Low back pain (LBP) is the most frequently reported musculoskeletal problem among older adults. In this age group, LBP has been associated with a host of negative consequences, including increases in mobility limitations, disability and healthcare utilization. Although LBP is a risk factor for functional decline in the elderly, the majority of research studies addressing LBP exclude people over the age of 60;therefore, clinicians have minimal evidence upon which to base their treatment decisions. The long-term goal of this line of work is to develop and test a comprehensive, standardized rehabilitation approach for older adults with chronic LBP that is specifically designed to reduce pain and optimize function. Due to the failure of many one-size-fits-all interventions for LBP, researchers have concluded that patients with LBP do not belong to one homogeneous group, but rather should be classified into subgroups that share similar clinical characteristics to better individualize care and improve clinical outcomes. Our promising preliminary work suggests that one such subgroup in the elderly population with chronic LBP is comprised of individuals with co-existing hip impairments (i.e. hip joint pain, morning stiffness and range of motion limitations). Our data suggest that these hip impairments, which are potentially modifiable through rehabilitation interventions, are more prevalent among older adults with chronic LBP and are associated with greater LBP severity and disability. In the past, others have discussed the concept of hip-spine syndrome, but it has not been systematically studied or adequately addressed from a rehabilitative intervention standpoint. The central hypothesis of this work is that, among older adults, co-existing hip impairments contribute to the development and persistence of chronic LBP, as well as to a greater level of pain-related disability and functional limitations. We propose a prospective cohort study of 250 older adults (aged 60-85 years) with a new or recent onset of LBP. We will perform a series of clinical hip assessments at baseline and follow up for 12 months.
The specific aims of this proposal are to investigate whether: (1) the presence and magnitude of clinical hip impairments at baseline predict the development of chronic LBP and greater LBP-related disability among older adults;(2) the presence and magnitude of clinical hip impairments at baseline predict a greater decline in physical function over the course of 12 months among older adults with a recent onset of LBP, and;(3) the presence and magnitude of clinical hip impairments at baseline predict a greater decline in societal participation over the course of 12 months among older adults with a recent onset of LBP. This study will lay the ground work for developing a therapeutic algorithm for evaluation and treatment of LBP, specifically for older adults, to focus on prevention of chronic LBP and development of functional limitations and disability.

Public Health Relevance

Given the prevalence of chronic low back pain (LBP) in community dwelling older adults and the associated negative functional consequences, this research will have a broad impact on public health as there has been limited research aimed at reducing pain and disability in the geriatric population with LBP. Potential benefits of this research include: (a) identifying treatment targets for the prevention of chronic LBP in the geriatric population;(b) delaying functional decline in this vulnerable population;and (c) future development of studies focused on reducing disability and health care utilization costs through the use of well-defined evaluation and treatment algorithms for elders with LBP.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Research Project (R01)
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Neurological, Aging and Musculoskeletal Epidemiology (NAME)
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Joseph, Lyndon
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University of Delaware
Other Health Professions
Schools of Allied Health Profes
United States
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Sions, Jaclyn Megan; Teyhen, Deydre S; Hicks, Gregory E (2017) Criterion Validity of Ultrasound Imaging: Assessment of Multifidi Cross-Sectional Area in Older Adults With and Without Chronic Low Back Pain. J Geriatr Phys Ther 40:74-79
Hicks, Gregory E; Sions, J Megan; Coyle, Peter C et al. (2017) Altered spatiotemporal characteristics of gait in older adults with chronic low back pain. Gait Posture 55:172-176
Sions, J Megan; Coyle, Peter C; Velasco, Teonette O et al. (2017) Multifidi Muscle Characteristics and Physical Function Among Older Adults With and Without Chronic Low Back Pain. Arch Phys Med Rehabil 98:51-57
Sions, Jaclyn Megan; Hicks, Gregory Evan (2017) Back Stiffness Is Associated with Physical Health and Low Back Pain-Related Disability in Community-Dwelling Older Adults. Pain Med 18:866-870
Hicks, Gregory E; Sions, J Megan; Velasco, Teonette O (2017) Hip Symptoms, Physical Performance, and Health Status in Older Adults With Chronic Low Back Pain: A Preliminary Investigation. Arch Phys Med Rehabil :
Coyle, Peter C; Velasco, Teonette; Sions, J Megan et al. (2017) Lumbar Mobility and Performance-Based Function: An Investigation in Older Adults with and without Chronic Low Back Pain. Pain Med 18:161-168
Sions, Jaclyn Megan; Smith, Andrew Craig; Hicks, Gregory Evan et al. (2016) Trunk Muscle Size and Composition Assessment in Older Adults with Chronic Low Back Pain: An Intra-Examiner and Inter-Examiner Reliability Study. Pain Med 17:1436-46
Shardell, Michelle; Hicks, Gregory E; Ferrucci, Luigi (2015) Doubly robust estimation and causal inference in longitudinal studies with dropout and truncation by death. Biostatistics 16:155-68
Shardell, Michelle; Semba, Richard D; Kalyani, Rita R et al. (2015) Serum 25-Hydroxyvitamin D, Plasma Klotho, and Lower-Extremity Physical Performance Among Older Adults: Findings From the InCHIANTI Study. J Gerontol A Biol Sci Med Sci 70:1156-62
Coyle, P C; Sions, J M; Velasco, T et al. (2015) Older Adults with Chronic Low Back Pain: A Clinical Population Vulnerable to Frailty? J Frailty Aging 4:188-90

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