Predictors of Persistent Disability and Back Pain in Older Adults with a New Episode of Care for Back Pain

Abstract

Objective: To identify predictors of persistent disability and back pain in older adults.

Design: Prospective cohort study.

Setting: Back pain outcomes using longitudinal data registry.

Subjects: Five thousand two hundred twenty adults age 65 years and older with a new primary care visit for back pain.

Methods: Baseline measurements included: demographics, health, and back pain characteristics. We abstracted imaging findings from 348 radiology reports. The primary outcomes were the Roland-Morris Disability Questionnaire (RMDQ) and back pain intensity. We defined persistent disability as RMDQ of 4/24 or higher at both six and 12 months and persistent back pain as pain 3/10 or higher at both six and 12 months.

Results: There were 2,498 of 4,143 (60.3%) participants with persistent disability, and 2,099 of 4,144 (50.7%) had persistent back pain. Adjusted analyses showed the following characteristics most strongly predictive of persistent disability and persistent back pain: sex, race, worse baseline clinical characteristics of back pain, leg pain, back-related disability and duration of symptoms, smoking, anxiety symptoms, depressive symptoms, a history of falls, greater number of comorbidities, knee osteoarthritis, wide-spread pain syndromes, and an index diagnosis of lumbar spinal stenosis. Within the imaging data subset, central spinal stenosis was not associated with disability or pain.

Conclusion: We found that many predictors in older adults were similar to those for younger populations.

Keywords: Disability; Older Adults; Predictors; Prognostic Factors; Chronic Back Pain.