The Clinical Course of Pain and Function in Older Adults with a New Primary Care Visit for Back Pain

Rundell, Sean D.; Sherman, Karen J.; Heagerty, Patrick J.; Mock, Charles; Jarvik, Jeffrey G.

doi:10.1111/jgs.13241

Cited by 59 publications

(53 citation statements)

References 28 publications

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“…Given the multifactorial nature of chronic pain, it is not surprising targeting pain has been shown to be an ineffective treatment strategy. 1 However, a targeted shift towards improving physical function rather than eliminating pain may prove beneficial. 38 Finding potentially modifiable factors that are linked to function (i.e.…”

Section: Discussionmentioning

confidence: 99%

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Multifidi Muscle Characteristics and Physical Function Among Older Adults With and Without Chronic Low Back Pain

Sions

Coyle

Velasco

et al. 2017

Archives of Physical Medicine and Rehabilitation

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Objective The purpose of this study was to determine if multifidi size and/or intramuscular fat were associated with self-reported and performance-based physical function in older adults with and without chronic LBP. Design Case-control study Setting Individuals participated in a standardized evaluation in a clinical laboratory and underwent magnetic resonance imaging (MRI) of the lumbar spine at a nearby facility. Patient Sample A volunteer sample of 106 community-dwelling older adults, aged 60-85 years, with (n=57) and without (n=49) chronic LBP were included in this secondary data analysis. Intervention Average right-left, L5 multifidi relative, i.e. total, cross-sectional area (rCSA); muscle-fat infiltration index (MFI), i.e. a measure of intramuscular fat; and relative muscle cross-sectional area (rmCSA), i.e. total CSA minus intramuscular fat CSA, were determined from MRIs. Linear regression modeling was performed with physical function measures as the dependent variables. Age, sex, and body mass index were entered as covariates. The main effects of L5 multifidi MFI and rmCSA, as well as their interaction with group assignment, were compared as independent variables. Main Outcome Measures Short Form-36 Health Survey Physical Functioning subscale (SF-36 PFS), Timed Up and Go (TUG), gait speed, and fast stair descent performance. Results Interaction terms between L5 multifidi MFI and group assignment were found to be significant contributors to the variance explained in all physical function measures (p≤.012). Neither the main effect, nor the interaction with group assignment for L5 multifidi rmCSA, significantly contributed to the variance explained in any of the physical function measures (p>.012). Conclusions Among older adults with chronic LBP of at least moderate intensity, L5 multifidi muscle composition, but not size, may help to explain physical function.

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Section: Discussionmentioning

confidence: 99%

“…1 Costs associated with spine-related treatment and disabilities are disproportionately higher for individuals with persistent, i.e. chronic, LBP as compared to those experiencing their first episode of pain.…”

mentioning

confidence: 99%

Multifidi Muscle Characteristics and Physical Function Among Older Adults With and Without Chronic Low Back Pain

Sions

Coyle

Velasco

et al. 2017

Archives of Physical Medicine and Rehabilitation

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“…62 We hypothesized that prognostic stratified care would be less effective compared to best current care for older (≥65 years) compared to younger patients. 28, 32, 46, 63, 66, 76 …”

Section: Methodsmentioning

confidence: 99%

“…We hypothesized that prognostic stratified care would be less effective compared to current best care for patients that reported a longer duration of symptoms. 33, 63, 66, 76 …”

Section: Methodsmentioning

confidence: 99%

Identifying Treatment Effect Modifiers in the STarT Back Trial: A Secondary Analysis

Beneciuk

Hill

Campbell

et al. 2017

The Journal of Pain

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Identification of patient characteristics influencing treatment outcomes is a top low back pain (LBP) research priority. Results from the STarT Back Trial support the effectiveness of prognostic stratified care for LBP compared to current best care, however patient characteristics associated with treatment response have not yet been explored. The purpose of this secondary analysis was to identify treatment-effect modifiers within the STarT Back Trial at 4 months follow-up (n=688). Treatment response was dichotomized using back-specific physical disability measured by the Roland-Morris Disability Questionnaire (≥7). Candidate modifiers were identified using previous literature and evaluated using logistic regression with statistical interaction terms to provide preliminary evidence of treatment-effect modification. Socioeconomic status (SES) was identified as an effect modifier for disability outcomes (OR = 1.71, P=.028). High SES patients receiving prognostic stratified care were 2.5 times less likely to have a poor outcome compared to low SES patients receiving best current care (OR = 0.40, P=.006). Education level (OR = 1.33, P=.109) and number of pain medications (OR = 0.64, P=.140) met our criteria for effect modification with weaker evidence (0.20>P≥0.05). These findings provide preliminary evidence for SES, education, and number of pain medications as treatment-effect modifiers of prognostic stratified care delivered in the STarT Back Trial. Perspective This analysis provides preliminary exploratory findings about the characteristics of patients who might least likely benefit from targeted treatment using prognostic stratified care for low back pain.

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“…Self-reported negative affect may distinguish important features among patients suffering from these medical conditions, including level of risk, [8] disability, [9–11] or recovery. [12]…”

Section: Introductionmentioning

confidence: 99%

Clinical validity of PROMIS Depression, Anxiety, and Anger across diverse clinical samples

Schalet

Pilkonis

et al. 2016

Journal of Clinical Epidemiology

352

238

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Objective To evaluate the responsiveness to change of the PROMIS® negative affect measures (Depression, Anxiety, and Anger) using longitudinal data collected in six chronic health conditions. Study Design and Setting Individuals with major depressive disorder (MDD), back pain, chronic obstructive pulmonary disease (COPD), chronic heart failure (CHF), and cancer completed PROMIS negative affect instruments as computerized adaptive test (CAT) or as fixed-length short form (SF) at baseline and a clinically-relevant follow-up interval. Participants also completed global ratings of health. Linear mixed effects models and standardized response means (SRM) were estimated at baseline and follow-up. Results 903 individuals participated (back pain, n = 218; cancer, n = 304; CHF, n = 60; COPD, n = 125; MDD, n = 196). All three negative affect instruments improved significantly for treatments of depression and pain. Depression improved for CHF patients (anxiety and anger not administered), while anxiety improved significantly in COPD groups (stable and exacerbation). Response to treatment was not assessed in cancer. Subgroups of patients reporting better or worse health showed a corresponding positive or negative average SRM for negative affect across samples. Conclusion This study provides evidence that the PROMIS negative affect scores are sensitive to change in intervention studies in which negative affect is expected to change. These results inform the estimation of meaningful change and enable comparative effectiveness research.

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The Clinical Course of Pain and Function in Older Adults with a New Primary Care Visit for Back Pain

Cited by 59 publications

References 28 publications

Multifidi Muscle Characteristics and Physical Function Among Older Adults With and Without Chronic Low Back Pain

Multifidi Muscle Characteristics and Physical Function Among Older Adults With and Without Chronic Low Back Pain

Identifying Treatment Effect Modifiers in the STarT Back Trial: A Secondary Analysis

Clinical validity of PROMIS Depression, Anxiety, and Anger across diverse clinical samples

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