title: From chronic low back pain to disability, a multifactorial mediated pathway: the InCHIANTI study.
abstract: METHODS
  Clinicoepidemiologic study in the Chianti area (Tuscany, Italy).
  
  
  OBJECTIVE
  To evaluate whether performance measures of lower extremity function confounds the association of low back pain (LBP) with self-report disability in specific basic and instrumental activities of daily living (IADLs).
  
  
  BACKGROUND
  LBP is high prevalent in older population and has a negative impact on functional status. Studies on the pathway leading from LBP to disability are limited and often the role played by important confounders is not considered.
  
  
  METHODS
  A total of 956 InCHIANTI study participants aged 65 and older able to complete performance-based tests of lower extremity function were included in this analysis. LBP was defined as a self-report of back pain "quite often-almost every day" in the past 12 months. Lower extremity function was evaluated administering the Short Physical Performance Battery. In addition, participants were asked to walk on a 7-m course and collect an object from the ground. Depressive symptoms (CES-D score), trunk flexion-extension range of motion, and hip-knee-foot pain were also considered in the pathway from LBP to disability.
  
  
  RESULTS
  Compared with participants who did not report LBP, those with LBP were more likely to report difficulty in performing most activities of daily living. LBP was also associated with disability in the activities of bathing, doing the laundry, performing heavy household chores, cutting toenails, shopping, and carrying a shopping bag. The association between LBP and disability in selected ADLs and IADLs was no longer statistical significant, after adjustment for performance in lower extremity function, with exception of the activity of "carrying a shopping bag".
  
  
  CONCLUSIONS
  The cross-sectional association between LBP and self-reported disability, in specific tasks is modulated by performance measures. Specific performance-based tests that explore the functional consequences of LBP may help design specific interventions of disability prevention and treatment in patients with LBP.
authors: Department of Medicine and Sciences of Aging, Laboratory of Clinical Epidemiology, University G. D'Annunzio Chieti, Italy. a.diiorio@unich.it
authors: Angelo
authors: A
authors: Di Iorio
authors: Michele
authors: M
authors: Abate
authors: Jack M
authors: JM
authors: Guralnik
authors: Stefania
authors: S
authors: Bandinelli
authors: Francesca
authors: F
authors: Cecchi
authors: Antonio
authors: A
authors: Cherubini
authors: Andrea
authors: A
authors: Corsonello
authors: Nunzia
authors: N
authors: Foschini
authors: Marianna
authors: M
authors: Guglielmi
authors: Fulvio
authors: F
authors: Lauretani
authors: Stefano
authors: S
authors: Volpato
authors: Giuseppe
authors: G
authors: Abate
authors: Luigi
authors: L
authors: Ferrucci
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008019:Life Style; D017116:Low Back Pain / Q000453:epidemiology* / Q000503:physiopathology*; D008297:Male; D011897:Random Allocation