Rundell Sean D, Sherman Karen J, Heagerty Patrick J, Mock Charles N, Jarvik Jeffrey G
Department of Rehabilitation Medicine, University of Washington, Seattle, Washington; Department of Comparative Effectiveness, Cost, and Outcomes Research Center, University of Washington, Seattle, Washington.
J Am Geriatr Soc. 2015 Mar;63(3):524-30. doi: 10.1111/jgs.13241. Epub 2015 Mar 6.
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.
Prospective inception cohort study.
Primary care settings of three integrated healthcare systems in the United States that participated in the Back pain Outcomes using Longitudinal Data (BOLD) registry.
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.
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.
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.
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.
通过描述疼痛强度、功能障碍、疼痛干扰以及12个月内背痛的缓解情况，报告因背痛首次前来初级保健就诊且在过去6个月内未因背痛进行过医疗就诊的老年人的临床病程。
前瞻性队列研究。
美国三个综合医疗系统的初级保健机构，这些机构参与了使用纵向数据的背痛结局（BOLD）登记。
5239名65岁及以上成年人中，有5211名（99.5%）达到了12个月随访日期。
基线人口统计学特征、EQ-5D评分、背痛持续时间、康复期望、抑郁和焦虑情况。在基线以及3个月、6个月和12个月时收集参与者报告的背部相关功能障碍（罗兰·莫里斯功能障碍问卷）、数字疼痛评分量表、疼痛干扰和背痛缓解情况等结局指标。
大多数改善发生在最初3个月内。背痛改善30%的人数及比例从3个月时的1950名（42.3%）增加到12个月时的1994名（44.8%），功能障碍改善30%的人数在3个月和12个月时分别为1331名（28.8%）和1576名（35.4%）。只有23.0%的人报告其背痛在12个月时已缓解。12个月内功能障碍和活动干扰的改善情况因年龄、背痛持续时间、抑郁和焦虑症状以及康复期望而异。
在初级保健机构中因背痛首次就诊的大多数老年人在12个月的随访期内存在持续的症状、功能障碍和干扰。未来需要开展研究以确定持续症状的危险因素和有效的干预措施。
