Classification of Geriatric Low Back Pain Based on Hip Characteristics With a 12-Month Longitudinal Exploration of Clinical Outcomes: Findings From Delaware Spine Studies

Abstract

Objective The purpose of this study is to identify geriatric chronic LBP subgroups based on the presence of potentially modifiable hip impairments, using Latent Variable Mixture Modeling (LVMM), and to examine the prospective relationship between these subgroups and key outcomes over time. Methods Baseline, 3-month, 6-month, and 12-month data were collected from a prospective cohort of 250 community-dwelling older adults with chronic LBP. Comprehensive hip (symptoms, strength, range of motion, and flexibility), LBP (intensity and disability), and mobility function (gait speed and Six-Minute Walk Test) examinations were performed at each timepoint. Baseline hip measures were included in LVMM; observed classes/subgroups were compared longitudinally on LBP and mobility function outcomes using mixed models. Results Regarding LVMM, a model with 3 classes/subgroups fit best. Broadly speaking, subgroups were differentiated best by hip strength and symptom presence: subgroup 1 = strong and nonsymptomatic (SNS), subgroup 2 = weak and nonsymptomatic (WNS), subgroup 3 = weak and symptomatic (WS). Regarding longitudinal mixed models, all subgroups improved in most outcomes over time. Specifically, over 12 months, the nonsymptomatic subgroups had lower LBP intensity and disability levels compared to the WS subgroup, whereas the SNS subgroup had better mobility function than the 2 “weak” subgroups. Conclusion These subgroup classifications may help in tailoring specific interventions in future trials. Special attention should be given to the WS subgroup, given their consistently poor LBP and mobility function outcomes. Impact Among older adults with chronic low back pain, there are 3 hip subgroups: “strong and nonsymptomatic,” “weak and nonsymptomatic,” and “weak and symptomatic.” People in these subgroups demonstrate different outcomes and require different treatment; proper identification will result in tailored interventions designed to benefit individual patients. In particular, people in the WS subgroup deserve special attention, as their outcomes are consistently poorer than those in the other subgroups.

A Novel Movement-Evoked Pain Provocation Test for Older Adults With Persistent Low Back Pain

“…The impetus then for researchers is to compare such experiences with MEPLO; thereby, ascertaining construct validity, content validity, and opportunities to refine and calibrate the test. Second, participants in this study had a primary symptom of persistent LBP but recent work suggests pain at other body sites such as the hip can influence pain and function in older adults with LBP 59. Future studies will investigate MEPLO performance in the context of concomitant or widespread pain.…”

“…Second, participants in this study had a primary symptom of persistent LBP but recent work suggests pain at other body sites such as the hip can influence pain and function in older adults with LBP. 59 Future studies will investigate MEPLO performance in the context of concomitant or widespread pain. Third, MEPLO was deemed feasible in the laboratory setting but at just under 18 minutes, may not be feasible for all clinical settings.…”

A Standardized Assessment of Movement-evoked Pain Ratings Is Associated With Functional Outcomes in Older Adults With Chronic Low Back Pain

“…Participants were recruited for a prospective cohort study, conducted from March 2013 to December 2016; details regarding study procedures and recruitment strategies have been previously published 28. Participants were eligible for participation if they were between the ages of 60 to 85 years, cognitively intact, and had nonspecific CLBP (ie, pain intensity≥3/10, pain frequency≥4 d/wk, pain duration≥3 mo).…”

“…Participants were recruited for a prospective cohort study, conducted from March 2013 to December 2016; details regarding study procedures and recruitment strategies have been previously published. 28 Participants were eligible for participation if they were between the ages of 60 to 85 years, cognitively intact, and had nonspecific CLBP (ie, pain intensity ≥ 3/10, pain frequency ≥ 4 d/wk, pain duration ≥ 3 mo). Exclusion criteria were nonmechanical LBP symptomatology, lower extremity pain intensity greater than LBP intensity, current spinal or hip fractures, severely impaired ambulatory capacity requiring the use of a walker, diagnosis of a progressive neurological disorder, and terminal illness.…”

Exercise for rotator cuff tendinopathy: Proposed mechanisms of recovery

“…There is potential to optimize management and improve outcomes if subgrouping around underlying mechanistic biomarkers are used to inform and adapt patient management In other body regions, researchers have defined patient subgroups, 42 and demonstrated that targeted treatments for subgroup deficits have improved outcomes over a non-specific general approach. 43–46 Studies exploring the development of treatment subgroups for RC tendinopathy are warranted. This mechanistic knowledge will enable the design of a stepped and matched treatment approach.…”