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

描述（由申请人提供）：下背痛（LBP）是老年人中最常见的肌肉骨骼问题。在这一年龄组中，腰痛与许多负面后果有关，包括行动受限、残疾和医疗保健利用的增加。虽然腰痛是老年人功能下降的一个危险因素，但大多数针对腰痛的研究都排除了60岁以上的人群；因此，临床医生的治疗决策所依据的证据很少。这项工作的长期目标是为患有慢性腰痛的老年人开发和测试一种全面、标准化的康复方法，专门用于减轻疼痛和优化功能。由于许多针对下腰痛的一刀切的干预措施失败，研究人员得出结论，下腰痛患者不属于一个同质组，而应分为具有相似临床特征的亚组，以更好地个性化护理和改善临床结果。我们有希望的初步工作表明，在老年慢性腰痛人群中，一个这样的亚组是由并存的髋关节损伤（即髋关节疼痛、晨僵和活动范围限制）的个体组成的。我们的数据表明，这些髋关节损伤可能通过康复干预来改变，在患有慢性下腰痛的老年人中更为普遍，并且与更严重的下腰痛和残疾有关。在过去，其他人已经讨论了髋关节-脊柱综合征的概念，但尚未从康复干预的角度对其进行系统研究或充分解决。这项工作的中心假设是，在老年人中，共存的髋关节损伤有助于慢性腰痛的发展和持续，以及更大程度的疼痛相关残疾和功能

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.