Restricting Back Pain in Community-Living Older Persons: A Mixed-Methods Approach

描述（由申请人提供）：虽然背痛是一种非常常见和昂贵的疾病，但大多数文献都集中在年轻人到中年人身上。该候选药物的初步研究表明，老年人的背痛，严重到足以导致活动受限（限制性背痛），既常见又经常是间歇性的。虽然限制老年人背部疼痛是很常见的，但对其影响和晚年痛苦的负担仍有很多需要了解的地方。本R03提案的总体目标是使用混合（定量和定性）方法确定限制老年人背部疼痛的影响。本研究的具体目的是：1)阐明限制背痛与老年人后续（新的或增加的）日常生活活动（ADL）和活动能力障碍之间的关系；2)从社会、身体和心理等多个维度探讨老年人对限制背痛如何影响日常生活的观点、经历和态度。我们假设，限制性背痛发作的次数和持续时间越长，ADL和活动能力的新发或残疾的发生率越高。我们预计，我们的定性结果将提供一个更全面的了解负担限制背部疼痛，更丰富的细节比什么是可从定量分析单独。为了实现我们的目标，我们将使用耶鲁突发事件项目（PEP）的数据，这是一个独特的、高度创新的队列，由754名70岁以上的非残疾人、社区生活人员组成。参与者每隔18个月完成一次全面的家庭评估，并在12年以上的时间里每月完成一次限制背痛和残疾的评估。由于某些问题仅凭定量数据无法轻易回答，我们还将对患有限制性背痛的老年人进行深入访谈，以确保我们从老年人的角度捕捉到一系列经验。直接相关的是，我们的研究结果将为临床医生、经历这种疾病的老年人及其家人提供创新、新颖和更准确的信息，以反映老年人限制背痛的负担。最终，更好地了解限制背痛的负担和影响是必要的一步，可以用来为开发有效的适合年龄和性别的评估工具和干预措施提供信息，以改善老年人这种常见疾病的结果。

DESCRIPTION (provided by applicant): Although back pain is a highly common and costly disorder, most of the literature has focused on young to middle-aged adults. Preliminary research from this candidate shows that back pain in older persons, severe enough to result in restricted activity (restricting back pain), is both common and frequently episodic. While restricting back pain in older persons is common, much remains to be learned about its impact and burden of suffering in later life. The overall objective of this R03 proposal is to determine, using mixed (quantitative and qualitative) methods, the impact of restricting back pain in older persons. The specific aims of the current proposal are 1) to elucidate the relationship between restricting back pain and subsequent (new or increasing) disability in activities of daily living (ADL) and mobility in older persons and, 2) to explore older persons' perspectives, experiences, and attitudes regarding how restricting back pain impacts daily life from multiple dimensions, including social, physical, and psychological. We hypothesize that a greater number and duration of restricting back pain episodes will be associated with more frequent occurrence of new or increasing disability in ADL and mobility. We anticipate that our qualitative results will provide a more comprehensive understanding of the burden of restricting back pain, in richer detail than what is available from quantitative analyses alone. To accomplish our aims, we will use data from the Yale Precipitating Events Project (PEP), a unique and highly innovative cohort of 754 non-disabled, community-living persons, over the age of 70 at enrollment. Participants have completed comprehensive, home-based assessments at 18-month intervals as well as monthly assessments of restricting back pain and disability for 12+ years. Because certain questions cannot be readily answered using quantitative data alone, we will also conduct in-depth interviews with older persons with restricting back pain to ensure that we capture the range of experiences from the older persons' perspective. Of immediate relevance, our results will provide clinicians, older persons who experience this disorder, and their families, with innovative, novel, and more accurate information that reflects the burden of restricting back pain in older persons. Ultimately, a better understanding of the burden and impact of restricting back pain is a necessary step that may be used to inform development of effective age- and sex-appropriate assessment tools and interventions to improve outcomes of this common condition in older persons.