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Roseen EJ, Patel KV, Ward R, de Grauw X, Atlas SJ, Bartels S, Keysor JJ, Bean JF. Trends in Chiropractic Care and Physical Rehabilitation Use Among Adults with Low Back Pain in the United States, 2002 to 2018. J Gen Intern Med 2024; 39:578-586. [PMID: 37856007 PMCID: PMC10973298 DOI: 10.1007/s11606-023-08438-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 09/18/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND While nonpharmacologic treatments are increasingly endorsed as first-line therapy for low back pain (LBP) in clinical practice guidelines, it is unclear if use of these treatments is increasing or equitable. OBJECTIVE Examine national trends in chiropractic care and physical rehabilitation (occupational/physical therapy (OT/PT)) use among adults with LBP. DESIGN/SETTING Serial cross-sectional analysis of the National Health Interview Survey, 2002 to 2018. PARTICIPANTS 146,087 adults reporting LBP in prior 3 months. METHODS We evaluated the association of survey year with chiropractic care or OT/PT use in prior 12 months. Logistic regression with multilevel linear splines was used to determine if chiropractic care or OT/PT use increased after the introduction of clinical guidelines. We also examined trends in use by age, sex, race, and ethnicity. When trends were similar over time, we present differences by these demographic characteristics as unadjusted ORs using data from all respondents. RESULTS Between 2002 and 2018, less than one-third of adults with LBP reported use of either chiropractic care or OT/PT. Rates did not change until 2016 when uptake increased with the introduction of clinical guidelines (2016-2018 vs 2002-2015, OR = 1.15; 95% CI: 1.10-1.19). Trends did not differ significantly by sex, race, or ethnicity (p for interactions > 0.05). Racial and ethnic disparities in chiropractic care or OT/PT use were identified and persisted over time. For example, compared to non-Hispanic adults, either chiropractic care or OT/PT use was lower among Hispanic adults (combined OR = 0.62, 95% CI: 0.65-0.73). By contrast, compared to White adults, Black adults had similar OT/PT use (OR = 0.98; 95% CI: 0.94-1.03) but lower for chiropractic care use (OR = 0.50; 95% CI: 0.47-0.53). CONCLUSIONS Although use of chiropractic care or OT/PT for LBP increased after the introduction of clinical guidelines in 2016, only about a third of US adults with LBP reported using these services between 2016 and 2018 and disparities in use have not improved.
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Affiliation(s)
- Eric J Roseen
- Section of General Internal Medicine, Department of Medicine, Boston University, Chobanian & Avedision School of Medicine and Boston Medical Center, Boston, MA, USA.
- New England Geriatric Research Education and Clinical Center, Veterans Affairs Boston Healthcare System, Boston, MA, USA.
- Department of Rehabilitation Science, MGH Institute of Health Professions, Boston, MA, USA.
| | - Kushang V Patel
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Rachel Ward
- New England Geriatric Research Education and Clinical Center, Veterans Affairs Boston Healthcare System, Boston, MA, USA
| | - Xinyao de Grauw
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Steven J Atlas
- Mongan Institute, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Stephen Bartels
- Mongan Institute, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Julie J Keysor
- Section of General Internal Medicine, Department of Medicine, Boston University, Chobanian & Avedision School of Medicine and Boston Medical Center, Boston, MA, USA
- Department of Physical Therapy, MGH Institute of Health Professions, Boston, MA, USA
| | - Jonathan F Bean
- New England Geriatric Research Education and Clinical Center, Veterans Affairs Boston Healthcare System, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Spaulding Rehabilitation Hospital, Boston, MA, USA
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Coyle PC, Pohlig RT, Knox PJ, Pugliese JM, Sions JM, Hicks GE. Trajectories of Physical Function and Disability Over 12 Months in Older Adults With Chronic Low Back Pain. J Geriatr Phys Ther 2024; 47:3-12. [PMID: 36125915 PMCID: PMC10017374 DOI: 10.1519/jpt.0000000000000365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Understanding prognosis is critical for clinical care and health policy initiatives. The purpose of this study was to determine whether distinct prognostic trajectories of physical function and disability exist in a cohort of 245 community-dwelling older adults with chronic low back pain (LBP), and to characterize the demographic, health, and pain-related profiles of each trajectory subgroup. METHODS All participants underwent standard clinic examinations at baseline, 3 months, 6 months, and 12 months. At each time point, the Late Life Function & Disability Instrument (LLFDI) was used to measure general physical function (LLFDI Function) and disability (LLFDI Disability-Limitation); the Quebec LBP Disability Questionnaire was used to measure disability due to pain. Growth mixture modeling (GMM) was performed on each outcome to identify distinct trajectory classes/subgroups; baseline demographic (eg, age and sex), health (eg, comorbidities, depressive symptoms, and physical activity level), and pain-related (eg, LBP intensity, pain-related fear, and pain catastrophizing) characteristic profiles were compared across subgroups. RESULTS GMM statistics revealed an optimal number of 3 to 4 trajectory subgroups, depending on the outcome examined. Subgroups differed across demographic, health, and pain-related characteristics; the classes with the most favorable prognoses had consistent profile patterns: fewer depressive symptoms, fewer comorbidities, higher physical activity levels, lower LBP intensities, less pain-related fear, and less pain catastrophizing. CONCLUSION Our findings indicate that several distinct trajectory subgroups exist that would have been masked by observing mean cohort change alone. Furthermore, subgroup characteristic profiles may help clinicians identify likely prognostic trajectories for their patients. Future research should focus on identifying modifiable risk factors that best predict group membership, and tailoring interventions to mitigate the risk of poor prognosis.
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Affiliation(s)
- Peter C. Coyle
- Department of Physical Therapy, University of Delaware, Newark, DE
| | - Ryan T. Pohlig
- Department of Epidemiology, University of Delaware, Newark, DE
- Biostatistics Core, University of Delaware, Newark, DE
| | - Patrick J. Knox
- Department of Physical Therapy, University of Delaware, Newark, DE
| | | | - J. Megan Sions
- Department of Physical Therapy, University of Delaware, Newark, DE
| | - Gregory E. Hicks
- Department of Physical Therapy, University of Delaware, Newark, DE
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Abdollahi S, Sheikhhoseini R, Rahimi M, Huddleston WE. The sacroiliac dysfunction and pain is associated with history of lower extremity sport related injuries. BMC Sports Sci Med Rehabil 2023; 15:36. [PMID: 36941717 PMCID: PMC10029172 DOI: 10.1186/s13102-023-00648-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 03/14/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND The purpose of this study was to examine the association of sacroiliac joint (SIJ) dysfunction and pain with overuse and acute lower limb and pelvic girdle injuries of Iranian basketball players. METHODS In this cross-sectional study, basketball-related injury data were collected during 2019-2020 from 204 basketball players of the Iranian league using the online Information Retrospective Injury Questionnaire. A researcher then performed ten clinical tests to assess SIJ dysfunction and pain (five tests for dysfunction and five tests for pain). Data analysis was performed by logistic regression at the confidence interval of 95%. RESULTS Within our sample (n = 204), injury rates were calculated across sub-groups of athletes that had only SIJ pain (n = 19), only SIJ dysfunction (n = 67), both SIJ pain and dysfunction (n = 15) or no SIJ complaints (n = 103). Across these groups, a total of 464 injuries were reported. SIJ pain group reported 80 injuries (17.2%), SIJ dysfunction group reported 210 injuries (45.2%), both SIJ pain and dysfunction group reported 58 injuries (12.5%, and the no SIJ pain or SIJ dysfunction group reported 116 injuries (25.0%). Participants with SIJ pain were more likely to report previous pelvic girdle injuries (overuse: odds ratio (OR): 0.017; 95% CI: 0.005-0.56; p < 0.001 and acute: OR: 0.197; 95%CI: 0.101-0.384; p < 0.001) and also lower limb injuries (overuse: OR: 0.179, 95%CI: 0.082-0.392, p < 0.001). Participants with SIJ dysfunction only were likely to report acute pelvic girdle injuries (OR: 0.165; 95%CI: 0.070-0.387; p < 0.001) and acute lower limb injuries (OR: 0.165; 95%CI: 0.030-0.184; p < 0.001). CONCLUSION The presence of SIJ dysfunction and pain is associated with a history of acute and overuse injuries in the pelvic girdle and lower limb. Thus, SIJ dysfunction and pain should be specifically evaluated and addressed when designing rehabilitation programs for sports-related injuries.
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Affiliation(s)
- Sajjad Abdollahi
- Department of Corrective Exercise & Sport Injury, Faculty of Physical Education and Sport Sciences, Allameh Tabataba'i University, Western Azadi Sport Complex Boulevard, Hakim Highway, Tehran, Iran
| | - Rahman Sheikhhoseini
- Department of Corrective Exercise & Sport Injury, Faculty of Physical Education and Sport Sciences, Allameh Tabataba'i University, Western Azadi Sport Complex Boulevard, Hakim Highway, Tehran, Iran.
| | - Mohammad Rahimi
- Department of Corrective Exercise & Sport Injuries, Faculty of Sport Sciences, Shahid Rajaee Teacher Training University, Western Azadi Sport Complex Boulevard, Hakim Highway, Tehran, Iran
| | - Wendy E Huddleston
- Department of Rehabilitation Sciences & Technology, College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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Roseen EJ, Rajendran I, Stein P, Fredman L, Fink HA, LaValley MP, Saper RB. Association of Back Pain with Mortality: a Systematic Review and Meta-analysis of Cohort Studies. J Gen Intern Med 2021; 36:3148-3158. [PMID: 33876379 PMCID: PMC8481518 DOI: 10.1007/s11606-021-06732-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/16/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Back pain is the most common cause of disability worldwide. While disability generally is associated with greater mortality, the association between back pain and mortality is unclear. Our objective was to examine whether back pain is associated with increased mortality risk and whether this association varies by age, sex, and back pain severity. METHODS A systematic search of published literature was conducted using PubMed, Web of Science, and Embase databases from inception through March 2019. We included English-language prospective cohort studies evaluating the association of back pain with all-cause mortality with follow-up periods >5 years. Three reviewers independently screened studies, abstracted data, and appraised risk of bias using the Quality in Prognosis Studies (QUIPS) tool. A random-effects meta-analysis estimated combined odds ratios (OR) and 95% confidence intervals (CI), using the most adjusted model from each study. Potential effect modification by a priori hypothesized factors (age, sex, and back pain severity) was evaluated with meta-regression and stratified estimates. RESULTS We identified eleven studies with 81,337 participants. Follow-up periods ranged from 5 to 23 years. The presence of any back pain, compared to none, was not associated with an increase in mortality (OR, 1.06; 95% CI, 0.97 to 1.16). However, back pain was associated with mortality in studies of women (OR, 1.22; 95% CI, 1.02 to 1.46) and among adults with more severe back pain (OR, 1.26; 95% CI, 1.14 to 1.40). CONCLUSION Back pain was associated with a modest increase in all-cause mortality among women and those with more severe back pain.
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Affiliation(s)
- Eric J Roseen
- Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA. .,Department of Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA. .,New England Geriatric Research, Education, and Clinical Center, VA Boston Healthcare System, Boston, MA, USA.
| | - Iniya Rajendran
- Department of General Internal Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Peter Stein
- Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USA
| | - Lisa Fredman
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Howard A Fink
- Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA.,Geriatric Research, Education, and Clinical Center, Veterans Affairs Health Care System, Minneapolis, MN, USA
| | - Michael P LaValley
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Robert B Saper
- Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
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5
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Low Back Pain in a Nova Scotian Emergency Department: Prevalence and Patient Characteristics in the Older Adult Patient Population. Can J Aging 2021; 41:145-153. [PMID: 34039455 DOI: 10.1017/s0714980821000118] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Low back pain is a major cause of disability in older adults, and results in many emergency department visits each year. Characteristics of the older back pain population are largely unknown. We conducted a retrospective study to examine the prevalence and patient characteristics for older (≥ 65 years of age) and younger (16-64 years of age) adults presenting with back pain. Study objectives were to describe the characteristics of older adults with back pain presenting to an emergency department and to identify age-group based differences in management. Older adults were most commonly diagnosed with non-specific low back pain (49%). For older adults with this diagnosis, the length of stay was 2.1 times longer (p < 0.001), and odds of being admitted to the hospital were 5.1 times higher (p < 0.001) than for younger adults. Patterns of management are different for younger and older adults with low back pain; this information can be used to direct future resource planning.
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Bowen E, Nayfe R, Milburn N, Mayo H, Reid MC, Fraenkel L, Weiner D, Halm EA, Makris UE. Do Decision Aids Benefit Patients with Chronic Musculoskeletal Pain? A Systematic Review. PAIN MEDICINE 2021; 21:951-969. [PMID: 31880805 DOI: 10.1093/pm/pnz280] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To review the effect of patient decision aids for adults making treatment decisions regarding the management of chronic musculoskeletal pain. METHODS We performed a systematic review of randomized controlled trials of adults using patient decision aids to make treatment decisions for chronic musculoskeletal pain in the outpatient setting. RESULTS Of 477 records screened, 17 met the inclusion criteria. Chronic musculoskeletal pain conditions included osteoarthritis of the hip, knee, or trapeziometacarpal joint and back pain. Thirteen studies evaluated the use of a decision aid for deciding between surgical and nonsurgical management. The remaining four studies evaluated decision aids for nonsurgical treatment options. Outcomes included decision quality, pain, function, and surgery utilization. The effects of decision aids on decision-making outcomes were mixed. Comparing decision aids with usual care, all five studies that examined knowledge scores found improvement in patient knowledge. None of the four studies that evaluated satisfaction with the decision-making process found a difference with use of a decision aid. There was limited and inconsistent data on other decision-related outcomes. Of the eight studies that evaluated surgery utilization, seven found no difference in surgery rates with use of a decision aid. Five studies made comparisons between different types of decision aids, and there was no clearly superior format. CONCLUSIONS Decision aids may improve patients' knowledge about treatment options for chronic musculoskeletal pain but largely did not impact other outcomes. Future efforts should focus on improving the effectiveness of decision aids and incorporating nonpharmacologic and nonsurgical management options.
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Affiliation(s)
- Emily Bowen
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Rabih Nayfe
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Nathaniel Milburn
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Helen Mayo
- Health Sciences Digital Library and Learning Center, UT Southwestern Medical Center, Dallas, Texas
| | - M C Reid
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, Cornell University, New York, New York
| | - Liana Fraenkel
- Yale University School of Medicine, New Haven, Connecticut
| | - Debra Weiner
- Geriatric Research, Education and Clinical Center, Veterans Administration Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Department of Medicine, Psychiatry, Anesthesiology and Clinical & Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Ethan A Halm
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Una E Makris
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas.,Department of Medicine, VA North Texas Health Care System, Dallas, Texas, USA
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7
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Nayfe R, Chansard M, Hynan LS, Mortensen EM, Annaswamy T, Fraenkel L, Makris UE. Comparison of patient-reported outcomes measurement information system and legacy instruments in multiple domains among older veterans with chronic back pain. BMC Musculoskelet Disord 2020; 21:598. [PMID: 32900386 PMCID: PMC7487821 DOI: 10.1186/s12891-020-03587-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 08/13/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Chronic low back pain (cLBP) results in significant physical, psycho-social and socioeconomic burden. Identifying efficient and reliable patient reported outcome measures is critical for research and clinical purposes. The NIH's Patient Reported Outcomes Measurement Information System (PROMIS) instruments have not been compared to validated "legacy" instruments in older adults with cLBP. This study evaluates construct (convergent and discriminant) validity and time to complete (TTC) PROMIS as compared to legacy instruments. METHODS We enrolled older Veterans (age 60+) with cLBP with/without leg pain scheduled for lumbar epidural steroid injections. Subjects completed PROMIS computer adaptive test item banks and corresponding legacy instruments in the following domains: pain intensity, interference, and behavior; functional status; depression and anxiety; fatigue; sleep and social functioning. Convergent and discriminant validity between PROMIS and legacy instruments was evaluated using Spearman rank order correlations; Mann-Whitney U tests compared TTC. RESULTS Of the 71 Veterans recruited, the median (IQR) age was 67 (63-71) years old, 94% were men, 76% were White, 17% Black, and 96% were Non-Hispanic. Spearman correlations between PROMIS and legacy instruments showed moderate to very strong convergent validity in all domains (r = 0.4-1.0), except for social functioning and pain behavior (PROMIS Pain Behavior with Fear Avoidance Belief Questionnaire). The total median TTC for all PROMIS items was significantly shorter than legacy items, 8 min 50 s vs 29 min 14 s respectively, p < 0.001. CONCLUSIONS Given time efficiency of using PROMIS, along with strong construct validity, PROMIS instruments are a practical choice for measuring multidimensional PROs in older Veterans with cLBP for both research and clinical purposes.
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Affiliation(s)
- Rabih Nayfe
- Department of Internal Medicine, UT Southwestern (UTSW) Medical Center, Dallas, TX, USA
| | | | - Linda S Hynan
- Department of Population and Data Sciences, UTSW, Dallas, TX, USA
- Department of Psychiatry, UTSW, Dallas, TX, USA
| | - Eric M Mortensen
- Department of Population and Data Sciences, UTSW, Dallas, TX, USA
- Department of Medicine, University of Connecticut, Farmington, CT, USA
- Department of Medicine, VA North Texas Health Care System, Dallas, TX, USA
| | - Thiru Annaswamy
- Department of Physical Medicine & Rehabilitation, VA North Texas Health Care System, Dallas, TX, USA
| | - Liana Fraenkel
- Department of Medicine, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Una E Makris
- Department of Internal Medicine, UT Southwestern (UTSW) Medical Center, Dallas, TX, USA.
- Department of Population and Data Sciences, UTSW, Dallas, TX, USA.
- Department of Medicine, VA North Texas Health Care System, Dallas, TX, USA.
- Department of Internal Medicine, Division of Rheumatic Diseases, VA North Texas Health Care System, 4500 S Lancaster Rd., Dallas, TX, 75216, USA.
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Caring for older veterans with chronic low back pain using a geriatric syndrome approach: Rationale and methods for the aging back clinics (ABC) trial. Contemp Clin Trials 2020; 95:106077. [PMID: 32593717 DOI: 10.1016/j.cct.2020.106077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 06/17/2020] [Accepted: 06/22/2020] [Indexed: 11/23/2022]
Abstract
The purpose of the ongoing trial is to improve care of older Veterans with chronic low back pain (CLBP, i.e., low back pain for ≥6 months on ≥ half the days). Current CLBP care is limited by being either overly spine-focused or non-specifically prescribed and both approaches frequently lead to suboptimal reduction in pain and improvement in function. Through prior studies we have laid the foundation for a patient-centered approach to care for older Veterans with CLBP in which the spine is a source of vulnerability but not the sole treatment target. The approach considers CLBP a geriatric syndrome, a final common pathway for the expression of multiple contributors rather than a disease of the spine. We describe here the rationale and design of a randomized controlled trial to test the efficacy of an older Veteran-centered approach to CLBP care in "Aging Back Clinics (ABCs)" compared with Usual Care (UC). Three hundred thirty Veterans age 65-89 with CLBP will be randomized to ABCs or UC and followed for 12 months after randomization. We will assess the impact of ABCs on our primary outcome of pain-associated disability with the Oswestry Disability Index at 6 and 12 months, and secondary outcomes of pain intensity, health-related quality of life, balance confidence, mobility and healthcare utilization. If shown efficacious, the approach tested in ABCs has the potential to transform the care of older adults with CLBP by improving the quality of life for millions, reducing morbidity and saving substantial healthcare costs.
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9
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Efficacy of an integrated, active rehabilitation protocol in patients ≥ 65 years of age with chronic mechanical low back pain. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 29:586-595. [PMID: 31845031 DOI: 10.1007/s00586-019-06248-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 10/03/2019] [Accepted: 12/06/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE This retrospective study aimed to determine the efficacy of an integrated active, rehabilitation protocol in patients ≥ 65 years of age with chronic mechanical low back pain and compare the results in similar patients in 50-64 years age group. METHODS Pre- and post-treatment mean numerical pain rating scale (NPRS) score, mean Oswestry disability index (ODI) score, treatment outcome category and minimal clinically important difference (MCID) thresholds achieved for NPRS and ODI scores post-treatment were compared among 697 patients in the 50-64 years and 495 patients in the ≥ 65 years age groups. RESULTS At a mean treatment duration of 57 days (range, 30-90 days), both mean NPRS score (p < 0.0001) and mean ODI score (p < 0.0001) were significantly higher in the ≥ 65 years age group when compared to the 50-64 years age group. However, post-treatment outcome categories (p = 0.17) and percentage of patients who achieved MCID thresholds for NPRS score (p = 0.13) and ODI score (p = 0.18) were not significantly different between the two groups. There was a significant correlation between post-treatment NPRS score and patient age and pre-treatment NPRS score and between post-treatment ODI score and incidence of osteoporosis and pre-treatment ODI score. CONCLUSION Although mean NPRS and ODI scores achieved were significantly better in patients of 50-64 years of age, our integrated active, rehabilitation protocol helped achieve significant improvement in NPRS score, MCID thresholds for NPRS and ODI scores and treatment outcomes in patients ≥ 65 years of age, similar to patients in the 50-64 years of age group, at the end of 3 months of treatment. These slides can be retrieved under Electronic Supplementary Material.
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10
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Madill ES, Samuels R, Newman DP, Boudreaux-Kelley M, Weiner DK. Development of an Evaluative, Educational, and Communication-Facilitating App for Older Adults with Chronic Low Back Pain: Patient Perceptions of Usability and Utility. PAIN MEDICINE 2019; 20:2120-2128. [PMID: 31329964 DOI: 10.1093/pm/pnz088] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The purpose of this study is to examine the usability and utility of an office-based iPad app that we developed for older adults with chronic low back pain (CLBP). The app screens for conditions that contribute to back pain and pain interference and provides personalized education based on patient responses. It also facilitates patient-provider communication regarding treatment targets and expectations. METHODS Forty-six older adults (age ≥60 years) with CLBP were recruited from the Veterans Affairs and from the Pittsburgh community. Testing was split into two phases. Alpha testing (N = 15) was used to drive design changes to the app. Beta testing (N = 30, after one participant withdrew) used a structured questionnaire to evaluate the app's usability and utility. RESULTS The application was rated highly for usability and utility (9.6 and 8.9 out of 10, respectively). The majority of participants (82.1%) agreed that the app would help them communicate with their doctor and that it gave them useful information about potentially harmful or unnecessary interventions such as opioids and imaging (79.2% and 75.0%). Participants (age ≥60 years, mean age = 75.5 years) were able to successfully use the application without assistance and would be willing to do so in their primary care office. CONCLUSIONS We present the development of a CLBP app that screens for pain contributors and provides personalized education based on patient responses. Such an app could be employed in a variety of clinical settings to help educate patients about their CLBP and to curtail unnecessary interventions. Patient outcomes are being tested in an ongoing clinical trial.
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Affiliation(s)
- Evan S Madill
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Rachel Samuels
- Geriatric Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - David P Newman
- Geriatric Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | | | - Debra K Weiner
- Geriatric Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Division of Geriatric Medicine, Department of Medicine.,Department of Psychiatry.,Department of Anesthesiology.,Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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11
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Jacobs ZG, Elnicki DM, Perera S, Weiner DK. An E-learning Module on Chronic Low Back Pain in Older Adults: Effect on Medical Resident Attitudes, Confidence, Knowledge, and Clinical Skills. PAIN MEDICINE 2019; 19:1112-1120. [PMID: 29315426 DOI: 10.1093/pm/pnx333] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective To determine 1) the feasibility of implementing an e-learning module on chronic low back pain (CLBP) in an older adult into an existing internal medicine residency curriculum and 2) the impact of this module on resident attitudes, confidence, knowledge, and clinical skills relating to CLBP. Methods Participants were assigned to complete either the online module (N = 73) or the Yale Office-based curriculum on CLBP (N = 70). Attitudes, confidence, and knowledge were evaluated pre- and postintervention via survey. A retrospective blinded chart review of resident clinic encounters was conducted, wherein diagnosis codes and physical exam documentation were rated as basic or advanced. Results There was no improvement in overall knowledge scores in either group (60% average on both metrics). There were tendencies for greater improvements in the intervention group compared with controls for confidence in managing fibromyalgia (2.4 to 2.9 vs 2.5 to 2.5, P = 0.06) and leg length discrepancy (1.8 to 2.5 vs 1.5 to 1.9, P = 0.05). Those exposed to the online module also showed an increase in the percentage of physical exam documentation rated as advanced following the intervention (13% to 32%, P = 0.006), whereas the control group showed no change (14% to 12%, P = 0.68). Conclusions An online module on CLBP in the older adult was a feasible addition to an existing curriculum for internal medicine residents. The module positively and substantively impacted resident clinical behaviors, as evidenced by enhanced sophistication in physical exam documentation; it also was associated with improved confidence in certain aspects of chronic pain management.
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Affiliation(s)
| | | | | | - Debra K Weiner
- Division of Geriatric Medicine.,Department of Medicine.,Department of Psychiatry.,Department of Anesthesiology.,Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.,VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Geriatric Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
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12
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Weiner DK, Gentili A, Coffey-Vega K, Morone N, Rossi M, Perera S. Biopsychosocial Profiles and Functional Correlates in Older Adults with Chronic Low Back Pain: A Preliminary Study. PAIN MEDICINE 2018; 20:1300-1310. [DOI: 10.1093/pm/pny065] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Abstract
Objective
To describe key peripheral and central nervous system (CNS) conditions in a group of older adults with chronic low back pain (CLBP) and their association with pain severity and self-reported and performance-based physical function.
Design
Cross-sectional.
Setting
Outpatient VA clinics.
Subjects
Forty-seven community-dwelling veterans with CLBP (age 68.0 ± 6.5 years, range = 60–88 years, 12.8% female, 66% white) participated.
Methods
Data were collected on peripheral pain generators—body mass index, American College of Rheumatology hip osteoarthritis criteria, neurogenic claudication (i.e., spinal stenosis), sacroiliac joint (SIJ) pain, myofascial pain, leg length discrepancy (LLD), and iliotibial band pain; and CNS pain generators—anxiety (GAD-7), depression (PHQ-9), insomnia (Insomnia Severity Index), maladaptive coping (Fear Avoidance Beliefs Questionnaire, Cognitive Strategies Questionnaire), and fibromyalgia (fibromyalgia survey). Outcomes were pain severity (0 to 10 scale, seven-day average and worst), self-reported pain interference (Roland Morris [RM] questionnaire), and gait speed.
Results
Approximately 96% had at least one peripheral CLBP contributor, 83% had at least one CNS contributor, and 80.9% had both peripheral and CNS contributors. Of the peripheral conditions, only SIJ pain and LLD were associated with outcomes. All of the CNS conditions and SIJ pain were related to RM score. Only depression/anxiety and LLD were associated with gait speed.
Conclusions
In this sample of older veterans, CLBP was a multifaceted condition. Both CNS and peripheral conditions were associated with self-reported and performance-based function. Additional investigation is required to determine the impact of treating these conditions on patient outcomes and health care utilization.
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Affiliation(s)
- Debra K Weiner
- Geriatric Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Department of Medicine
- Department of Psychiatry
- Department of Anesthesiology
- Clinical and Translational Sciences Institute
| | - Angela Gentili
- Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA
| | | | - Natalia Morone
- Department of Medicine
- Clinical and Translational Sciences Institute
| | - Michelle Rossi
- Geriatric Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Department of Medicine
| | - Subashan Perera
- Department of Medicine
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania
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