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How Does Low Back Pain Impact Physical Function in Independent, Well-Functioning Older Adults? Evidence from the Health ABC Cohort and Implications for the Future

Authors

  • Debra K. Weiner MD,

    Corresponding author
    1. 1Division of Geriatric Medicine, Department of Medicine, 2Department of Psychiatry, 3Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; 4Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania; 5Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis National Institutionon on Aging, Bethesda, MD, Tennessee; 6Laboratory of Epidemiology, Demography and Biometry, 7Intramural Research Program, National Institute on Aging, Baltimore, Maryland; and 8Preventive Sciences Group, University of California at San Francisco, San Francisco, California
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  • 13 * Catherine L. Haggerty PhD,

    1. 1Division of Geriatric Medicine, Department of Medicine, 2Department of Psychiatry, 3Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; 4Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania; 5Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis National Institutionon on Aging, Bethesda, MD, Tennessee; 6Laboratory of Epidemiology, Demography and Biometry, 7Intramural Research Program, National Institute on Aging, Baltimore, Maryland; and 8Preventive Sciences Group, University of California at San Francisco, San Francisco, California
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  • 4 Stephen B. Kritchevsky PhD,

    1. 1Division of Geriatric Medicine, Department of Medicine, 2Department of Psychiatry, 3Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; 4Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania; 5Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis National Institutionon on Aging, Bethesda, MD, Tennessee; 6Laboratory of Epidemiology, Demography and Biometry, 7Intramural Research Program, National Institute on Aging, Baltimore, Maryland; and 8Preventive Sciences Group, University of California at San Francisco, San Francisco, California
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  • 5 Tamara Harris MD,

    1. 1Division of Geriatric Medicine, Department of Medicine, 2Department of Psychiatry, 3Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; 4Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania; 5Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis National Institutionon on Aging, Bethesda, MD, Tennessee; 6Laboratory of Epidemiology, Demography and Biometry, 7Intramural Research Program, National Institute on Aging, Baltimore, Maryland; and 8Preventive Sciences Group, University of California at San Francisco, San Francisco, California
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  • 6 Eleanor M. Simonsick PhD,

    1. 1Division of Geriatric Medicine, Department of Medicine, 2Department of Psychiatry, 3Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; 4Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania; 5Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis National Institutionon on Aging, Bethesda, MD, Tennessee; 6Laboratory of Epidemiology, Demography and Biometry, 7Intramural Research Program, National Institute on Aging, Baltimore, Maryland; and 8Preventive Sciences Group, University of California at San Francisco, San Francisco, California
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  • 7 Michael Nevitt PhD,

    1. 1Division of Geriatric Medicine, Department of Medicine, 2Department of Psychiatry, 3Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; 4Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania; 5Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis National Institutionon on Aging, Bethesda, MD, Tennessee; 6Laboratory of Epidemiology, Demography and Biometry, 7Intramural Research Program, National Institute on Aging, Baltimore, Maryland; and 8Preventive Sciences Group, University of California at San Francisco, San Francisco, California
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  • 8 Anne Newman MD,

    1. 1Division of Geriatric Medicine, Department of Medicine, 2Department of Psychiatry, 3Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; 4Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania; 5Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis National Institutionon on Aging, Bethesda, MD, Tennessee; 6Laboratory of Epidemiology, Demography and Biometry, 7Intramural Research Program, National Institute on Aging, Baltimore, Maryland; and 8Preventive Sciences Group, University of California at San Francisco, San Francisco, California
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  • and 1,4 Health, Aging, and Body Composition Research Group

    1. 1Division of Geriatric Medicine, Department of Medicine, 2Department of Psychiatry, 3Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; 4Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania; 5Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis National Institutionon on Aging, Bethesda, MD, Tennessee; 6Laboratory of Epidemiology, Demography and Biometry, 7Intramural Research Program, National Institute on Aging, Baltimore, Maryland; and 8Preventive Sciences Group, University of California at San Francisco, San Francisco, California
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  • This work was supported by the National Institute on Aging contracts N01-AG-6-2101, N01-AG-6-2103, and N01-AG-6-2106.

*UPMC Pain Medicine at Centre Commons, 5750 Centre Avenue, Suite 400, Pittsburgh, PA 15206. Tel: (412) 665-8051; Fax: (412) 665-8067; E-mail: dweiner@pitt.edu.

ABSTRACT

Objective. To determine the relationships between low back pain (LBP) frequency and intensity and self-reported and performance-based physical function in a large cohort of well-functioning older adults.

Design. Cross-sectional survey and examination.

Setting. Community-based cohort of the Health, Aging, and Body Composition (Health ABC) study.

Participants. Participants were 2,766 community-dwelling adults, aged 70–79; 42% were African American, 52% were men.

Outcome Measures. 1) Back pain—location, frequency, intensity; 2) Hip and/or knee pain; 3) Body mass index (BMI); 4) Self-reported difficulty doing functional tasks; 5) Lower extremity function, using the battery from the Established Populations for Epidemiologic Studies in the Elderly (EPESE); 6) Self-rated health; 7) Comorbidity; 8) Depressive symptoms, using the Center for Epidemiological Studies-Depression (CES-D) scale.

Results. LBP was common (36%), and its frequency/intensity was significantly associated with other pain and comorbidities. In gender-specific models, LBP frequency/intensity was not significantly associated with EPESE performance score after adjusting for age, race, BMI, CES-D score, knee pain, hip pain, and other comorbidities. LBP frequency/intensity, however, was significantly associated with self-reported difficulty with most functional tasks after adjusting for important confounders.

Conclusions. Among well-functioning community-dwelling older adults, LBP frequency/intensity was associated with perceived difficulty in performing important functional tasks, but not with observed physical performance. The demonstrated dose-response relationship between pain frequency/intensity and self-reported task performance difficulty underscores the importance of clinical efforts to treat pain without necessarily eradicating it. Additional work is needed to determine whether back pain is associated with a risk for progressive functional decline and loss of independence in older adults and whether therapeutic interventions can ameliorate decline and, therefore, preserve independence.

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