Predictors of Persistent Disability and Back Pain in Older Adults with a New Episode of Care for Back Pain.
To identify predictors of persistent disability and back pain in older adults.



Prospective cohort study.



Back pain outcomes using longitudinal data registry.



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



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.



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.



We found that many predictors in older adults were similar to those for younger populations.
Department of Rehabilitation Medicine.|Comparative Effectiveness, Cost, and Outcomes Research Center.
Sean D
SD
Rundell
Group Health Research Institute, Seattle, Washington.
Karen J
KJ
Sherman
Center for Biomedical Statistics.
Patrick J
PJ
Heagerty
Department of Epidemiology, University of Washington and Harborview Injury Prevention Research Center, Seattle, Washington.
Charles N
CN
Mock
Department of Health Services.
Nathan J
NJ
Dettori
Center for Biomedical Statistics.
Bryan A
BA
Comstock
Division of Research, Kaiser Permanente Northern California, Oakland, CA.
Andrew L
AL
Avins
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, and Spine Unit, Harvard Vanguard Medical Associates, Boston, MA.
Srdjan S
SS
Nedeljkovic
Henry Ford Hospital, Neuroscience Institute, Detroit, MI, USA.
David R
DR
Nerenz
Comparative Effectiveness, Cost, and Outcomes Research Center.|Department of Radiology, Neurological Surgery, Orthopedic Surgery and Sports Medicine, Health Services and Pharmacy, University of Washington, Seattle, Washington.
Jeffrey G
JG
Jarvik
D000368:Aged; D000369:Aged, 80 and over; D001416:Back Pain / Q000000981:diagnostic imaging* / Q000628:therapy; D015331:Cohort Studies; D004185:Disability Evaluation; D006233:Persons with Disabilities; D017050:Episode of Care; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010147:Pain Measurement / Q000379:methods* / Q000639:trends; D011237:Predictive Value of Tests; D011446:Prospective Studies
Disability; Older Adults; Predictors; Prognostic Factors;  Chronic Back Pain