The Prevalence of Back and Leg Pain and the Cross-sectional Association With Adverse Health Outcomes in Community Dwelling Older Adults in England

Abstract

Study Design: Cross-sectional analysis of the Oxford Pain, Activity and Lifestyle (OPAL) Cohort Study Summary of background data: Epidemiological data describing the prevalence of back pain (BP) and leg pain in older adults in England is lacking.Objective: To assess the prevalence of BP and leg pain and determine their relationship with adverse health states among older adults in England.Methods: 5,304 community-dwelling adults (aged 65-100 years) enrolled in the OPAL cohort study who provided data on BP and leg pain were included. Participants were classified into four groups based on reports of back and leg pain: 1) no BP, 2) BP only, 3) BP and leg pain which was likely to be neurogenic claudication (NC), 4) and BP and leg pain which was not NC. Adverse health states were frailty, falls, mobility decline, low walking confidence, poor sleep quality and urinary incontinence. We collected demographic and socioeconomic information, health-related quality of life and existing health conditions, and estimated the association between BP presentations and adverse health states using regression analysis.Results: Thirty-four percent of participants (1,786/5,304) reported BP only, 11.2% (n=594/5,304) reported BP and NC and 8.3% (n=441/5,304) reported BP and non-NC leg pain. Participants with BP had worse quality of life compared to those without BP. All BP presentations were significantly associated with adverse health states. Those with NC were most affected. In particular, there was greater relative risk (RR) of low walking confidence ), frailty ) and mobility decline (RR 95%CI 1.74 [1.54-1.97]) compared to no BP. Conclusion:Back and leg pain is a common problem for older adults and associated with reduced quality of life and adverse health states. Findings suggest a need to develop more effective treatment for older adults with back pain especially for those with neurogenic claudication.

The Clinical Effectiveness of a Physiotherapy Delivered Physical and Psychological Group Intervention for Older Adults With Neurogenic Claudication: The BOOST Randomized Controlled Trial

“…Back pain is often present. Approximately 11% of community-dwelling older adults report symptoms consistent with NC ( 3 , 4 ). Symptoms are thought to arise from pressure on nerves and blood vessels in the spinal canal caused by degenerative narrowing of the spinal canal.…”

“…Narrowing may or may not be evident on imaging ( 1 ), and if present, the condition is termed lumbar spinal stenosis. NC substantially affects an individual’s confidence and ability to walk and is associated with adverse health outcomes and reduced quality of life ( 3 , 5 ).…”

Longitudinal qualitative study of living with neurogenic claudication

“…It is frequently reported in adults aged above 60 years. 1 2 NC usually presents as pain and discomfort radiating from the back into the buttocks and legs in a unilateral or bilateral pattern. It is provoked by walking or prolonged standing and relieved by sitting or lumbar flexion.…”

“… 4 5 The impact of back and leg pain consistent with NC on health status is more marked than for people with other patterns of back and leg pain; for older adults, compared with those who report back pain only or have leg pain which is not consistent with NC, those with NC report lower quality of life and are more likely to be frail, be less confident to walk half a mile and to report a decline in their mobility over the last year. 1 The variation in symptom trajectory for people with NC is illustrated by a study of 146 people with NC followed up for 3 years (without surgical treatment); symptoms improved for about one-third of patients, remained unchanged for half the patients and worsened in a few. 6 …”

“…Neurogenic claudication (NC) is caused by narrowing of the spinal canal (lumbar canal stenosis) most often due to osteoarthritis of the spine or spondylosis. It is frequently reported in adults aged above 60 years 1 2. NC usually presents as pain and discomfort radiating from the back into the buttocks and legs in a unilateral or bilateral pattern.…”