Course and prognosis of older back pain patients in general practice: A prospective cohort study

Abstract

The aim of the current study was to determine the course of back pain in older patients and identify prognostic factors for non-recovery at 3 months' follow-up. We conducted a prospective cohort study (the BACE study) of patients aged >55 years visiting a general practitioner (GP) with a new episode of back pain in the Netherlands. The course of back pain was described in terms of self-perceived recovery, pain severity, disability, pain medication, and GP visits at 6 weeks' and 3 months' follow-up. Prognostic factors for non-recovery at 3 months' follow-up were derived from the baseline questionnaire and physical examination. Variables with a prognostic value were identified with multivariable logistic regression analysis (method backward), and an area under the receiver operating curve (AUC) was calculated for the prognostic model. A total of 675 back pain patients (mean age 66.4 (SD 7.6) years) participated in the BACE cohort study. At 6 weeks' follow-up 64% of the patients reported non-recovery from back pain. At 3 months' follow-up 61% still reported non-recovery, but only 26% of these patients had revisited the GP. Longer duration of the back pain, severity of back pain, history of back pain, absence of radiating pain in the leg below the knee, number of comorbidities, patients' expectation of non-recovery, and a longer duration of the timed 'Up and Go' test were significantly associated with non-recovery in a multiple regression model (AUC 0.79). This information can help GPs identify older back pain patients at risk for non-recovery.

Age Group Comparisons of TENS Response Among Individuals With Chronic Axial Low Back Pain

“…In addition, while lumbar patho-anatomical changes increase with age, pathology has not been strongly associated with pain severity or found to predict pain recovery. 2,24,25,51 However, use of imaging in future studies will elucidate whether interactions exist between pathology and TENS response among older adults.…”

Clinical outcomes of early and later physical therapist services for older adults with back pain

“…Adults with acute back pain typically have a good prognosis [3,4], but after 3 months of symptoms, the prognosis is considerably less favorable as the improvement in pain and disability is small for the patients with ongoing pain and disability [3,5,6]. Little is known about the prognosis for new episodes of back pain for older adults, but initial evidence suggests it is less favorable [7]. A greater proportion of older adults continue to have back pain and limited function at 3 months compared with the studies of younger adults [3,4,7].…”

“…Little is known about the prognosis for new episodes of back pain for older adults, but initial evidence suggests it is less favorable [7]. A greater proportion of older adults continue to have back pain and limited function at 3 months compared with the studies of younger adults [3,4,7].…”

“…Nonsteroidal anti-inflammatories can be used as needed for symptom relief [8]. These guidelines are not specific to older adults, who may have additional comorbidities, greater degenerative conditions, and a different prognosis than younger adults [7,9,10]. Because of these differences, it is possible that an alternative approach to managing new episodes of back pain in older adults may be more appropriate than what is suggested by the current guidelines.…”

Physical Therapy for Low Back Pain: What Is It, and When Do We Offer It to Patients?

“…is not part of the prognostic scale, yet studies have found that duration of symptoms is, not surprisingly, a predictor of future duration of spine symptoms. 11,12 Clinicians choosing to use this scale should consider taking duration into account, especially if the back pain is functionally impairing.…”