Chronic disease self-management program for low back pain in the elderly.
OBJECTIVE
To evaluate the effectiveness of Stanford's Chronic Disease Self-Management Program (CDSMP) for chronic low back pain (LBP) in older Americans.


METHODS
Randomized controlled trial.


METHODS
Community-based program offered at 12 locations.


METHODS
Community-dwelling seniors (n = 109) aged 60 and older with chronic LBP of mechanical origin.


METHODS
Patients were randomly allocated to the CDSMP or to a 6-month, wait-list control group. The program included one 2.5-hour session per week for 6 weeks. Outcomes evaluated at 6 months included 100-point modified Von Korff pain and disability scales; days with pain and disability; SF-36 general health, energy-fatigue, and emotional well-being scales; 2 scales from the Arthritis Self-Efficacy Scale, self-care attitudes/behaviors, and health services utilization.


RESULTS
For pain at 6 months, the primary outcome, the adjusted mean difference between the program and control, was -1.0 (P = .835). There was a sizable advantage for the program in disability averaged over the course of the entire 6-month study (-9.2, P = .027), but not at the 6-month follow-up (-5.8, P = .278). There was an interaction between intervention and baseline disability days favoring the program for higher baseline values (P = .007). The CDSMP affected emotional well-being (7.6, P = .037) and energy-fatigue (5.1, P = .274). There were no differences for self-efficacy, pain days, and general health.


CONCLUSIONS
There was no advantage for the CDSMP over a wait-list control for improving pain, general health, self-efficacy, and self-care attitudes in older Americans with chronic LBP. A benefit was suggested for emotional well-being, fatigue, functional disability, and days with disability.
Haas
Mitchell
M
Center for Outcomes Studies, Western States Chiropractic College, Portland, OR 97230, USA. mhaas@wschiro.edu
Groupp
Elyse
E
Muench
John
J
Kraemer
Dale
D
Brummel-Smith
Ken
K
Sharma
Rajiv
R
Ganger
Bonnie
B
Attwood
Michael
M
Fairweather
Alisa
A
D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D004185:Disability Evaluation; D004644:Emotions; D005221:Fatigue; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D008297:Male; D012648:Self Care; D013997:Time Factors; D016896:Treatment Outcome