Association of Functional Disability and Biopsychosocial Factors in Older Adults With Low Back Pain Who Live in the Amazonas State Brazil: A Cross-Sectional Study

ObjectiveThe purpose of this study was to identify social and clinical factors associated with levels of functional disability (FD) in older adults with low back pain (LBP) in the city of Manaus, Amazonas, Brazil.MethodsA cross-sectional study of 557 adults with LBP aged ≥60 years was completed. Sociodemographic and clinical features, pain intensity (Numeric Rating Scale), FD (Roland Morris Disability Questionnaire), physical activity (International Physical Activity Questionnaire-short version), body mass index, educational level, health perception, emotional level, and self-reported diseases were evaluated. Statistical analysis was used to verify the association between quantitative variables and a group; Student t test or Mann-Whitney test, and analysis of variance (normality assumption) or Kruskal-Wallis test (non-parametric), P value of less than .05.ResultsThere were 81.3% female participants, 54.9% self-reported their race and/or skin color as brown, and 37.8% were sedentary. Pain intensity scores were 6.26 ± 2.19 in female participants and 5.82 ± 1.84 in male participants. Mean FD scores were 11.68 ± 6.08 for female participants and 9.61 ± 5.76 for males participants, although 39.7% of the total group presented with severe disability (score ≥14) and FD was associated with female sex (P = .001), physical activity (P ≤ 0.001), body mass index (P ≤ .001), emotional level (P < .001), and health perception (P < .001).ConclusionIn this group of older adults with LBP, FD was associated with female sex, level of physical activity, body mass index, emotional level, and health perception. Many factors that were identified with FD are modifiable; therefore, interventions, such as nutrition education and re-conceptualization of self-emotional and health perception, may have potential to help in preventing and reducing FD.     

Associations of Multiple Chronic Conditions With Physical Performance and Falls Among Older Adults With Back Pain: A Longitudinal,Population-based Study

ObjectiveTo determine the association of chronic conditions measured at baseline with physical performance and falls over time among older adults with back pain. We examined both number and type (depression, anxiety, arthritis) of chronic conditions.DesignRetrospective cohort study.SettingNational Health and Aging Trends Study.ParticipantsA total of 2438 community-dwelling Medicare beneficiaries aged ≥65 years with bothersome back pain (N=2438). The sample was mostly female (62%; 95% confidence interval [CI], 59%-64%) and aged 65-74 years (56%; 95% CI, 53%-58%).InterventionsNot applicable.Main Outcome MeasuresShort Physical Performance Battery (SPPB) (range, 0-12, lower indicates worse function) and recurrent falls measured annually over 6 years.ResultsMultiple chronic conditions were highly prevalent (82%; 95% CI, 79%-84%) among those reporting back pain. Adjusted regressions using survey weights with Taylor series linearization method and containing interaction terms for comorbidity and time showed having 2-3 chronic conditions vs 0-1 was associated with lower SPPB scores, and differences grew over time (for example 0.61 points lower [95% CI, −0.88 to −0.34] and 1.22 points lower [95% CI, −1.76 to −0.67] in rounds 3 and 6, respectively). Having ≥4 chronic conditions was associated with lower SPPB scores at all time points vs 0-1 (point estimate range, −1.72 to −2.31). Arthritis alone; the combination of arthritis with depression; and the triad of arthritis, depression, and anxiety were associated with lower SPPB scores at all time points. Logistic regression models showed presence of 2-3 and ≥4 chronic conditions was associated with increased odds of recurrent falls in any given year (odds ratio, 1.91; 95% CI, 1.35-2.69 and odds ratio, 3.92; 95% CI, 2.81-5.46, respectively). Those with the triad of arthritis, depression, and anxiety had greater odds of recurrent falls vs none or 1 condition.ConclusionsAmong older adults with back pain, those with multiple chronic conditions, including co-occurrence of arthritis, depression, and anxiety, have greater risk for poor physical functioning and falls over time.     

Multifidi Muscle Characteristics and Physical Function Among Older Adults With and Without Chronic Low Back Pain

Objective

To determine whether multifidi size, intramuscular fat, or both, are associated with self-reported and performance-based physical function in older adults with and without chronic low back pain (LBP).

Profiling Modifiable Psychosocial Factors Among Children With Chronic Pain: A Person-Centered Methodology

Targeting individually based psychosocial profiles when treating children with chronic pain and their families is key to effective behavioral health intervention and in line with tenants of precision medicine. Extant research is primarily driven by variable-centered models that focus on broad, group-level differences. The current study adopts a person-centered approach, latent profile analysis (LPA), to identify patient subgroups. Cross-sectional data are presented from 366 children (8–17 years; M = 14.48; standard deviation = 2.36) with chronic pain and a primary caregiver (94% mothers). LPA indicator variables were self-reported: fatigue, internalizing symptoms, pain catastrophizing, and pain acceptance; and parent-reported: pain catastrophizing and responses to child pain. One-way analyses of variances examined the effect of profiles on child age, pain, and function. LPA identified a 4-profile solution. Class 1 (12%) demonstrated the lowest scores (conveying least risk) across 5 of 6 factors. Class 4 (37%) had the highest scores (conveying greatest risk) across all factors. Classes 2 (12%) and 3 (39%) demonstrated more variability across domains. Results revealed significant effects of profile based on child age, pain, and function. This study highlights differential presentation of treatment-modifiable domains within a large sample. LPA methodology is showcased to potentially facilitate clinical conceptualizations and tailored approaches to intervention in pediatric chronic pain.PerspectiveThis article presents a methodological and statistical approach that may be beneficial to better assess individual profiles of pediatric pain functioning. Tools that allow providers to better match patient presentation and intervention are in line with the tenants of precision medicine and may ultimately serve to improve child outcomes.     

Correlation Among Pain Intensity,Catastrophizing, and Falls in Older Individuals With Unilateral Knee Osteoarthritis: A Cross-Sectional Study

ObjectiveThe purpose of this study was to investigate whether pain intensity and catastrophizing are associated with fear of falls and the number of falls in older persons with knee osteoarthritis (OA).MethodsA cross-sectional study was conducted involving 100 volunteers (male and female participants), 60 to 80 years old, with a diagnosis of knee OA. Patients were recruited from a physical therapy clinic in the city of São Paulo, Brazil, from March 2019 to November 2019. The following measures were used for the evaluations: Numerical Rating Pain Scale (NRPS), Pain-Related Self-Statement Scale (PRSS), and Falls Efficacy Scale. In statistical analysis, histograms were created to determine the distribution of data. Spearman's correlation coefficients (r_s) were then calculated to determine the strength of the associations among the variables. The receiver operating characteristic curve was used to identify the accuracy of PRSS and NRPS in differentiating participants with a history of falls from those without.ResultsNo significant correlation was found among the pain intensity, pain catastrophizing, fear of falling, and number of falls (r_s value ranging from –0.033 to –0.167; P value ranging from .096-.743). The accuracy of PRSS and NRPS in differentiating participants with falls from those without was insufficient, with area under the curve values of 0.46 and 0.42, respectively.ConclusionPain catastrophizing and intensity were not significantly associated with fear of falling and numbers of falls in older individuals with unilateral knee OA.     

Physical and Psychosocial Factors in the Prevention of Chronic Pain in Older Age

Chronic pain is recognized as a major challenge as people age. Yet, despite growing research on chronic pain management, there is little research into chronic pain prevention. Thus there is a clear need to identify multimodal activities that could be encouraged among older adults as part of a healthy lifestyle to decrease the incidence risk of chronic pain. Using data from the English Longitudinal Study of Ageing we tracked 2,631 adults aged ≥50 years who were free from chronic pain at baseline across a decade and explore whether physical or psychosocial factors reduced the risk of developing chronic pain. In relation to physical factors, engaging in vigorous weekly activity was protective against the development of chronic pain (odds ratio 0.74, standard error 0.07, 95% confidence interval 0.62–0.89) when controlling for all identified socioeconomic, health, and social confounders. However, no effects were found for moderate weekly activity. In relation to psychosocial factors, cultural engagement was also protective against the development of chronic pain (odds ratio 0.75, standard error 0.07, 95% confidence interval 0.63–0.91), but community group participation was not. These findings extend previous work showing that physical activity and psychosocial factors such as positive affect are key factors in the long-term success of chronic pain self-management. Future interventional studies for chronic pain are encouraged.

Association of Dynamic Joint Power With Functional Limitations in Older Adults With Symptomatic Knee Osteoarthritis

Segal NA, Yack HJ, Brubaker M, Torner JC, Wallace R. Association of dynamic joint power with functional limitations in older adults with symptomatic knee osteoarthritis.

Objectives

To determine which lower-limb joint moments and powers characterize the level of gait performance of older adults with symptomatic knee osteoarthritis (OA).

Design

Cross-sectional observational study.

Setting

University motion analysis laboratory.

Participants

Community-dwelling adults (N=60; 27 men, 33 women; age 50-79y) with symptomatic knee OA.

Interventions

Not applicable.

Main Outcome Measures

Physical function was measured using the long-distance corridor walk, the Short Physical Performance Battery, and the Late Life Function and Disability Instrument (LLFDI Function). Joint moments and power were estimated using an inverse dynamics solution after 3-dimensional computerized motion analysis.

Results

Subjects aged 64.2±7.4 years were recruited. Ranges (mean ± SD) for the 400-m walk time and the LLFDI Advanced Lower-Limb Function score were 215.3 to 536.8 (304.1±62.3) seconds and 31.5 to 100 (57.0±14.9) points, respectively. In women, hip abductor moment (loading response), hip abductor power (midstance), eccentric hamstring moment (terminal stance), and power (terminal swing) accounted for 41%, 31%, 14%, and 48% of the variance in the 400-m walk time, respectively (model R²=.61, P<.003). In men, plantar flexor and hip flexor power (preswing) accounted for 19% and 24% of the variance in the 400-m walk time, respectively (model R²=.32, P=.025).

Conclusions

There is evidence that men and women with higher mobility function tend to rely more on an ankle strategy rather than a hip strategy for gait. In higher functioning men, higher knee extensor and flexor strength may contribute to an ankle strategy, whereas hip abductor weakness may bias women with lower mobility function to minimize loading across the knee via use of a hip strategy. These parameters may serve as foci for rehabilitation interventions aimed at reducing mobility limitations.     

Chronic Pain and Frailty in Community-Dwelling Older Adults: A Systematic Review

ObjectiveOur aim was to examine the relationship between chronic pain and frailty in community-dwelling older adults.DesignA systematic review method following the Joanna Briggs Institute Reviewers’ Manual 2015.Data sourcesMEDLINE, Cochrane Library Plus, Science Direct, Scielo, LILACS, and the Joanna Briggs Institute database of systematic reviews and implementation reports were searched using different combinations of the terms “frail,” “frailty,” and “pain.”Review/analysis methodsOriginal publications of nononcologic chronic pain and frailty status in community-dwelling older adults published in English or Spanish were included. Because of the heterogeneity of the studies, a narrative approach was used to summarize the results.ResultsA total of 23 studies were finally selected for the systematic review. Most of them (n = 14) were cross-sectional studies, and there were also longitudinal studies (n = 4), cohort studies (n = 3), and randomized controlled trials (n = 2). Most of the studies found an association between chronic pain and frailty in terms of prevalence; approximately 45% of frail patients had chronic pain, and prevalence can reach 70%.ConclusionsThe studies analyzed suggest that chronic pain has a predictive effect for frailty in older adults compared with those reporting no pain. Higher pain intensity, chronic widespread pain, and higher pain interference were also related to frailty status. No specific interventions for managing chronic pain in frail or prefrail older adults were found.     

Physical Health Impairment and Depression Among Older Adults

Factors were examined that contribute to depression among older adults, aged 60 to 75 years. A convenience sample of 80 older adults living independently in the community was used. There were no differences found between participants with high or low physical impairment for demographic characteristics. Significant differences were found between the two groups for mastery, social resources and depression. Mastery, social resources and economic resources were significant predictors of depression. The findings support the empirical and theoretical links between stressful life events, specificaIly physicaI heaIth impairment, and depression .     

Impact of Physical Activities on Frailty in Community-Dwelling Older Women

Aims: The aim of the study was to determine whether increased physical activities (PA) affect frailty for old women, 75 years and older (OO), compared to 60–74 years old (YO). Methods: This cross-sectional study measured 19 frailty indicators (muscle strength and endurance, balance, gait characteristics, and function), using 46 community-dwelling women. PA were divided into three levels by caloric expenditure per week (<2,000 kcal/week, 2,000–3,999 kcal/week, >4,000 kcal/week). Results: As PA level increased, a gap (=difference) between OO and YO narrowed for step length and function, but for quadriceps strength and endurance, a gap widened. Conclusions: Frailty progresses with aging but older women who engage in a high level of physical activity (>4,000 kcal/week) can increase mobility and functional capacity, but not for muscle strength and endurance. Starting regular resistance training activities early in the aging process is critical to improve or maintain muscle quality to offset age-related frailty.     

Association Between Psychosocial Parameters and Response to Chiropractic Care Among Older Adults With Chronic Low Back Pain: Secondary Analysis of a Randomized Clinical Trial

ObjectivesThe purpose of this study was to determine whether baseline self-efficacy, fear of pain with movement (kinesiophobia), or change in either were associated with clinically important improvement in disability among older adults with chronic low back pain after 12 weeks of chiropractic spinal manipulation (CSM) and exercise.MethodsThis secondary analysis used randomized trial data from community-dwelling adults aged 65 years or older with chronic spinal disability who received non-pharmacological treatment of CSM and exercise. Those with ≥30% reduction in the Oswestry Disability Index (ODI) after 12 weeks of treatment were considered responders to care. Psychosocial measures included the Pain Self-Efficacy Questionnaire (PSEQ) and the Tampa Scale of Kinesiophobia (TSK). Logistic regression–assessed associations were between psychosocial, demographic, and low back predictors and 30% ODI improvement.ResultsThere were 176 community-dwelling older adults included in this analysis. Mean age was 71 years, 59.7% were women; 176 (96.7%) had complete data. Baseline disability (ODI = 26.1 ± 9.3) and back pain (5.0 ± 1.9, 0-10 scale) were moderate. Baseline PSEQ reflected higher self-efficacy (47.7 ± 7.8, 0-60 scale) with minimal kinesiophobia (TSK 34.3 ± 5.2, 17-68 scale). Seventy-two (40.9%) achieved 30% reduction in ODI (mean –5.4 ± 7.9) after 12 weeks of treatment. Mean self-efficacy improvement was clinically important (2.5 ± 6.5 points); kinesiophobia (–2.7 ± 4.4 points) and LBP (–1.6 points) also improved. Baseline PSEQ and percent improvement in PSEQ and TSK were associated with response to treatment in univariate regression analyses but not in multiple regression models that included low back predictors. LBP duration >4 years negatively impacted recovery.ConclusionsAmong this sample of older adults who received chiropractic manipulation and exercise, baseline self-efficacy and improvements in self-efficacy and kinesiophobia were individually associated with clinically important reductions in disability post-intervention, although not in adjusted models when LBP duration was included.     

Energy Impairments in Older Adults With Low Back Pain and Radiculopathy: A Matched Case-Control Study

Objectives

To investigate the impact that the presence of chronic low back pain with radiculopathy (CLBPR) may have on (1) energy efficiency and (2) energy capacity among community-dwelling older adults.

Exercises for Older Adults With Knee and Hip Pain

Half of all older adults report knee and/or hip pain. Obesity and sedentary lifestyle contribute to the incidence and prevalence of painful knee and hip conditions. Weight loss should be a priority in overweight or obese patients. Improving joint function over time requires a balance of rest and usage. Practitioners should assess joint disorders and recommend exercises for reducing knee and hip pain with patients when appropriate. Instruction should include a combination of 1) stretching and flexibility, 2) strength training, and 3) endurance conditioning exercises. Even small improvements in exercise can make meaningful improvements in pain, movement, endurance, and quality of life.