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

描述(由申请人提供)：腰背痛(LBP)是老年人中最常见的肌肉骨骼问题。在这个年龄段，LBP与一系列负面后果有关，包括行动能力受限、残疾和医疗保健利用率的增加。尽管LBP是老年人功能衰退的危险因素，但大多数针对LBP的研究排除了60岁以上的人；因此，临床医生几乎没有证据来做出治疗决定。这项工作的长期目标是为患有慢性LBP的老年人开发和测试一种全面、标准化的康复方法，这种方法专门设计用于减轻疼痛和优化功能。由于许多针对LBP的一刀切的干预措施都失败了，研究人员得出结论，LBP患者不属于一个同质组，而应该被归类为具有相似临床特征的亚组，以更好地个体化护理和改善临床结果。我们有希望的初步工作表明，在患有慢性LBP的老年人群中，有一个这样的亚组是由同时存在髋关节损伤(如髋关节疼痛、晨僵和活动范围受限)的个体组成的。我们的数据表明，这些髋关节损伤可能可以通过康复干预来改变，在患有慢性LBP的老年人中更普遍，并与更严重的LBP严重程度和残疾有关。在过去，其他人讨论了髋椎综合征的概念，但还没有从康复干预的角度对其进行系统的研究或充分解决。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LBP的发展和持续，以及更高水平的疼痛相关残疾和功能 限制。我们提出了一项前瞻性队列研究，研究对象为250名新发或新近发病的老年人(年龄60-85岁)。我们将在基线上进行一系列临床髋关节评估，并随访12个月。这项建议的具体目的是调查：(1)基线临床髋关节损害的存在和程度是否可以预测慢性LBP的发展和老年人中与LBP相关的更大的残疾；(2)基线临床髋关节损害的存在和程度是否预测最近发生LBP的老年人在12个月期间身体功能的更大下降；以及(3)基线临床髋关节损害的存在和程度是否预测最近发生LBP的老年人在12个月的过程中社会参与度下降更大。这项研究将为开发一种评估和治疗LBP的治疗算法奠定基础，特别是针对老年人，重点关注慢性LBP的预防和功能限制和残疾的发展。

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.