Volume 63, Issue 3 p. 524-530
Brief Reports

The Clinical Course of Pain and Function in Older Adults with a New Primary Care Visit for Back Pain

Sean D. Rundell DPT, PhD

Corresponding Author

Sean D. Rundell DPT, PhD

Department of Rehabilitation Medicine, University of Washington, Seattle, Washington

Department of Comparative Effectiveness, Cost, and Outcomes Research Center, University of Washington, Seattle, Washington

Address correspondence to Sean Rundell, University of Washington, Box 359455, 4333 Brooklyn Ave NE, Seattle, WA 98105. E-mail: [email protected]Search for more papers by this author
Karen J. Sherman PhD, MPH

Karen J. Sherman PhD, MPH

Department of Epidemiology, University of Washington, Seattle, Washington

Department of Group Health Research Institute, University of Washington, Seattle, Washington

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Patrick J. Heagerty PhD

Patrick J. Heagerty PhD

Department of Biostatistics, University of Washington, Seattle, Washington

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Charles N. Mock MD, PhD, MPH

Charles N. Mock MD, PhD, MPH

Department of Epidemiology, University of Washington, Seattle, Washington

Department of Surgery, University of Washington, Seattle, Washington

Department of Harborview Injury Prevention & Research Center, University of Washington, Seattle, Washington

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Jeffrey G. Jarvik MD, MPH

Jeffrey G. Jarvik MD, MPH

Department of Radiology, University of Washington, Seattle, Washington

Department of Neurological Surgery, University of Washington, Seattle, Washington

Department of Orthopedics and Sports Medicine, University of Washington, Seattle, Washington

Department of Health Services and Pharmacy, University of Washington, Seattle, Washington

Department of Comparative Effectiveness, Cost, and Outcomes Research Center, University of Washington, Seattle, Washington

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First published: 06 March 2015
Citations: 53

Abstract

Objectives

To report the clinical course of older adults presenting for a new primary care visit for back pain, no healthcare visit for back pain within the prior 6 months, by describing pain intensity, disability, pain interference, and resolution of back pain over 12 months.

Design

Prospective inception cohort study.

Setting

Primary care settings of three integrated healthcare systems in the United States that participated in the Back pain Outcomes using Longitudinal Data (BOLD) registry.

Participants

Five thousand two hundred eleven (99.5%) of the 5,239 adults aged 65 and older who had reached their 12-month follow-up date.

Measurements

Baseline demographic characteristics, EQ-5D score, duration of back pain, expectation for recovery, depression, and anxiety. Participant-reported outcomes of back-related disability (Roland Morris Disability Questionnaire), numerical pain rating scale, pain interference, and resolution of back pain were collected at baseline and 3, 6, and 12 months.

Results

Most improvement occurred within the first 3 months. The number and proportion with 30% improvement in back pain increased from 1,950 (42.3%) at 3 months to 1,994 (44.8%) by 12 months, and 1,331 (28.8%) and 1,576 (35.4%) had 30% improvement in disability at 3 and 12 months. Only 23.0% reported that their back pain had resolved at 12 months. Improvements in disability and interference with activity over 12 months differed according to age, duration of back pain, symptoms of depression and anxiety, and expectation for recovery.

Conclusion

The majority of older adults in primary care practice settings presenting with a new visit for back pain have persistent symptoms, disability, and interference over 12 months of follow-up. Future research is needed to identify risk factors for persistent symptoms and effective interventions.