Vigdal Ørjan Nesse, Storheim Kjersti, Killingmo Rikke Munk, Småstuen Milada Cvancarova, Grotle Margreth
Department of Physiotherapy, Faculty of Health Science, OsloMet-Oslo Metropolitan University, Oslo, Norway.
Research and Communication Unit for Musculoskeletal Health (FORMI), Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway.
Pain. 2023 Apr 1;164(4):e207-e216. doi: 10.1097/j.pain.0000000000002779. Epub 2022 Sep 8.
Back pain and comorbidity are common in older adults. Comorbidity is a promising prognostic factor for the clinical course of back-related disability, but confirmatory studies assessing its prognostic value are needed. Thus, the aims of this study were to describe the clinical course of back-related disability during 1-year follow-up in patients aged ≥55 years visiting primary care (general practitioner, physiotherapist, or chiropractor) with a new episode of back pain and assess the prognostic value of comorbidity on back-related disability during 1-year follow-up. A prospective cohort study was conducted, including 452 patients. The outcome measure was Roland-Morris Disability Questionnaire (RMDQ, range 0-24) measured at baseline and at 3-, 6-, and 12-month follow-up. The Self-Administered Comorbidity Questionnaire was used to assess comorbidity count (CC, range 0-15) and comorbidity burden (CB, range 0-45). The RMDQ scores improved from median (interquartile range) 9 (4-13) at baseline to 4 (1-9), 4 (0-9), and 3 (0-9) at 3, 6, and 12 months, respectively. Using linear mixed-effects models, we found that CC and CB were independently associated with RMDQ scores. A 1-point increase in CC was associated with an increase in RMDQ score of 0.76 points (95% confidence interval [0.48-1.04]) over the follow-up year, adjusted for known prognostic factors. A 1-point increase in CB was associated with an increased RMDQ score of 0.47 points (95% confidence interval [0.33-0.61]). In conclusion, the clinical course of back-related disability for older adults presenting in primary care was favorable, and increased comorbidity was an independent prognostic factor for increased disability levels.
背痛和共病在老年人中很常见。共病是与背部相关残疾临床病程的一个有前景的预后因素，但需要进行评估其预后价值的验证性研究。因此，本研究的目的是描述年龄≥55岁、因新发背痛就诊于初级保健机构（全科医生、物理治疗师或脊椎治疗师）的患者在1年随访期间与背部相关残疾的临床病程，并评估共病在1年随访期间对与背部相关残疾的预后价值。进行了一项前瞻性队列研究，纳入452例患者。结局指标为在基线以及3个月、6个月和12个月随访时测量的罗兰-莫里斯残疾问卷（RMDQ，范围0 - 24）。使用自填式共病问卷评估共病计数（CC，范围0 - 15）和共病负担（CB，范围0 - 45）。RMDQ评分从基线时的中位数（四分位间距）9（4 - 13）分别改善至3个月时的4（1 - 9）、6个月时的4（0 - 9）和12个月时的3（0 - 9）。使用线性混合效应模型，我们发现CC和CB与RMDQ评分独立相关。在对已知预后因素进行校正后，随访一年中CC每增加1分，RMDQ评分增加0.76分（95%置信区间[0.48 - 1.04]）。CB每增加1分，RMDQ评分增加0.47分（95%置信区间[0.33 - 0.61]）。总之，在初级保健机构就诊的老年人中，与背部相关残疾的临床病程是良好的，共病增加是残疾水平升高的独立预后因素。
