A Standardized Assessment of Movement-evoked Pain Ratings Is Associated With Functional Outcomes in Older Adults With Chronic Low Back Pain

Abstract

Objective: Despite high prevalence estimates, chronic low back pain (CLBP) remains poorly understood among older adults. Movement-evoked pain (MeP) is an understudied factor in this population that may importantly contribute to disability. This study investigated whether a novel MeP paradigm contributed to selfreported and performance-based function in older adults with CLBP.Materials and Methods: This secondary analysis includes baseline data from 230 older adults with CLBP in the context of a prospective cohort study. The Repeated Chair Rise Test, Six Minute Walk Test, and Stair Climbing Test were used to elicit pain posttest LBP ratings were aggregated to yield the MeP variable. Selfreported and performance-based function were measured by the Late Life Function and Disability Index (LLFDI) scaled function score and Timed Up-and-Go Test (TUG), respectively. Robust regression with HC3 standard errors was used to model adjusted associations between MeP and both functional outcomes; age, sex, body mass index, and pain characteristics (ie, intensity, quality, and duration) were utilized as covariates.Results: MeP was present in 81.3% of participants, with an average rating of 5.09 (SD = 5.4). Greater aggregated posttest MeP was associated with decreased LLFDI scores (b = −0.30, t = −2.81, P = 0.005) and poorer TUG performance (b = 0.081, t = 2.35, P = 0.020), independent of covariates. LBP intensity, quality and duration were not associated with the LLFDI or TUG, (all P > 0.05).Discussion: Aggregated posttest MeP independently contributed to worse self-reported and performance-based function among older adults with CLBP. To understand long-term consequences of MeP, future studies should examine longitudinal associations between MeP and function in this population.

A Novel Movement-Evoked Pain Provocation Test for Older Adults With Persistent Low Back Pain

“…Importantly, their study was the first to operationally define MEP as an aggregate score. 35 Tasks included in MEPLO have also been used for older adults with other pain conditions, such as knee osteoarthritis. For example, Wideman et al 40 found MEP in older adults with knee osteoarthritis increased by 130% during the 6-minute walk test; which was associated with both walk test distance and self-reported physical function.…”

“…1) is a battery of 4 physical performance tests that were chosen for the following 4 reasons: (1) tests are already standardized, (2) tests are currently used in research and clinical care, (3) tests were previously shown to reflect reduced physical performance for older adults with pain conditions, and (4) tests have high ecological validity since the movements or tasks within each test are routinely performed in an older adult's home and community. 33,35,[37][38][39][40][53][54][55] The first task is a 30-second repetitive chair rise test ("rising"), which involves performing as many sit-to-stand sequences as possible in a 30-second period. Next, participants performed the repetitive trunk rotation test ("rotating"), where with arms crossed in a seated position, participants completed 10 rotations to the right followed by 10 rotations to the left.…”

“…35 The aggregate method was associated with poorer self-reported and performance-based physical function in older adults with LBP. 35 Accordingly, we developed the Movement-evoked Provocation Test of Low Back Pain in Older Adults (MEPLO). Our first aim was to determine whether the MEPLO was safe and feasible to perform.…”

“…First, researchers have adopted a wide variety of tests to provoke MEP—from single plane joint movements25,30 to multiple functional movements performed successively 31. However, to date, no test includes the breadth of movements generalizable to older adult daily life and most problematic for those with LBP: rising from a chair, rotating the trunk, reaching, and walking 32–40. Second, the best calculation method to quantify MEP is not yet known.…”

“…The traditional method is a simple 2-point change or “delta” calculation, that is, postmovement minus premovement pain. However, a recent study investigated a new “aggregate” calculation—that is, taking multiple pain ratings after multiple movements and adding them together 35. The aggregate method was associated with poorer self-reported and performance-based physical function in older adults with LBP 35…”