Do medical factors predict disability in older adults with persistent low back pain?

Abstract

Persistent low back pain (LBP) is one of the most common and challenging persistent pain conditions in older adults. Medical comorbidity also is common in these individuals, but its impact on disability has not been examined. The purpose of this study was, using a cross-sectional design, to examine the functional impact of pain-related and general medical comorbidity on 100 community dwelling older adults (mean age 74.3) with persistent mechanical LBP. Subjects received a structured history and physical examination, lumbosacral spine X-rays, and standardized tests of physical function. Pain-related variables included intensity, duration, extent, and lumbar motion-induced pain. General medical variables included age, comorbidity, number of medications, depressive symptoms, back range of motion, body mass index, and severity of radiographic pathology. Function/disability measures included self-reported disability, gait speed, and mean number of static lifts and amount of work performed during a dynamic lifting task. Structural equation modeling was used to evaluate the influence of pain and medical variables on function/disability. The overall regression model indicated pain and medical variables were significantly associated with function/disability measures (R2=0.45, P<0.01). Individual regression coefficients, however, indicated that only pain duration (r=-0.36, P<0.05) and pain severity (r=0.37, P<0.001) were significantly associated with function/disability. Despite the prevalence of medical co-morbidities in older PLBP subjects, they appear to be of limited utility in understanding level of disability. These findings also underscore the need to optimize pain treatment in independent older adults to optimize physical function and delay the onset of dependent living status.

Associação de dor crônica com uso de serviços de saúde em idosos residentes em São Paulo

“…Use of health care services increases among those suffering from incapacitating chronic 2,3,15,21 and intense pain, 3,12,21,24 as seen in this study.…”

Dor crônica em idosos residentes em São Paulo, Brasil: prevalência, características e associação com capacidade funcional e mobilidade (Estudo SABE)

“…Algumas características da dor estão associadas a maiores déficit funcionais e incapacidade, como dores intensas 16,26,35,39,40 , múltiplos locais de dor 28,36,39 , dores em região dorsal 8,17,29,30,34 e em membros inferiores 17,34,39 .…”

Patient Age Is Related to the Types of Physical Therapy Interventions Provided for Chronic Low Back Pain: An Observational Study

“…Older individuals (60 years or older) in the Wittink et al 53 study reported similar pain intensities but better psychological outcomes than their younger counterparts. Weiner et al 50 found an inverse relationship between pain duration and disability in elderly subjects. In addition, older individuals may consider maintenance of safe and independent movement and function to be a higher priority for intervention if the pain they are experiencing is manageable from their point of view.…”

“…Additionally, the literature reporting the factors associated with CLBP as people age is sparse. Weiner et al 50 examined measures of lumbar flexibility and radiographic evidence of degenerative disease in a study of elders with persistent low back pain (mean  SD, 74.3  4.7 years). Impairments consistent with possible joint restriction were noted with both measures; however, neither demonstrated an association with function or disability in the subjects.…”