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Hip Symptoms, Physical Performance, and Health Status in Older Adults With Chronic Low Back Pain: A Preliminary Investigation

Published:October 27, 2017DOI:https://doi.org/10.1016/j.apmr.2017.10.006

      Abstract

      Objectives

      To determine (1) whether there are differences in the prevalence of clinical hip symptoms between older adults with and without chronic low back pain (CLBP); and (2) whether coexisting hip symptoms are associated with worse physical performance and poorer health-related quality of life (HRQOL).

      Design

      Case-control study.

      Setting

      Individuals participated in a standardized evaluation in a clinical laboratory.

      Participants

      Clinical hip symptoms, which are proposed predictors of radiographic hip osteoarthritis according to American College of Rheumatology guidelines, were evaluated in a volunteer sample of community-dwelling older adults with CLBP (n=54; aged 60–85y) and in age- and sex-matched healthy controls (n=54).

      Interventions

      Not applicable.

      Main Outcome Measures

      Physical performance was measured by the repeated chair rise test and stair-climbing test. HRQOL was measured by the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36).

      Results

      Hip joint pain, morning stiffness, and pain with hip internal rotation were more common among older adults with CLBP (P<.05). Participants with CLBP and coexisting hip symptoms had worse physical performance than individuals without CLBP or hip symptoms (P<.0001). Additionally, the presence of coexisting hip symptoms was associated with worse HRQOL, particularly in the domains of social functioning, mental health, and role limitations attributable to emotional problems as measured by the SF-36 (P<.01).

      Conclusions

      Given our limited understanding of CLBP among older adults, there is a definitive need to systematically explore coexisting pain conditions that may contribute to worse outcomes. Based on these data, future longitudinal studies should explore whether coexisting hip symptoms are associated with a worse prognosis in older adults with CLBP.

      Keywords

      List of abbreviations:

      BMI (body mass index), CLBP (chronic low back pain), HRQOL (health-related quality of life), IR (internal rotation), LBP (low back pain), MANOVA (multivariate analysis of variance), OA (osteoarthritis), SF-36 (Medical Outcomes Study 36-Item Short-Form Health Survey)
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      References

        • Bressler H.B.
        • Keyes W.J.
        • Rochon P.A.
        • Badley E.
        The prevalence of low back pain in the elderly. A systematic review of the literature.
        Spine (Phila Pa 1976). 1999; 24: 1813-1819
        • Patel K.V.
        • Guralnik J.M.
        • Dansie E.J.
        • Turk D.C.
        Prevalence and impact of pain among older adults in the United States: findings from the 2011 National Health and Aging Trends Study.
        Pain. 2013; 154: 2649-2657
        • Weiner D.K.
        • Kim Y.
        • Bonino P.
        • Wang T.
        Low back pain in older adults: are we utilizing healthcare resources wisely?.
        Pain Med. 2006; 7: 143
        • Engel C.C.
        • von Korff M.
        • Katon W.J.
        Back pain in primary care: predictors of high health-care costs.
        Pain. 1996; 65: 197-204
        • Reid M.C.
        • Williams C.S.
        • Gill T.M.
        Back pain and decline in lower extremity physical function among community-dwelling older persons.
        J Gerontol A Biol Sci Med Sci. 2005; 60: 793-797
        • Hicks G.E.
        • Simonsick E.M.
        • Harris T.B.
        • et al.
        Trunk muscle composition as a predictor of reduced functional capacity in the Health, Aging and Body Composition study: the moderating role of back pain.
        J Gerontol A Biol Sci Med Sci. 2005; 60: 1420-1424
        • Leveille S.G.
        • Guralnik J.M.
        • Hochberg M.
        • et al.
        Low back pain and disability in older women: independent association with difficulty but not inability to perform daily activities.
        J Gerontol A Biol Sci Med Sci. 1999; 54: M487-M493
        • Institute of Medicine (U.S.) Committee on Advancing Pain Research, Care, and Education
        Relieving pain in America: a blueprint for transforming prevention, care, education, and research.
        National Academy of Sciences, Washington (DC)2011
        • Maixner W.
        • Fillingim R.B.
        • Williams D.A.
        • Smith S.B.
        • Slade G.D.
        Overlapping chronic pain conditions: implications for diagnosis and classification.
        J Pain. 2016; 17: T93-T107
        • Lesher J.M.
        • Dreyfuss P.
        • Hager N.
        • Kaplan M.
        • Furman M.
        Hip joint pain referral patterns: a descriptive study.
        Pain Med. 2008; 9: 22-25
        • Offierski C.M.
        • MacNab I.
        Hip-spine syndrome.
        Spine (Phila Pa 1976). 1983; 8: 316-321
        • Clohisy J.C.
        • Knaus E.R.
        • Hunt D.M.
        • Lesher J.M.
        • Harris-Hayes M.
        • Prather H.
        Clinical presentation of patients with symptomatic anterior hip impingement.
        Clin Orthop Relat Res. 2009; 467: 638-644
        • Sembrano J.N.
        • Polly Jr., D.W.
        How often is low back pain not coming from the back?.
        Spine (Phila Pa 1976). 2009; 34: E27-E32
        • Ben-Galim P.
        • Ben-Galim T.
        • Rand N.
        • et al.
        Hip-spine syndrome: the effect of total hip replacement surgery on low back pain in severe osteoarthritis of the hip.
        Spine (Phila Pa 1976). 2007; 32: 2099-2102
        • Hsieh P.H.
        • Chang Y.
        • Chen D.W.
        • Lee M.S.
        • Shih H.N.
        • Ueng S.W.
        Pain distribution and response to total hip arthroplasty: a prospective observational study in 113 patients with end-stage hip disease.
        J Orthop Sci. 2012; 17: 213-218
        • Chimenti P.C.
        • Drinkwater C.J.
        • Li W.
        • Lemay C.A.
        • Franklin P.D.
        • O'Keefe R.J.
        Factors associated with early improvement in low back pain after total hip arthroplasty: a multi-center prospective cohort analyses.
        J Arthroplasty. 2016; 31: 176-179
        • Hicks G.E.
        • Sions J.M.
        • Velasco T.O.
        • Manal T.J.
        Trunk muscle training augmented with neuromuscular electrical stimulation appears to improve function in older adults with chronic low back pain: a randomized preliminary trial.
        Clin J Pain. 2016; 32: 898-906
        • Rudy T.E.
        • Weiner D.K.
        • Lieber S.J.
        • Slaboda J.
        • Boston J.R.
        The impact of chronic low back pain on older adults: a comparative study of patients and controls.
        Pain. 2007; 131: 293-301
        • Williamson A.
        • Hoggart B.
        Pain: a review of three commonly used pain rating scales.
        J Clin Nurs. 2005; 14: 798-804
        • Altman R.
        • Alarcon G.
        • Appelrouth D.
        • et al.
        The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip.
        Arthritis Rheum. 1991; 34: 505-514
        • Zhang F.
        • Ferrucci L.
        • Culham E.
        • Metter E.J.
        • Guralnik J.
        • Deshpande N.
        Performance on five times sit-to-stand task as a predictor of subsequent falls and disability in older persons.
        J Aging Health. 2013; 25: 478-492
        • Wang C.Y.
        • Yeh C.J.
        • Hu M.H.
        Mobility-related performance tests to predict mobility disability at 2-year follow-up in community-dwelling older adults.
        Arch Gerontol Geriatr. 2011; 52: 1-4
        • Startzell J.K.
        • Owens D.A.
        • Mulfinger L.M.
        • Cavanagh P.R.
        Stair negotiation in older people: a review.
        J Am Geriatr Soc. 2000; 48: 567-580
        • Mizner R.L.
        • Petterson S.C.
        • Stevens J.E.
        • Axe M.J.
        • Snyder-Mackler L.
        Preoperative quadriceps strength predicts functional ability one year after total knee arthroplasty.
        J Rheumatol. 2005; 32: 1533-1539
        • Zeni Jr., J.A.
        • Snyder-Mackler L.
        Preoperative predictors of persistent impairments during stair ascent and descent after total knee arthroplasty.
        J Bone Joint Surg Am. 2010; 92: 1130-1136
        • Bean J.
        • Herman S.
        • Kiely D.K.
        • et al.
        Weighted stair climbing in mobility-limited older people: a pilot study.
        J Am Geriatr Soc. 2002; 50: 663-670
        • McHorney C.A.
        • Ware Jr., J.E.
        • Lu J.F.
        • Sherbourne C.D.
        The MOS 36-Item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups.
        Med Care. 1994; 32: 40-66
        • McHorney C.A.
        • Ware Jr., J.E.
        • Raczek A.E.
        The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs.
        Med Care. 1993; 31: 247-263
        • Jewell D.
        Guide to evidence-based physical therapy practice.
        Jones and Bartlett, Sudbury2008
        • Kim C.
        • Linsenmeyer K.D.
        • Vlad S.C.
        • et al.
        Prevalence of radiographic and symptomatic hip osteoarthritis in an urban United States community: the Framingham osteoarthritis study.
        Arthritis Rheumatol. 2014; 66: 3013-3017
        • Wainner R.S.
        • Whitman J.M.
        • Cleland J.A.
        • Flynn T.W.
        Regional interdependence: a musculoskeletal examination model whose time has come.
        J Orthop Sports Phys Ther. 2007; 37: 658-660
        • Bohannon R.W.
        Reference values for the five-repetition sit-to-stand test: a descriptive meta-analysis of data from elders.
        Percept Mot Skills. 2006; 103: 215-222
        • Oh-Park M.
        • Wang C.
        • Verghese J.
        Stair negotiation time in community-dwelling older adults: normative values and association with functional decline.
        Arch Phys Med Rehabil. 2011; 92: 2006-2011
        • Guralnik J.M.
        • Ferrucci L.
        • Pieper C.F.
        • et al.
        Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the Short Physical Performance Battery.
        J Gerontol A Biol Sci Med Sci. 2000; 55: M221-M231
        • Guralnik J.M.
        • Ferrucci L.
        • Simonsick E.M.
        • Salive M.E.
        • Wallace R.B.
        Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability.
        N Engl J Med. 1995; 332: 556-561
        • Chen Q.
        • Hayman L.L.
        • Shmerling R.H.
        • Bean J.F.
        • Leveille S.G.
        Characteristics of chronic pain associated with sleep difficulty in older adults: the Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly (MOBILIZE) Boston study.
        J Am Geriatr Soc. 2011; 59: 1385-1392
        • Morales-Espinoza E.M.
        • Kostov B.
        • Salami D.C.
        • et al.
        Complexity, comorbidity, and health care costs associated with chronic widespread pain in primary care.
        Pain. 2016; 157: 818-826
        • Mayer T.G.
        • Towns B.L.
        • Neblett R.
        • Theodore B.R.
        • Gatchel R.J.
        Chronic widespread pain in patients with occupational spinal disorders: prevalence, psychiatric comorbidity, and association with outcomes.
        Spine (Phila Pa 1976). 2008; 33: 1889-1897
        • Glass T.A.
        • de Leon C.M.
        • Marottoli R.A.
        • Berkman L.F.
        Population based study of social and productive activities as predictors of survival among elderly Americans.
        BMJ. 1999; 319: 478-483
        • Weiner D.K.
        • Fang M.
        • Gentili A.
        • et al.
        Deconstructing chronic low back pain in the older adult—step by step evidence and expert-based recommendations for evaluation and treatment: part I: hip osteoarthritis.
        Pain Med. 2015; 16: 886-897