Low back pain (LBP) is the most frequently reported musculoskeletal problem among older adults. Unique to this age group, LBP is notably associated with a decline in mobility function. Clinicians have minimal evidence upon which to base treatment decisions for older adults with LBP due to lack of research studies directly focusing on this population. Thus, the long-term goal of this line of research is to develop and test a standardized rehabilitation approach for older adults with chronic LBP that is specifically designed to optimize mobility function by addressing pain and the unique impairments identified during the initial funding period of this grant. LBP experts 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. Identification of clinical subgroups is the first step in the development of a comprehensive therapeutic algorithm. During the initial funding period, we explored the hypothesis that modifiable, co-existing hip impairments (pain, stiffness, weakness, motion restrictions) in older adults with a primary complaint of chronic LBP would predict poor outcomes. Ultimately, in the context of a prospective cohort study of 250 older adults with chronic LBP, we confirmed this hypothesis and identified a subgroup based upon the combined presence of elevated hip pain and global weakness of the hip musculature; further, this subgroup (>40% of the sample) was at risk for markedly worse LBP and functional outcomes over the course of 12 months. Given our robust predictive findings, we developed a hip-focused rehabilitation intervention (2x/week for 8 weeks) based on current best evidence to address the hip impairments in this subgroup. Our preliminary data from the initial testing of this intervention suggest that this LBP subgroup may have a more favorable LBP treatment response when the identified hip impairments are also addressed. Therefore, the natural next step is to refine and explore the efficacy of this hip-focused intervention for the newly identified at-risk subgroup through the conduct of a well-controlled Phase II trial. In this renewal application, we propose a multi- site, single-blinded, randomized controlled, Phase II trial of 180 older adults with chronic LBP who are classified as members of the at-risk hip-spine subgroup. We will investigate whether a hip-focused intervention warrants further investigation as a treatment approach to improve LBP-related disability and physical function (gait speed) among older adults with chronic LBP. Manual therapy will be used to address hip joint pain and progressive strengthening will address hip weakness. We will also investigate improvements in hip joint pain, hip strength and functional self- efficacy as underlying mechanisms contributing to treatment success. Successful completion of this Phase II trial will provide the critical information needed to plan a definitive trial for an a priori determined, at-risk subgroup identified in our initial funding period. This line of work has the potential to transform the rehabilitative care of older adults with chronic LBP by providing treatment that specifically focuses on the amelioration of pain with the overall goal of preventing functional decline for older adults with chronic pain.

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) establishing preliminary efficacy of a tailored treatment approach for 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.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
5R01AG041202-08
Application #
9939375
Study Section
Neurological, Aging and Musculoskeletal Epidemiology (NAME)
Program Officer
Joseph, Lyndon
Project Start
2012-08-01
Project End
2022-05-31
Budget Start
2020-06-01
Budget End
2021-05-31
Support Year
8
Fiscal Year
2020
Total Cost
Indirect Cost
Name
University of Delaware
Department
Other Health Professions
Type
Sch Allied Health Professions
DUNS #
059007500
City
Newark
State
DE
Country
United States
Zip Code
19716
Coyle, Peter C; Pugliese, Jenifer M; Sions, J Megan et al. (2018) Energy Impairments in Older Adults With Low Back Pain and Radiculopathy: A Matched Case-Control Study. Arch Phys Med Rehabil 99:2251-2256
Coyle, Peter C; Schrack, Jennifer A; Hicks, Gregory E (2018) Pain Energy Model of Mobility Limitation in the Older Adult. Pain Med 19:1559-1569
Hicks, Gregory E; Sions, J Megan; Velasco, Teonette O (2018) Hip Symptoms, Physical Performance, and Health Status in Older Adults With Chronic Low Back Pain: A Preliminary Investigation. Arch Phys Med Rehabil 99:1273-1278
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
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; Coyle, Peter C et al. (2017) Altered spatiotemporal characteristics of gait in older adults with chronic low back pain. Gait Posture 55:172-176
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

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