title: The clinical course of pain and function in older adults with a new primary care visit for back pain.
abstract: OBJECTIVE
  To report the clinical course of older adults presenting for a new primary care visit for back pain, no healthcare visit for back pain within the prior 6 months, by describing pain intensity, disability, pain interference, and resolution of back pain over 12 months.
  
  
  METHODS
  Prospective inception cohort study.
  
  
  METHODS
  Primary care settings of three integrated healthcare systems in the United States that participated in the Back pain Outcomes using Longitudinal Data (BOLD) registry.
  
  
  METHODS
  Five thousand two hundred eleven (99.5%) of the 5,239 adults aged 65 and older who had reached their 12-month follow-up date.
  
  
  METHODS
  Baseline demographic characteristics, EQ-5D score, duration of back pain, expectation for recovery, depression, and anxiety. Participant-reported outcomes of back-related disability (Roland Morris Disability Questionnaire), numerical pain rating scale, pain interference, and resolution of back pain were collected at baseline and 3, 6, and 12 months.
  
  
  RESULTS
  Most improvement occurred within the first 3 months. The number and proportion with 30% improvement in back pain increased from 1,950 (42.3%) at 3 months to 1,994 (44.8%) by 12 months, and 1,331 (28.8%) and 1,576 (35.4%) had 30% improvement in disability at 3 and 12 months. Only 23.0% reported that their back pain had resolved at 12 months. Improvements in disability and interference with activity over 12 months differed according to age, duration of back pain, symptoms of depression and anxiety, and expectation for recovery.
  
  
  CONCLUSIONS
  The majority of older adults in primary care practice settings presenting with a new visit for back pain have persistent symptoms, disability, and interference over 12 months of follow-up. Future research is needed to identify risk factors for persistent symptoms and effective interventions.
authors.affiliation: Department of Rehabilitation Medicine, University of Washington, Seattle, Washington; Department of Comparative Effectiveness, Cost, and Outcomes Research Center, University of Washington, Seattle, Washington.
authors.forename: Sean D
authors.initials: SD
authors.lastname: Rundell
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Sherman
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Heagerty
authors.forename: Charles N
authors.initials: CN
authors.lastname: Mock
authors.forename: Jeffrey G
authors.initials: JG
authors.lastname: Jarvik
mesh_terms: D000368:Aged; D001416:Back Pain / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D015331:Cohort Studies; D006233:Persons with Disabilities; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D011320:Primary Health Care; D011446:Prospective Studies
keywords: back pain; disability; older adults; prognosis