Physical Therapy Department
What are your general research interests?
My research has primarily focused on improving physical function in older adults with musculoskeletal conditions, with the work evolving to focus on two specific populations: older adults with low back pain (LBP) and older adults who have sustained hip fractures. My primary line of work here at UD is the LBP research, while my hip fracture work is accomplished through longstanding collaborations with investigators from the Baltimore Hip Studies in the Department of Epidemiology and Public Health at the University of Maryland School of Medicine. In my LBP work, we have focused on understanding the causes, correlates and consequences of spinal pain in the geriatric population. We have clearly shown that LBP can have a significant negative consequence on how older adults function in their daily lives and participate in society. I also have a strong interest in recovery of physical function after the trauma of a hip fracture population. The hip fracture work has focused on understanding sex differences in the sequelae of hip fracture via a large epidemiologic study, as well as exploring sex differences in the epidemiology of bone and muscle composition after hip fracture. Regardless of the orthopedic patient population, the overarching goal of my research is to develop rehabilitation interventions that will maximize physical function in older adults.
What are your current projects and how are they funded?
In a project that was recently funded by the National Institute on Aging (National Institutes of Health), we will be studying modifiable risk factors that contribute to the development and persistence of chronic LBP, as well as to a greater level of pain-related disability and functional limitations.
LBP is the most frequently reported musculoskeletal problem among older adults. In this age group, LBP has been associated with a host of negative consequences, including increases in mobility limitations, disability, and healthcare utilization. Although LBP is a risk factor for functional decline among older adults, 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.
The long-term goal of this work 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. Due to the failure of many one-size-fits-all interventions for LBP, 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. Our promising preliminary work suggests that we may be able to identify subgroups in the elderly population with chronic LBP. We plan to recruit a cohort of 250 adults aged 60-85 years with a new or recent onset of LBP. We will perform a series of risk factor assessments at baseline and follow these participants up for 12 months to determine whether specific modifiable risk factors are associated with the development of worse pain profiles, greater functional decline, and greater disability. This study will lay the groundwork for developing a therapeutic algorithm for evaluation and treatment of LBP, specifically for older adults, to focus on prevention of chronic LBP and development of functional limitations and disability.
In terms of the hip fracture work, I will continue to collaborate with the Baltimore Hip Studies group as a co-investigator on a recently funded Merit Award, which will explore the underlying mechanisms of a multi-modal exercise intervention and preliminarily test the additional effects of a protein supplement immediately following exercise. I have been intimately involved in the development of the protein supplement component of this project.
Who are your collaborators on these projects?
For the LBP project, my primary collaborators are Dr. Debra Weiner, a geriatrician/pain specialist at the University of Pittsburgh; Dr. Michelle Shardell, a biostatistician at the University of Maryland School of Medicine (UMSOM); Dr. Lynn Snyder-Mackler, Alumni Distinguished Professor in the Department of Physical Therapy here at the University of Delaware (UDPT); Dr. Tara Manal, Director of Clinical Services for UDPT; Dr. Megan Sions, Post-Doctoral Fellow from UDPT; and Dr. Teonette Velasco, Research Physical Therapist from UDPT. We will also be collaborating with physicians from the Department of Family and Community Medicine at Christiana Care under the leadership of Dr. Michael Rosenthal.
For the hip fracture work, I collaborate with investigators from the Baltimore Hip Studies group, which is led by Dr. Jay Magaziner, Professor and Chair of Epidemiology and Public Health at UMSOM, and Dr. Denise Orwig, Associate Director of the Baltimore Hip Studies.
What are the likely next steps in your work?
We are just beginning the LBP project, which is a 5-year grant from the National Institutes of Health. We anticipate that the results of this study, along with our findings from a recently completed NIH-funded preliminary trial, will put us in a great position to develop and propose a comprehensive intervention for older adults with LBP that is focused on reducing pain, as well as improving physical function and societal participation.
How would you describe your work’s importance to an interested lay audience?
Given the prevalence of chronic low back pain in community-dwelling older adults and the associated negative functional consequences, this research will have a broad impact on public health as there has been limited research aimed at reducing pain and disability in the geriatric population with LBP. Potential benefits of this research include identifying treatment targets for the prevention of chronic LBP in the geriatric population, delaying functional decline for older adults, and developing future studies focused on reducing disability and health care utilization costs through the use of well-defined evaluation and treatment algorithms for older adults with LBP.