Advertisement

Family History Influences the Effectiveness of Home Exercise in Older People With Chronic Low Back Pain: A Secondary Analysis of a Randomized Controlled Trial

      Highlights

      • Family history of low back pain (LBP) can reduce activity in older people with LBP.
      • Family history may also have a negative influence on pain and self-efficacy.
      • Video game exercises are beneficial for older people without a family history of LBP.
      • Video game exercises have no effect on those with a family history of severe LBP.

      Abstract

      Objective

      To investigate whether a family history of low back pain (LBP) influences patient outcomes and treatment effects following home exercises in older people with chronic LBP.

      Design

      Secondary analysis of a randomized controlled trial.

      Setting

      Local community.

      Participants

      People older than 55 years with chronic LBP (N=60).

      Interventions

      Participants in the intervention group completed video game exercises for 60 minutes 3 times per week for 8 weeks. Participants in the control group were instructed to maintain their usual levels of activity and care seeking behaviors.

      Main Outcomes Measures

      Participants indicated whether any of their immediate family members had a history of “any” LBP or “activity-limiting” LBP at baseline. We collected self-reported measures of pain, function, pain self-efficacy, care seeking, physical activity, disability, fear of movement and/or reinjury, and falls efficacy at baseline, 8 weeks, 3 months, and 6 months. We performed regression analyses to determine whether a family history of LBP predicted patient outcomes and moderated the effects of home exercise.

      Results

      Participants with a family history of any LBP were less likely to be highly active than those without a family history (odds ratio, 0.08; 95% CI, 0.01-0.42; P=.003). Home-based video game exercises led to improvements in function in those without a family history of activity-limiting LBP (β=1.78; 95% CI, 0.56-3.00; P=.006) but not in those with a family history (β=−0.17; 95% CI, −2.56 to 2.21; P=.880) (interaction P=.049). A family history of LBP did not influence the remaining patient outcomes or treatment effects.

      Conclusions

      A family history of LBP appears to negatively influence physical activity levels in older people with chronic LBP. Further, home-based video game exercises appear to be beneficial for older people with chronic LBP that do not have a family history of LBP.

      Keywords

      List of abbreviations:

      LBP (low back pain), RAPA (Rapid Assessment of Physical Activity), RCT (randomized controlled trial)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Vos T.
        • Barber R.M.
        • Bell B.
        • et al.
        Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.
        Lancet. 2015; 386: 743-800
        • Wenig C.M.
        • Schmidt C.O.
        • Kohlmann T.
        • Schweikert B.
        Costs of back pain in Germany.
        Eur J Pain. 2009; 13: 280-286
        • Walker B.F.
        • Muller R.
        • Grant W.D.
        Low back pain in Australian adults: the economic burden.
        Asia Pac J Public Health. 2003; 15: 79-87
        • Frymoyer J.W.
        • Cats-Baril W.L.
        An overview of the incidences and costs of low back pain.
        Orthop Clin North Am. 1991; 22: 263-271
        • Gore M.
        • Sadosky A.
        • Stacey B.R.
        • Tai K.S.
        • Leslie D.
        The burden of chronic low back pain: clinical comorbidities, treatment patterns, and health care costs in usual care settings.
        Spine (Phila Pa 1976). 2012; 37: E668-E677
        • Becker A.
        • Held H.
        • Redaelli M.
        • et al.
        Low back pain in primary care: costs of care and prediction of future health care utilization.
        Spine (Phila Pa 1976). 2010; 35: 1714-1720
        • Hoy D.
        • March L.
        • Brooks P.
        • et al.
        The global burden of low back pain: estimates from the Global Burden of Disease 2010 study.
        Ann Rheum Dis. 2014; 73: 968-974
        • Scheele J.
        • Enthoven W.T.
        • Bierma-Zeinstra S.M.
        • et al.
        Course and prognosis of older back pain patients in general practice: a prospective cohort study.
        Pain. 2013; 154: 951-957
        • Hayden J.A.
        • van Tulder M.W.
        • Tomlinson G.
        Systematic review: strategies for using exercise therapy to improve outcomes in chronic low back pain.
        Ann Intern Med. 2005; 142: 776-785
        • Escolar-Reina P.
        • Medina-Mirapeix F.
        • Gascon-Canovas J.J.
        • et al.
        How do care-provider and home exercise program characteristics affect patient adherence in chronic neck and back pain: a qualitative study.
        BMC Health Serv Res. 2010; 10: 60
        • Zadro J.R.
        • Shirley D.
        • Simic M.
        • et al.
        Video-game based exercises for older people with chronic low back pain: a randomised controlled trial (GAMEBACK).
        Phys Ther. 2019; 99: 14-27
        • Cecchi F.
        • Pasquini G.
        • Paperini A.
        • et al.
        Predictors of response to exercise therapy for chronic low back pain: result of a prospective study with one year follow-up.
        Eur J Phys Rehabil Med. 2014; 50: 143-151
        • Hicks G.E.
        • Fritz J.M.
        • Delitto A.
        • McGill S.M.
        Preliminary development of a clinical prediction rule for determining which patients with low back pain will respond to a stabilization exercise program.
        Arch Phys Med Rehabil. 2005; 86: 1753-1762
        • Childs J.D.
        • Fritz J.M.
        • Flynn T.W.
        • et al.
        A clinical prediction rule to identify patients with low back pain most likely to benefit from spinal manipulation: a validation study.
        Ann Intern Med. 2004; 141: 920-928
        • Long A.
        • Donelson R.
        • Fung T.
        Does it matter which exercise? A randomized control trial of exercise for low back pain.
        Spine (Phila Pa 1976). 2004; 29: 2593-2602
        • Zadro J.R.
        • Shirley D.
        • Andrade T.B.
        • Scurrah K.J.
        • Bauman A.
        • Ferreira P.H.
        The beneficial effects of physical activity: is it down to your genes? a systematic review and meta-analysis of twin and family studies.
        Sports Med Open. 2017; 3: 4
        • Aggarwal N.
        • Anand T.
        • Kishore J.
        • Ingle G.K.
        Low back pain and associated risk factors among undergraduate students of a medical college in Delhi.
        Educ Health (Abingdon). 2013; 26: 103-108
        • Yao W.
        • Luo C.
        • Ai F.
        • Chen Q.
        Risk factors for nonspecific low-back pain in Chinese adolescents: a case-control study.
        Pain Med. 2012; 13: 658-664
        • Masiero S.
        • Carraro E.
        • Celia A.
        • Sarto D.
        • Ermani M.
        Prevalence of nonspecific low back pain in schoolchildren aged between 13 and 15 years.
        Acta Paediatr. 2008; 97: 212-216
        • Matsudaira K.
        • Konishi H.
        • Miyoshi K.
        • Isomura T.
        • Inuzuka K.
        Potential risk factors of persistent low back pain developing from mild low back pain in urban Japanese workers.
        PLoS One. 2014; 9e93924
        • Hallegraeff J.M.
        • Krijnen W.P.
        • van der Schans C.P.
        • de Greef M.H.
        Expectations about recovery from acute non-specific low back pain predict absence from usual work due to chronic low back pain: a systematic review.
        J Physiother. 2012; 58: 165-172
        • Kuijer W.
        • Groothoff J.W.
        • Brouwer S.
        • Geertzen J.H.
        • Dijkstra P.U.
        Prediction of sickness absence in patients with chronic low back pain: a systematic review.
        J Occup Rehabil. 2006; 16: 439-467
        • Wertli M.M.
        • Eugster R.
        • Held U.
        • Steurer J.
        • Kofmehl R.
        • Weiser S.
        Catastrophizing-a prognostic factor for outcome in patients with low back pain: a systematic review.
        Spine J. 2014; 14: 2639-2657
        • Fujii T.
        • Matsudaira K.
        • Oka H.
        Factors associated with fear-avoidance beliefs about low back pain.
        J Orthop Sci. 2013; 18: 909-915
        • Urquhart D.M.
        • Bell R.J.
        • Cicuttini F.M.
        • Cui J.
        • Forbes A.
        • Davis S.R.
        Negative beliefs about low back pain are associated with high pain intensity and high level disability in community-based women.
        BMC Musculoskelet Disord. 2008; 9: 148
        • Ferreira P.H.
        • Beckenkamp P.
        • Maher C.G.
        • Hopper J.L.
        • Ferreira M.L.
        Nature or nurture in low back pain? Results of a systematic review of studies based on twin samples.
        Eur J Pain. 2012; 17: 957-971
        • Zadro J.R.
        • Shirley D.
        • Sanchez-Romera J.F.
        • Ordonana J.R.
        • Ferreira P.H.
        Does familial aggregation of chronic low back pain impact on recovery? A population-based twin study.
        Spine (Phila Pa 1976). 2017; 42: 1295-1301
        • Zadro J.R.
        • Shirley D.
        • Simic M.
        • et al.
        Video-game based exercises for older people with chronic low back pain: a protocol for a feasibility randomised controlled trial (the GAMEBACK trial).
        Physiother. 2016; 103: 146-153
        • Thompson P.D.
        • Arena R.
        • Riebe D.
        • Pescatello L.S.
        ACSM's new preparticipation health screening recommendations from ACSM's guidelines for exercise testing and prescription, ninth edition.
        Curr Sports Med Rep. 2013; 12: 215-217
        • Folstein M.F.
        • Folstein S.E.
        • McHugh P.R.
        Mini-mental state". A practical method for grading the cognitive state of patients for the clinician.
        J Psychiatr Res. 1975; 12: 189-198
        • Stapleton C.
        • Hough P.
        • Oldmeadow L.
        • Bull K.
        • Hill K.
        • Greenwood K.
        Four-item fall risk screening tool for subacute and residential aged care: the first step in fall prevention.
        Australas J Ageing. 2009; 28: 139-143
        • Topolski T.D.
        • LoGerfo J.
        • Patrick D.L.
        • Williams B.
        • Walwick J.
        • Patrick M.B.
        The Rapid Assessment of Physical Activity (RAPA) among older adults.
        Prev Chronic Dis. 2006; 3: A118
        • Nicholas M.K.
        The pain self-efficacy questionnaire: taking pain into account.
        Eur J Pain. 2007; 11: 153-163
        • Von Korff M.
        • Jensen M.P.
        • Karoly P.
        Assessing global pain severity by self-report in clinical and health services research.
        Spine (Phila Pa 1976). 2000; 25: 3140-3151
        • Stratford P.
        • Gill C.
        • Westaway M.
        • Binkley J.
        Assessing disability and change on individual patients: a report of a patient specific measure.
        Physiother Can. 1995; 47: 258-263
        • Roland M.
        • Morris R.
        A study of the natural history of back pain. Part I: development of a reliable and sensitive measure of disability in low-back pain.
        Spine (Phila Pa 1976). 1983; 8: 141-144
        • Woby S.R.
        • Roach N.K.
        • Urmston M.
        • Watson P.J.
        Psychometric properties of the TSK-11: a shortened version of the Tampa Scale for Kinesiophobia.
        Pain. 2005; 117: 137-144
        • Hauer K.
        • Yardley L.
        • Beyer N.
        • et al.
        Validation of the Falls Efficacy Scale and Falls Efficacy Scale International in geriatric patients with and without cognitive impairment: results of self-report and interview-based questionnaires.
        Gerontology. 2010; 56: 190-199
        • Gurung T.
        • Ellard D.R.
        • Mistry D.
        • Patel S.
        • Underwood M.
        Identifying potential moderators for response to treatment in low back pain: a systematic review.
        Physiotherapy. 2015; 101: 243-251
        • Beneciuk J.M.
        • Hill J.C.
        • Campbell P.
        • et al.
        Identifying treatment effect modifiers in the STarT Back trial: a secondary analysis.
        J Pain. 2017; 18: 54-65
        • Garcia A.N.
        • Costa Lda C.
        • Hancock M.
        • Costa L.O.
        Identifying patients with chronic low back pain who respond best to mechanical diagnosis and therapy: secondary analysis of a randomized controlled trial.
        Phys Ther. 2016; 96: 623-630
        • Ferreira P.H.
        • Ferreira M.L.
        • Maher C.G.
        • Refshauge K.M.
        • Latimer J.
        • Adams R.D.
        The therapeutic alliance between clinicians and patients predicts outcome in chronic low back pain.
        Phys Ther. 2013; 93: 470-478
        • Brookes S.T.
        • Whitely E.
        • Egger M.
        • Smith G.D.
        • Mulheran P.A.
        • Peters T.J.
        Subgroup analyses in randomized trials: risks of subgroup-specific analyses; power and sample size for the interaction test.
        J Clin Epidemiol. 2004; 57: 229-236
        • Walker B.F.
        • Muller R.
        • Grant W.D.
        Low back pain in Australian adults: prevalence and associated disability.
        J Manipulative Physiol Ther. 2004; 27: 238-244
      1. Global recommendations on physical activity for health. World Health Organization, Geneva, Switzerland2010
        • de Vilhena e Santos D.M.
        • Katzmarzyk P.T.
        • Seabra A.F.
        • Maia J.A.
        Genetics of physical activity and physical inactivity in humans.
        Behav Genet. 2012; 42: 559-578
        • Ornelas I.J.
        • Perreira K.M.
        • Ayala G.X.
        Parental influences on adolescent physical activity: a longitudinal study.
        Int J Behav Nutr Phys Act. 2007; 4: 3
        • Pereira L.S.
        • Sherrington C.
        • Ferreira M.L.
        • et al.
        Self-reported chronic pain is associated with physical performance in older people leaving aged care rehabilitation.
        Clin Interv Aging. 2014; 9: 259-265
        • Griffin D.W.
        • Harmon D.C.
        • Kennedy N.M.
        Do patients with chronic low back pain have an altered level and/or pattern of physical activity compared to healthy individuals? A systematic review of the literature.
        Physiotherapy. 2012; 98: 13-23
        • Pincus T.
        • Miles C.
        • Froud R.
        • Underwood M.
        • Carnes D.
        • Taylor S.J.
        Methodological criteria for the assessment of moderators in systematic reviews of randomised controlled trials: a consensus study.
        BMC Med Res Methodol. 2011; 11: 14
        • Hancock M.
        • Herbert R.D.
        • Maher C.G.
        A guide to interpretation of studies investigating subgroups of responders to physical therapy interventions.
        Phys Ther. 2009; 89: 698-704
        • Kamper S.J.
        • Maher C.G.
        • Hancock M.J.
        • Koes B.W.
        • Croft P.R.
        • Hay E.
        Treatment-based subgroups of low back pain: a guide to appraisal of research studies and a summary of current evidence.
        Best Pract Res Clin Rheumatol. 2010; 24: 181-191