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Risk Factors for Disabling Low Back Pain in Older Adults


Background

  • Low back pain (LBP) is the most frequently reported musculoskeletal problem among older adults(1-2) and is a risk factor for functional decline in the elderly(3-4).
  • The majority of research studies addressing LBP exclude people over the age of 60; therefore, clinicians have minimal evidence upon which to base their treatment decisions.
  • Researchers have concluded that patients with LBP do not belong to one homogeneous group, but rather should be classified into subgroups that share similar clinical characteristics to better individualize care and improve clinical outcomes(5-6).

Description of Study

  • The long-term goal of this study is to develop and test a comprehensive, standardized rehabilitation approach for older adults with chronic LBP that is specifically designed to reduce pain and optimize function.
  • 250 community-dwelling, older adults (ages 60-85 years) will be recruited over 5 years.
  • This will be a 12-month longitudinal, cohort study of older adults with current LBP, to evaluate trajectories of pain, activity limitations, and participation restrictions.
  • Participants will be recruited through local primary care practices.
  • Participants will be initially screened via phone for eligibility.
  • If eligible, participants will be seen for a total of 4 visits by licensed physical therapists at the University of Delaware by members of the Delaware Spine Studies research team. 
  • Eligible participants will undergo a two-part initial physical therapy evaluation including:
    • A standardized low back evaluation and physical performance testing
    • Ultrasound imaging evaluations of the back and hip muscles.
  • Participants will receive repeat physical therapy evaluations at 3, 6, and 12 months.
  • This is an observational, natural history study; therefore, we will not modify nor suggest any changes to the current treatment plan that have been previously established by the participant’s primary care practitioner.
  • This study is federally funded by the National Institutes of Health. 
Inclusion Criteria
Exclusion Criteria
Potential participants must…
  • be between the ages of 60 and 85 years.
  • have current low back pain.
  • have at least moderate low back pain.
  • have low back pain that occurs every day or almost every day.
  • be community-dwelling (i.e. cannot live in nursing home or skilled nursing facility).
  • be ambulatory.
  • be able to complete phone interviews and written forms independently.
Older adults will be excluded if they have…
  • certain conditions of the back (i.e. ankylosing spondylitis, rheumatoid arthritis, vertebral compression fractures, carcinoma metastatic to the spine).
  •  Lower extremity pain that is greater than their back pain.
  • have a progressive, concurrent condition (i.e. Parkinson’s, multiple sclerosis, etc.).
  • severely limited mobility.
  • uncontrolled high blood pressure.
  • severe vision or hearing impairments.

STAGES OF THE STUDY

Phone Interview

Prior to entering into the study, each potential participant will be interviewed via phone by a member of the research team to determine whether he/she meets preliminary criteria for inclusion in the study.  He/she shall be given a detailed description of the study and have all questions answered.

Participation Benefits

  • Participants will receive a comprehensive physical therapy examination at no cost to them. 
  • Results from the physical therapy examination, specifically information regarding physical performance testing that may be used in assessment of fall risk, will be sent to the referring primary care practitioner. 
  • Participants may receive up to $200 compensation for participation in 4 visits ($50/visit)

Contact Information

If you have any questions, please contact Megan Sions, PhD, PT, OCS, a co-investigator for this study.  Dr. Sions’ contact information is:

References

  1. Bressler HB, Keyes WJ, Rochon PA, Badley E. The prevalence of low back pain in the     elderly. A systematic review of the literature. Spine 1999;24:1813-9.
  2. Koch H SM. Office-based ambulatory care for patients 75 years old and over, National Ambulatory Medical Care Survey, 1980 and 1981. Hyattsville, MD: Advance Data from Vital and Health Statistics, National Center for Health Statistics (NCHS). 1985. Report No.: No.110.DHHS Pub.No.(PHS) 85-1250.
  3. Leveille SG, Guralnik JM, Hochberg M, et al. Low back pain and disability in older women: independent association with difficulty but not inability to perform daily activities. J Gerontol A Biol Sci Med Sci 1999;54:M487-93.
  4. Reid MC, Williams CS, Gill TM. Back pain and decline in lower extremity physical function among community-dwelling older persons. J Gerontol A Biol Sci Med Sci 2005;60:7-93
  5. Delitto A, Erhard RE, Bowling RW. A treatment-based classification approach to low back syndrome: identifying and staging patients for conservative treatment. Phys Ther 1995;75:470-85; discussion 85-9.
  6. Borkan JM, Koes B, Reis S, Cherkin DC. A report from the Second International Forum for Primary Care Research on Low Back Pain. Reexamining priorities. Spine (Phila Pa 1976) 1998;23:1992-6.