Trajectories of pain and disability in older adults with acute low back pain: Longitudinal data of the BACE-Brazil cohort.

BACKGROUND: Although the literature describes a favorable course of low back pain (LBP) in adults, little information is available for older adults. LBP is prevalent and complex in older adults, and the analysis of its trajectories may contribute to the improvement of therapeutic approaches. OBJECTIVE: To describe pain and disability trajectories in older adults with a new episode of LBP. METHODS: Older adults (n = 542), aged >55 years with a new episode of nonspecific LBP, were followed for 12 months in a prospective cohort. Pain intensity (Numeric Rating Scale) and disability (Roland-Morris Disability Questionnaire) were assessed at baseline and 3, 6, 9, and 12 months. Latent class growth analysis (LCGA) was used to model pain and disability scores over time. Baseline biopsychosocial characteristics were compared using one-way analysis of variance or Chi-square test (α=0.05). RESULTS: The LCGA identified three and four trajectories in the pain and disability courses, respectively. Trajectories with low, intermediate, or high scores over time were defined. Worse biopsychosocial status at baseline was associated with worst prognosis over 12 months. Low educational level, physical inactivity, poor mobility, recent falls, worse fall self-efficacy, presence of depressive symptoms, more kinesiophobia, greater number of comorbidities, and the presence of other LBP-associated complaints were found in older adults with severe and persistent symptoms. CONCLUSION: The trajectories allow the identification of clusters with similar clinical prognoses in older adults with a new episode of LPB. In practice, excessive treatments and unnecessary tests can be avoided, while more accurate and targeted interventions can be implemented.

Biopsychosocial factors associated with disability in older adults with acute low back pain: BACE-Brasil study. / Fatores biopsicossociais associados com a incapacidade em idosos com dor lombar aguda: estudo BACE-Brasil.

This cross-sectional study evaluated the association of biopsychosocial factors with disability in older adults with a new episode of acute low back pain. Older patients with a new episode of acute low back pain were included and those with cognitive alterations and severe motor impairment were excluded. Disability was assessed using the Roland Morris Disability Questionnaire. The biopsychosocial factors (clinical, functional, health status, psychological and social variables) were evaluated by a structured multidimensional questionnaire and physical examination. A multivariate linear regression was used to analyze data with a statistical significance of 0.05. A total of 386 older individuals with a mean age of 71.6 (± 4.2) years and disability of 13.7 (± 5.7) points were enrolled. Our regression analyses identified that worse physical and mental health (assessed through SF-36), low falls self-efficacy, trouble sleeping due to pain, worse kinesiophobia levels, higher body mass indexes, lumbar morning stiffness, increased pain intensity, female gender and worse functional mobility were significantly associated with baseline disability (p < 0.05). Low back pain-related disability is significantly associated with worse biopsychosocial health conditions in older adults.

Este estudo transversal avaliou a associação de fatores biopsicossociais com a incapacidade em idosos com um novo episódio de dor lombar aguda. Foram incluídos idosos com um novo episódio de dor lombar aguda e excluídos aqueles com alterações cognitivas e deficiências motoras graves. A incapacidade foi avaliada pelo Roland Morris Disability Questionnaire. Os fatores biopsicossociais (variáveis clínicas, funcionais, estado de saúde, psicológicas e sociais) foram avaliados por um questionário estruturado multidimensional e exame físico. Regressão linear multivariada foi utilizada para análise dos dados com significância estatística de 0,05. Participaram 386 idosos com média de idade de 71,6 (±4,2) anos e incapacidade de 13,7 (±5,7) pontos. A análise de regressão linear multivariada identificou que pior saúde física e mental (avaliados através do SF-36), baixa autoeficácia em quedas, dificuldade para dormir por causa da dor, piores níveis de cinesiofobia, maiores índices de massa corporal, presença de rigidez matinal na coluna lombar, maior intensidade de dor, sexo feminino e pior mobilidade funcional foram significativamente associados com incapacidade (p < 0,05). Incapacidade relacionada à dor lombar está significativamente associada com piores condições biopsicossociais de saúde em idosos.

Fatores biopsicossociais associados com a incapacidade em idosos com dor lombar aguda: estudo BACE-Brasil / Biopsychosocial factors associated with disability in older adults with acute low back pain: BACE-Brasil study

Resumo Este estudo transversal avaliou a associação de fatores biopsicossociais com a incapacidade em idosos com um novo episódio de dor lombar aguda. Foram incluídos idosos com um novo episódio de dor lombar aguda e excluídos aqueles com alterações cognitivas e deficiências motoras graves. A incapacidade foi avaliada pelo Roland Morris Disability Questionnaire. Os fatores biopsicossociais (variáveis clínicas, funcionais, estado de saúde, psicológicas e sociais) foram avaliados por um questionário estruturado multidimensional e exame físico. Regressão linear multivariada foi utilizada para análise dos dados com significância estatística de 0,05. Participaram 386 idosos com média de idade de 71,6 (±4,2) anos e incapacidade de 13,7 (±5,7) pontos. A análise de regressão linear multivariada identificou que pior saúde física e mental (avaliados através do SF-36), baixa autoeficácia em quedas, dificuldade para dormir por causa da dor, piores níveis de cinesiofobia, maiores índices de massa corporal, presença de rigidez matinal na coluna lombar, maior intensidade de dor, sexo feminino e pior mobilidade funcional foram significativamente associados com incapacidade (p < 0,05). Incapacidade relacionada à dor lombar está significativamente associada com piores condições biopsicossociais de saúde em idosos.

Abstract This cross-sectional study evaluated the association of biopsychosocial factors with disability in older adults with a new episode of acute low back pain. Older patients with a new episode of acute low back pain were included and those with cognitive alterations and severe motor impairment were excluded. Disability was assessed using the Roland Morris Disability Questionnaire. The biopsychosocial factors (clinical, functional, health status, psychological and social variables) were evaluated by a structured multidimensional questionnaire and physical examination. A multivariate linear regression was used to analyze data with a statistical significance of 0.05. A total of 386 older individuals with a mean age of 71.6 (± 4.2) years and disability of 13.7 (± 5.7) points were enrolled. Our regression analyses identified that worse physical and mental health (assessed through SF-36), low falls self-efficacy, trouble sleeping due to pain, worse kinesiophobia levels, higher body mass indexes, lumbar morning stiffness, increased pain intensity, female gender and worse functional mobility were significantly associated with baseline disability (p < 0.05). Low back pain-related disability is significantly associated with worse biopsychosocial health conditions in older adults.

The Brazilian Back Complaints in the Elders (Brazilian BACE) study: characteristics of Brazilian older adults with a new episode of low back pain.

OBJECTIVE: Low back pain (LBP) is little explored in the aging population especially when considering age-relevant and culturally dependent outcomes. We aimed to describe socio-demographic and clinical characteristics of Brazilian older people with a new episode of LBP presenting to primary care. METHODS: We sourced baseline information on socio-demographic, pain-related and clinical characteristics from 602 older adults from the Brazilian Back Complaints in the Elders (Brazilian BACE) study. We analyzed differences in pain, disability, functional capacity and psychosocial factors between sub-groups based on age (i.e. participants aged 55-74 or ≥75 years), education (i.e. those with four years or less of schooling or those with more than four years of schooling) and income (i.e. participants who reported earning two or less minimal wages or three and more). RESULTS: Participants presented severe LBP (7.18/10, SD: 2.59). Younger participants were slightly more disabled (mean difference 1.29 points, 95% confidence interval [CI]: 0.03/5.56), reporting poorer physical health, and less fall-related self-efficacy (mean difference of 2.41, 95% CI 0.35/4.46). Those less educated, and those with income equal or less than two minimum wages had more disability, pain catastrophizing and worse functional capacity. CONCLUSIONS: This was the first study showing that Brazilian older adults with LBP present high levels of functional disability and psychological distress, especially those with low socioeconomic status.

Anterior Trunk Mobility Does Not Predict Disability in Elderly Women With Acute Low Back Pain: Brazilian Back Complaints in the Elders (BACE-Brazil) Study Results.

STUDY DESIGN: Cross-sectional, ancillary study of an international multicenter epidemiological study. OBJECTIVE: To investigate the relationship of the anterior trunk mobility with self-report and physical performance measures in elderly women with acute low back pain (LBP). SUMMARY OF BACKGROUND DATA: LBP is one of the most prevalent pain complaints in the elderly population. It is postulated that the increased range of motion of limited joints of the trunk may improve LBP and functionality of patients. Recent studies have, however, questioned the association between trunk range of motion and the functional status. METHODS: The present study included a convenience sample of elderly women from the community aged 60 years and older who presented with a new (acute) episode of LBP. Volunteers with severe diseases and visual, hearing and mobility losses, or cognitive impairment were excluded. Trunk mobility was assessed by the fingertip-to-floor test. Functionality was assessed by the Roland-Morris Questionnaire (RMQ) and gait speed test. Statistical analysis was performed by using hierarchical linear regression model. RESULTS: Data from 459 elderly women, mean age of 69.0 (6.1) years old, were used to describe this report. The additional predictive value for the inclusion of independent variable trunk mobility was only 4.4% in the RMQ score and 1.5% in the gait speed test, respectively. A reduced hierarchical linear regression model showed that the significant predictors for RMQ and gait speed test were body mass index, pain intensity, and trunk mobility. CONCLUSION: This was the first study to investigate the relationship between trunk mobility and functionality in elderly women with acute LBP. The results suggest that these clinical parameters are independent from each other. LEVEL OF EVIDENCE: N/A.

Inflammatory mediators, muscle and functional performance of community-dwelling elderly women.

The purpose of this study was to investigate the correlation and association between inflammatory mediators and muscle and functional performance in elderly women. We conducted a cross-sectional study. Plasma concentrations of interleukin-6 (IL-6) and soluble receptor for tumor necrosis factor alpha (sTNFR1) were determined by enzyme-linked immune sorbent assay. The muscle performance was measured using a isokinetic dynamometer and assessment of handgrip strength was performed using a Jamar® dynamometer. Functional performance was assessed through a walking speed test. Statistical analysis was performed using the Pearson or Spearman correlation. The association between the variables was determined by multiple regression analysis. 221 volunteers (71.07±4.93 years) participated in the study. Plasma levels of IL-6 (0.87pg/mL) correlated with the power of the knee extensors (r=0.14; p=0.03) and the power of the knee flexors (r=0.16; p=0.01); the plasma levels of sTNFR1 (1051.70pg/mL) did not correlate with any dependent variable. The regression models showed that the variables IL-6, level of physical activity and depressive status explained 5.5% (R(2)=0.055, p<0.01) of average power of knee extensors variability. For the average power of knee flexors, the final model showed that the factors IL-6 and level of physical activity explained 4.1% (R(2)=0.041, p<0.01). There was no negative correlation between inflammatory mediators and muscle or physical performance in elderly women. These results may be explained by the fact that the cytokine levels did not reach the threshold needed to influence the muscle tissue and functionality of the participants.

Impacto das alterações visuais nas quedas, desempenho funcional, controle postural e no equilíbrio dos idosos: uma revisão de literatura / The impact of visual alterations on falls, functional performance, postural control and balance in the elderly: a literature review

Idosos com déficits visuais podem alterar seu estilo de vida e sua independência funcional. As alterações visuais podem ocasionar a redução na interação social e na qualidade de vida, presença de depressão e quedas. O controle do equilíbrio corporal pode estar diminuído em indivíduos com déficits visuais. O objetivo deste estudo é realizar uma revisão da literatura dos últimos 15 anos sobre o impacto das alterações visuais nas quedas, no desempenho funcional, no controle postural e no equilíbrio dos idosos. A avaliação da acuidade visual pode não ser suficiente para identificar indivíduos com risco de quedas. Outras medidas relacionadas à função visual, como contraste, sensibilidade e profundidade, também são importantes. Muitos problemas relacionados à baixa visão em idosos são passíveis de correção e tratamento, seja através das órteses ou mesmo da extração da catarata, melhorando, assim, a função visual e motora.

Visual impairment in the elderly may alter their life style and functional independence. Visual alterations may cause depression, falls and a reduction in social interaction, altering the quality of life. The control of body balance may be impaired in individuals with visual deficits. The objective of this study was to review the last 15 years of literature on the impact of visual alterations through feedback from the visual system, on functional performance, on postural control and on balance in the elderly. The assessment of visual acuity may not be sufficient to identify those individuals who are at risk of falling. Other measurements related to visual function, such as contrast, sensitivity and depth perception, are also important. Many problems related to impaired vision in the elderly are correctable or treatable, either by the use of reflective vision correction or by extraction of cataracts, thus improving both visual and motor functions.