Chronic Low Back Pain in Older Adults: The Role of Co-Existing Hip Impairments

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DESCRIPTION (provided by applicant): Low back pain (LBP) is the most frequently reported musculoskeletal problem among older adults. In this age group, LBP has been associated with a host of negative consequences, including increases in mobility limitations, disability and healthcare utilization. Although LBP is a risk factor for functional decline in the elderly, the majority of research studies addressing LBP exclude people over the age of 60; therefore, clinicians have minimal evidence upon which to base their treatment decisions. The long-term goal of this line of work is to develop and test a comprehensive, standardized rehabilitation approach for older adults with chronic LBP that is specifically designed to reduce pain and optimize function. Due to the failure of many one-size-fits-all interventions for LBP, researchers have concluded that patients with LBP do not belong to one homogeneous group, but rather should be classified into subgroups that share similar clinical characteristics to better individualize care and improve clinical outcomes. Our promising preliminary work suggests that one such subgroup in the elderly population with chronic LBP is comprised of individuals with co-existing hip impairments (i.e. hip joint pain, morning stiffness and range of motion limitations). Our data suggest that these hip impairments, which are potentially modifiable through rehabilitation interventions, are more prevalent among older adults with chronic LBP and are associated with greater LBP severity and disability. In the past, others have discussed the concept of hip-spine syndrome, but it has not been systematically studied or adequately addressed from a rehabilitative intervention standpoint. The central hypothesis of this work is that, among older adults, co-existing hip impairments contribute to the development and persistence of chronic LBP, as well as to a greater level of pain-related disability and functional limitations. We propose a prospective cohort study of 250 older adults (aged 60-85 years) with a new or recent onset of LBP. We will perform a series of clinical hip assessments at baseline and follow up for 12 months. The specific aims of this proposal are to investigate whether: (1) the presence and magnitude of clinical hip impairments at baseline predict the development of chronic LBP and greater LBP-related disability among older adults; (2) the presence and magnitude of clinical hip impairments at baseline predict a greater decline in physical function over the course of 12 months among older adults with a recent onset of LBP, and;(3) the presence and magnitude of clinical hip impairments at baseline predict a greater decline in societal participation over the course of 12 months among older adults with a recent onset of LBP. This study will lay the ground work for developing a therapeutic algorithm for evaluation and treatment of LBP, specifically for older adults, to focus on prevention of chronic LBP and development of functional limitations and disability.