Back pain in seniors: the Back pain Outcomes using Longitudinal Data (BOLD) cohort baseline data

Abstract

BackgroundBack pain represents a substantial burden globally, ranking first in a recent assessment among causes of years lived with disability. Though back pain is widely studied among working age adults, there are gaps with respect to basic descriptive epidemiology among seniors, especially in the United States. Our goal was to describe how pain, function and health-related quality of life vary by demographic and geographic factors among seniors presenting to primary care providers with new episodes of care for back pain.MethodsWe examined baseline data from the Back pain Outcomes using Longitudinal Data (BOLD) registry, the largest inception cohort to date of seniors presenting to a primary care provider for back pain. The sample included 5,239 patients ≥ 65 years old with a new primary care visit for back pain at three integrated health systems (Northern California Kaiser-Permanente, Henry Ford Health System [Detroit], and Harvard Vanguard Medical Associates [Boston]). We examined differences in patient characteristics across healthcare sites and associations of patient sociodemographic and clinical characteristics with baseline patient-reported measures of pain, function, and health-related quality of life.ResultsPatients differed across sites in demographic and other characteristics. The Detroit site had more African-American patients (50%) compared with the other sites (7-8%). The Boston site had more college graduates (68%) compared with Detroit (20%). Female sex, lower educational status, African-American race, and older age were associated with worse functional disability as measured by the Roland-Morris Disability Questionnaire. Except for age, these factors were also associated with worse pain.ConclusionsBaseline pain and functional impairment varied substantially with a number of factors in the BOLD cohort. Healthcare site was an important factor. After controlling for healthcare site, lower education, female sex, African-American race, and older age were associated with worse physical disability and all of these factors except age were associated with worse pain.Trial registrationClinical Trials.gov NCT01776242; Registration date: June 13, 2012.

Trajectories of Symptoms and Function in Older Adults With Low Back Disorders

“…We adjusted the analysis for study sites, given differences in demographics and management approaches. 9 Latent class models were fi tted iteratively, starting with 1 cluster and adding additional clusters until the model obtained the largest number of clusters for which the number of participants in each group was at least 5% of the sample. We plotted mean trajectories for each latent class for each outcome and a point-wise 95% confi dence interval about group means.…”

Cost-effectiveness of spinal manipulative therapy, supervised exercise, and home exercise for older adults with chronic neck pain

“…However, participants in this study were similar to other populations of older adults in the U.S. with neck or back pain. [72, 73]…”

Case Studies from the Clinic: Initiating and Implementing Patient-Reported Outcome Measures

“…In addition, instruments that are identified by sub-specialty clinics as measuring domains important to their care are also used. As an example, in the Center for Aids Research, PROs are collected in two phases: (1) a review of systems is done at each clinic visit, and (2) 21,22 The aim of the project was to determine if imaging of the lumbar spine within 6 weeks of the index visit (early imaging) was associated with worse patient-reported outcomes over time and increased health care utilization and costs. Researchers measured patient-reported pain characteristics (duration, location, severity, and interference with function, activity, and sleep); back-related disability; psychological distress; healthrelated quality of life; falls; and recovery expectation.…”