Older adults presenting at primary care for back-related disability have a favorable clinical trajectory, but increased comorbidity count and burden are associated with increased back-related disability levels, according to study results published in Pain.
The Back Complaints in the Elderly-Norway (BACE-N) study (ClinicalTrials.gov Identifier: NCT04261309) was a prospective, observational study conducted between 2015 and 2020. Patients (N=452) aged 55 years and older who were seeking primary care for back-related disability at a general practitioner, physiotherapist, or chiropractor were evaluated by the Roland-Morris Disability Questionnaire (RMDQ) every 3 months for a year.
The study population included patients with a median age of 66 (IQR, 59-72) years, 52.0% were women, 25.6% had a BMI of at least 30.00 kg/m2, 67% had been experiencing pain for less than 6 weeks, and RMDQ score was 9 (IQR, 4-13). The most common comorbidities were hypertension (35.3%), osteoarthritis (30.6%), heart disease (15.4%), depression (7.6%), diabetes (6.9%), osteoporosis (6.7%), and lung disease (5.8%).
The number of patients who completed the RMDQ at baseline was 407, decreasing to 336 at month 3, 326 at month 6, and 300 at month 12, respectively.
The most improvement in RMDQ scores was observed between baseline and month 3. In general, scores were maintained from month 3 to month 12.
An increase in the number of comorbidities by 1 was associated with a 0.75-point higher RMDQ score. Similarly, a 1-point increase in comorbidity burden increased RMDQ score by 0.47 points. In the full model, comorbidity count (R2, 0.287) and comorbidity burden (R2, 0.301) were related with back-related disability over 12 months.
Results from a sensitivity analysis were consistent with the main analysis.
Study limitations include a high number of patients lost during follow-up, an inability to collect data on all eligible patients, and using self-reported measures for comorbidity.
“The clinical course of back-related disability in older adults is generally favorable, which is important for clinicians when providing prognostic information in their clinical encounters,” the study authors wrote. “Our confirmatory prognostic factor analyses emphasize the importance for clinicians to assess and address comorbidities in older adults with back pain, and for stakeholders to develop integrated care pathways to improve outcomes.”
This article originally appeared on Clinical Pain Advisor
Vigdal ØN, Storheim K, Killingmo RM, Småstuen MC, Grotle M. The 1-year clinical course of back-related disability and the prognostic value of comorbidity among older adults with back pain in primary care. Pain. Published online September 8, 2022. doi:10.1097/j.pain.0000000000002779