METHOD In this prospective cohort study, we evaluated 754 adults, aged ≥70 years who were initially nondisabled in eADL. Restricting back pain and disability were assessed during monthly interviews for up to 159 months. Associations between restricting back pain and subsequent eADL and iADL disability were evaluated using recurrent events Cox models, adjusted for fixed-in-time and time-varying covariates. RESULTS Strong associations were found between restricting back pain and eADL and iADL disability, with hazard ratios (95% confidence intervals) of 3.47 [3.01, 3.90] and 2.33 [2.08, 2.61], respectively. DISCUSSION Restricting back pain was independently associated with subsequent disability in eADL and iADL. Interventions focused on decreasing restricting back pain in older adults may have the potential to reduce the subsequent burden of disability.
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Affiliation(s)
- Una E Makris
- 1 VA North Texas Health Care System, Dallas, USA.,2 UT Southwestern Medical Center, Dallas, USA
| | | | - Liana Fraenkel
- 3 Yale School of Medicine, New Haven, CT, USA.,4 Veterans Administration Medical Center, West Haven, CT, USA
| | - Ling Han
- 3 Yale School of Medicine, New Haven, CT, USA
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