Highlights
- •Older adults with a new visit to primary care for back pain with comorbid knee or hip osteoarthritis have modestly increased back-related disability, pain interference with activity, and lower health-related quality of life over 12 months.
- •Improvement in back-related disability was less among older adults with knee osteoarthritis, therefore influencing the clinical course of back pain in this subgroup.
- •There was no difference in total back-related health care use, but the utilization of specific categories of use (physical therapy and spinal injections) was more common among older adults with comorbid knee osteoarthritis.
- •These findings suggest rehabilitation providers may need to consider tailoring treatment approaches for older adults with back pain who also have knee or hip osteoarthritis because comorbid osteoarthritis was associated with worse outcomes.
Abstract
Objective
To examine if a comorbid diagnosis of knee or hip osteoarthritis (OA) in older adults
with new back pain visits is associated with long-term patient-reported outcomes and
back-related health care use.
Design
Prospective cohort study.
Setting
Three integrated health systems forming the Back pain Outcomes using Longitudinal
Data cohort.
Participants
Participants (N=5155) were older adults (≥65y) with a new visit for back pain and
a complete electronic health record data.
Interventions
Not applicable; we obtained OA diagnoses using diagnostic codes in the electronic
health record 12 months prior to the new back pain visit.
Main Outcome Measures
The Roland-Morris Disability Questionnaire (RDQ) and the EuroQol-5D (EQ-5D) were key
patient-reported outcomes. Health care use, measured by relative-value units (RVUs),
was summed for the 12 months after the initial visit. We used linear mixed-effects
models to model patient-reported outcomes. We also used generalized linear models
to test the association between comorbid knee or hip OA and total back-related RVUs.
Results
Of the 5155 participants, 368 (7.1%) had a comorbid knee OA diagnosis, and 94 (1.8%)
had a hip OA diagnosis. Of the participants, 4711 (91.4%) had neither knee nor hip
OA. In adjusted models, the 12-month RDQ score was 1.23 points higher (95% confidence
interval [CI], 0.72–1.74) for patients with knee OA and 1.26 points higher (95% CI,
0.24–2.27) for those with hip OA than those without knee or hip OA, respectively.
A lower EQ-5D score was found among participants with knee OA (.02 lower; 95% CI,
−.04 to −.01) and hip OA diagnoses (.03 lower; 95% CI, −.05 to −.01) compared with
those without knee or hip OA, respectively. Comorbid knee or hip OA was not significantly
associated with total 12-month back-related resource use.
Conclusions
Comorbid knee or hip OA in older adults with a new back pain visit was associated
with modestly worse long-term disability and health-related quality of life.
Keywords
List of abbreviations:
BPI (Brief Pain Inventory), CI (confidence interval), EHR (electronic health record), EQ-5D (EuroQol-5D), ICD-9 (International Classification of Diseases, 9th Revision), NRS (numerical rating scale), OA (osteoarthritis), RDQ (Roland-Morris Disability Questionnaire), RVU (relative-value unit)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: August 09, 2016
Footnotes
Supported by the Agency for Healthcare Research and Quality (grant nos. 1R01HS01922201 and 1R01HS022972-01), and a K12 grant from the Agency for Healthcare Research and Quality (grant no. 1K12HS022982-01).
Disclosures: J.G.J. reports financial relations with PhysioSonics, HealthHelp, and Google outside the submitted work. The other authors have nothing to disclose.
Identification
Copyright
© 2016 by the American Congress of Rehabilitation Medicine
