Department of Physical Therapy, University of Delaware, Newark, Delaware, USA.
Department of Epidemiology, University of Delaware, Newark, Delaware, USA.
Phys Ther. 2021 Dec 1;101(12). doi: 10.1093/ptj/pzab227.
The purpose of this study is to identify geriatric chronic low back pain (LBP) subgroups based on the presence of potentially modifiable hip impairments, using Latent Variable Mixture Modeling (LVMM), and to examine the prospective relationship between these subgroups and key outcomes over time.
Baseline, 3-month, 6-month, and 12-month data were collected from a prospective cohort of 250 community-dwelling older adults with chronic LBP. Comprehensive hip (symptoms, strength, range of motion, and flexibility), LBP (intensity and disability), and mobility function (gait speed and 6-Minute Walk Test) examinations were performed at each timepoint. Baseline hip measures were included in LVMM; observed classes/subgroups were compared longitudinally on LBP and mobility function outcomes using mixed models.
Regarding LVMM, a model with 3 classes/subgroup fit best. Broadly speaking, subgroups were differentiated best by hip strength and symptom presence: subgroup 1 = strong and nonsymptomatic, subgroup 2 = weak and nonsymptomatic, and subgroup 3 = weak and symptomatic (WS). Regarding longitudinal mixed models, all subgroups improved in most outcomes over time. Specifically, over 12 months, the nonsymptomatic subgroups had lower LBP intensity and disability levels compared with the WS subgroup, whereas the strong and nonsymptomatic subgroup had better mobility function than the 2 "weak" subgroups.
These subgroup classifications may help in tailoring specific interventions in future trials. Special attention should be given to the WS subgroup given their consistently poor LBP and mobility function outcomes.
Among older adults with chronic low back pain, there are 3 hip subgroups: "strong and nonsymptomatic," "weak and nonsymptomatic," and "weak and symptomatic." People in these subgroups demonstrate different outcomes and require different treatment; proper identification will result in tailored interventions designed to benefit individual patients. In particular, people in the WS subgroup deserve special attention, because their outcomes are consistently poorer than those in the other subgroups.
本研究旨在通过潜在可改变的髋关节损伤，使用潜在变量混合建模（LVMM），确定老年慢性下背痛（LBP）亚组，并研究这些亚组与关键结局的前瞻性关系。
从 250 名慢性 LBP 的社区居住的老年患者前瞻性队列中收集基线、3 个月、6 个月和 12 个月的数据。在每个时间点进行全面的髋关节（症状、力量、活动范围和灵活性）、LBP（强度和残疾）和移动功能（步态速度和 6 分钟步行测试）检查。将基线髋关节测量值纳入 LVMM；使用混合模型比较观察到的亚组/组在 LBP 和移动功能结局上的纵向比较。
关于 LVMM，具有 3 个亚组/组的模型拟合最好。总体而言，亚组之间最好通过髋关节力量和症状存在来区分：亚组 1=强壮且无症状，亚组 2=弱且无症状，亚组 3=弱且有症状（WS）。关于纵向混合模型，所有亚组在大多数结局上随时间推移均有所改善。具体而言，在 12 个月内，无症状亚组的 LBP 强度和残疾水平低于 WS 亚组，而强壮且无症状亚组的移动功能优于 2 个“弱”亚组。
这些亚组分类可能有助于未来试验中定制特定的干预措施。鉴于 WS 亚组的 LBP 和移动功能结局始终较差，应特别注意该亚组。
在患有慢性下背痛的老年人中，有 3 个髋关节亚组：“强壮且无症状”、“弱且无症状”和“弱且有症状”。这些亚组的患者表现出不同的结局，需要不同的治疗；正确识别将导致针对个别患者的定制干预措施。特别是，WS 亚组的患者需要特别关注，因为他们的结局始终比其他亚组差。
