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Jarvik JG, Gold LS, Tan K, Friedly JL, Nedeljkovic SS, Comstock BA, Deyo RA, Turner JA, Bresnahan BW, Rundell SD, James KT, Nerenz DR, Avins AL, Bauer Z, Kessler L, Heagerty PJ. Long-term outcomes of a large, prospective observational cohort of older adults with back pain. Spine J 2018; 18:1540-1551. [PMID: 29391206 DOI: 10.1016/j.spinee.2018.01.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 11/25/2017] [Accepted: 01/19/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Although back pain is common among older adults, there is relatively little research on the course of back pain in this age group. PURPOSE Our primary goals were to report 2-year outcomes of older adults initiating primary care for back pain and to examine the relative importance of patient factors versus medical interventions in predicting 2-year disability and pain. STUDY DESIGN/SETTING This study used a predictive model using data from a prospective, observational cohort from a primary care setting. PATIENT SAMPLE The study included patients aged ≥65 years at the time of new primary care visits for back pain. OUTCOME MEASURES Self-reported 2-year disability (Roland-Morris Disability Questionnaire [RDQ]) and back pain (0-10 numerical rating scale [NRS]). METHODS We developed our models using a machine learning least absolute shrinkage and selection operator approach. We evaluated the predictive value of baseline characteristics and the incremental value of interventions that occurred between 0 and 90 days, and the change in patient disability and pain from 0 to 90 days. Limitations included confounding by indication and unmeasured confounding. RESULTS Of 4,665 patients (89%) with follow-up, both RDQ (from mean 9.6 [95% confidence interval {CI} 9.4-9.7] to mean 8.3 [95% CI 8.0-8.5]) and back pain NRS (from mean 5.0 [95% CI 4.9-5.1] to mean 3.5 [95% CI 3.4-3.6]) scores improved slightly. Only 16% (15%-18%) reported no back pain-related disability or back pain at 2 years after initial visits. Regression model parameters explained 40% of the variation (R2) in 2-year RDQ scores, and the addition of 0- to 3-month change in RDQ score and pain improved prediction (R2=51%). The most consistent predictors of 2-year RDQ scores and back pain NRS scores were 0- to 90-day change in each respective outcome and patient confidence in improvement. Patients experienced 50% and 43% improvement in back pain and disability, respectively, 2 years after their initial visit. However, fewer than 20% of patients had complete resolution of their back pain and disability at that time. CONCLUSIONS Baseline patient factors were more important than early interventions in explaining disability and pain after 2 years.
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Affiliation(s)
- Jeffrey G Jarvik
- Department of Radiology, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA; Department of Neurological Surgery, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA; Department of Health Services, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA; Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, 4333 Brooklyn Ave, Seattle, WA, 98105, USA.
| | - Laura S Gold
- Department of Radiology, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA; Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, 4333 Brooklyn Ave, Seattle, WA, 98105, USA
| | - Katherine Tan
- Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, 4333 Brooklyn Ave, Seattle, WA, 98105, USA; Department of Biostatistics, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Janna L Friedly
- Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, 4333 Brooklyn Ave, Seattle, WA, 98105, USA; Department of Rehabilitation Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Srdjan S Nedeljkovic
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital and Spine Unit, Harvard Vanguard Medical Associates, 75 Francis St, Boston, MA, 02115, USA
| | - Bryan A Comstock
- Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, 4333 Brooklyn Ave, Seattle, WA, 98105, USA; Department of Biostatistics, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Richard A Deyo
- Department of Family Medicine, Department of Internal Medicine, Oregon Institute of Occupational Health Sciences, Oregon Health and Science University, 3303 SW Bond Ave, Portland, OR, 97239, USA
| | - Judith A Turner
- Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, 4333 Brooklyn Ave, Seattle, WA, 98105, USA; Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Brian W Bresnahan
- Department of Radiology, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA; Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, 4333 Brooklyn Ave, Seattle, WA, 98105, USA; Department of Pharmacy, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Sean D Rundell
- Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, 4333 Brooklyn Ave, Seattle, WA, 98105, USA; Department of Rehabilitation Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Kathryn T James
- Department of Radiology, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA; Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, 4333 Brooklyn Ave, Seattle, WA, 98105, USA
| | - David R Nerenz
- Neuroscience Institute, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, 48202, USA
| | - Andrew L Avins
- Division of Research, Northern California Kaiser-Permanente, 2000 Broadway, Oakland, CA, 94612, USA
| | - Zoya Bauer
- Department of Radiology, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA; Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, 4333 Brooklyn Ave, Seattle, WA, 98105, USA
| | - Larry Kessler
- Department of Health Services, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA; Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, 4333 Brooklyn Ave, Seattle, WA, 98105, USA
| | - Patrick J Heagerty
- Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, 4333 Brooklyn Ave, Seattle, WA, 98105, USA; Department of Biostatistics, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
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