Purpose: Low back pain (LBP) is the most common musculoskeletal complaint among the geriatric population. Musculoskeletal clinicians have often proposed a link between the hip and lumbar spine in older adults. Offierski and McNab originally described hip-spine syndrome as the presence of lumbar symptoms due to an abnormal biomechanical relationship between the hip joint and spine likely related to degenerative pathology in one or both joints; but, little work has been done to understand whether the additional burden of co-existing hip symptoms might impact pain-related psychologic factors in an individual with LBP. The purpose of this study was to determine whether the presence of hip symptoms, which are indicative of hip osteoarthritis (OA), are associated with self-efficacy, kinesiophobia and fear-avoidance beliefs among older adults with a primary complaint of low back pain. Methods: We have conducted an analysis of baseline data from the Delaware Spine Studies cohort study of 228 older adults with a primary complaint of LBP that is greater than any other musculoskeletal pain complaint (mean age: 69.75+/−6.85 years). We examined clinical hip symptoms that were proposed predictors of radiographic hip OA according to American College of Rheumatology (ACR) guidelines by Altman et al, including hip joint pain, morning stiffness in the hip that lasts less than 60 minutes and pain with hip internal rotation (IR). The following subscales of the Low Back Activity Confidence Scale were used to assess self-efficacy: self-efficacy for functional activities, self-efficacy for self-regulation of back health and self-efficacy for regular exercise. The Tampa Scale for Kinesiophobia (TSK-11) was used to capture kinesiophobia. And, the Physical Activity subscale of the Fear Avoidance Beliefs Questionnaire (FABQ-PA) was used to capture fear avoidance beliefs about LBP. Analysis of covariance (ANCOVA) was used to determine the association between presence of any hip symptoms (1 or more hip symptoms) and our psychologic outcomes of interest, self-efficacy, kinesiophobia and fear avoidance. ANCOVA models were adjusted for age, sex and education. Results: Of the 228 participants with LBP, 166 (72.8%) had one or more hip symptoms. Co-existence of 1 or more hip symptoms was associated with lower levels of self-efficacy for functional activities (−12.22 points, 95%CI: −19.43, −5.02, p = .001), greater levels of fear-avoidance beliefs (+3.48 points, 95%CI: 0.46, 6.50, p = .024) and greater levels of kinesiophobia (+4.55 points, 95%CI: 0.17, 8.93, p = .042) as compared to absence of hip symptoms. Presence of hip symptoms was not associated with self-efficacy for self-regulation of back health or self-efficacy for exercise (p>.05). Conclusions: Hip symptoms are prevalent among older adults with a primary complaint of LBP; and, the additional burden of these hip symptoms is associated with reduced self-efficacy, as well as heightened kinesiophobia and fear avoidance beliefs. There has long been consensus that researchers should focus on classifying patients into clinically relevant subgroups that share similar clinical characteristics to improve treatment outcomes. It appears that one such subgroup among older adults with LBP consists of those with co-existing hip symptoms. Given that poor self-efficacy and elevated pain-related fears are related to poor outcomes in low back pain