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

描述(申请人提供)：尽管背部疼痛是一种非常常见且代价高昂的疾病，但大多数文献都集中在年轻人到中年人身上。这位候选人的初步研究表明，老年人的背部疼痛严重到足以导致活动受限(受限背部疼痛)，既常见又经常发作。虽然在老年人中限制背部疼痛是很常见的，但关于其对晚年生活中痛苦的影响和负担仍有许多需要了解。R03提案的总体目标是使用混合(定量和定性)方法来确定限制老年人背部疼痛的影响。本提案的具体目的是：1)阐明老年人腰部疼痛与随后(新增的或增加的)日常生活活动(ADL)和活动能力丧失之间的关系；2)从社会、生理和心理等多个维度探讨老年人对腰部疼痛如何影响日常生活的观点、经历和态度。我们假设，限制背部疼痛发作的次数和持续时间越多，ADL和活动能力方面新的或不断增加的残疾的发生率就会越高。我们预计，我们的定性结果将提供对限制背部疼痛负担的更全面的了解，比仅从定量分析获得的更丰富的细节。为了实现我们的目标，我们将使用耶鲁大学沉淀事件项目(PEP)的数据，该项目是一个独特的、高度创新的队列，由754名70岁以上的非残疾人组成，在注册时。参与者每隔18个月完成一次基于家庭的全面评估，并在12年以上的时间里每月进行一次限制背部疼痛和残疾的评估。由于某些问题不能仅用定量数据轻易回答，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各种经历。直接相关的是，我们的结果将为临床医生、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，反映限制老年人背部疼痛的负担。归根结底，更好地了解限制背部疼痛的负担和影响是必要的步骤，可用于制定有效的、适合年龄和性别的评估工具和干预措施，以改善老年人这种常见疾病的结果。 与公共卫生相关：尽管背痛是一种非常常见且代价高昂的疾病，但关于其影响和在以后的生活中遭受痛苦的负担，仍有许多需要了解。这项R03申请中的拟议研究将使用混合方法(定量和定性)来提供关于限制背部疼痛(背部疼痛严重到导致活动受限)的影响的新的、高质量的、基于证据的信息，使用跟踪调查超过12年的大量社区生活老年人的数据。最终，这项研究的结果将使人们更好地了解限制背部疼痛的负担和影响，这些负担和影响可用于制定有效的、适合年龄和性别的评估工具和干预措施，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. PUBLIC HEALTH RELEVANCE: Although back pain is a highly common and costly disorder, much remains to be learned about its impact and burden of suffering in later life. The proposed research in this R03 application will use mixed methods (quantitative and qualitative) to provide novel, high-quality, evidence-based information on the impact of restricting back pain (back pain severe enough to result in restricted activity) using data from a large cohort of community-living older persons followed for over 12 years. Ultimately, the results of this study will provide a better understanding of the burden and impact of restricting back pain 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.