New Episode Of Back Pain Research Articles

Clinical Course and Prognostic Factors of Older Patients With Back Pain and Radiating Leg Pain in General Practice: BACE Cohort Study.

Patients with back pain (BP) and radiating leg pain have poorer clinical outcomes compared to patients with BP alone. We aimed to describe the 1-year clinical course and to identify prognostic factors associated with non-recovery in older BP patients with radiating leg pain. Patients in the BACE cohort aged >55years with a new episode of BP and radiating leg pain were included (n=377). Data on clinical outcomes were collected until 1-year follow-up. Uni- and multivariable regression analyses were performed to investigate the association between potential prognostic factors and three non-recovery outcomes at the 1-year follow-up. More than half of the patients (65%) did not recover after 12months. In multivariable analyses, poor self-rated health (odds ratio [OR] 2.34, 95% CI: 1.20-4.56) and BP duration at baseline (OR 1.48, 1.12-1.96) were significantly associated with non-recovery for BP as outcome; age (OR 1.04, 1.03-1.05), smoking (OR 1.14, 1.00-1.30), depressive symptomatology (OR 1.03, 1.02-1.04), kinesiophobia (OR 1.03, 1.02-1.04), poor self-rated health (OR 2.09, 1.83-2.39), baseline disability (OR 1.16, 1.14-1.17), BP duration (OR 1.49, 1.41-1.57), leg pain (OR 1.52, 1.37-1.68), pain during rotation (OR 1.71, 1.53-1.90) and other musculoskeletal complaints (OR 1.34, 1.17-1.52) were associated with disability. No factors were associated with leg pain. Several prognostic factors were associated with non-recovery in older patients with BP and radiating leg pain. Primary care clinicians should be aware of these factors in managing these patients.

Predictive validity of the STarT Back screening tool among older adults with back pain.

The predictive validity of the STarT Back screening tool among older adults is uncertain. This study aimed to assess the predictive validity of the SBT among older adults in primary care. This prospective cohort study included 452 patients aged ≥55 years seeking Norwegian primary care with a new episode of back pain. A poor outcome (persistent disabling back pain) was defined as a score of ≥7/24 on the Roland-Morris Disability Questionnaire (RMDQ) at 3, 6 or 12 months of follow-up. The ability of the SBT risk groups to identify persistent disabling back pain was assessed with multivariable logistic regression, area under receiver operating characteristics curve (AUC), and with the accuracy measures sensitivity, specificity, predictive values and likelihood ratios. The adjusted odds ratios (95% CI) for persistent disabling back pain were 2.40 (1.34-4.30) at 3 months, 3.42 (1.76-6.67) at 6 months and 2.81 (1.47-5.38) at 12 months for the medium-risk group (n = 118), and 8.90 (1.83-43.24), 2.66 (0.81-8.67) and 4.53 (1.24-16.46) for the high-risk group (n = 27), compared to the low-risk group (n = 282). There were no statistically significant differences in odds between the medium- and high-risk groups at any time point. AUC values (95% CI) were 0.65 (0.59-0.71), 0.67 (0.60-0.73) and 0.65 (0.58-0.71) at 3, 6 and 12 months. Accuracy measures were poor at all time points, with particularly poor sensitivity and negative likelihood ratio values. The predictive validity of the SBT risk groups in predicting persistent disabling back pain in older adults was poor. This study found that the STarT Back screening tool had poor predictive validity among older adults and that it may need recalibration or extension before widespread implementation among older adults. Having valid tools for this population may aid clinicians with allocating scarce healthcare resources, which is especially important considering the rapidly ageing population and its expected challenge to the healthcare systems.

Does the intensity of pain and disability affect health-related quality of life of older adults with back pain? Multilevel analysis between Brazil and Netherlands: a cross-sectional study of the BACE consortium

BackgroundThe prognosis of back pain (BP) in the older adults is less favorable than in younger adults and progress to adverse outcomes and consequent worsening of health-related quality of life (HRQoL). The present study aimed to verify the association between BP intensity, disability and HRQoL in older adults residents in Brazil and Netherlands, and to evaluate whether the country of residence influences the associations.MethodsData were collected from 602 Brazilian and 675 Dutch participants with a new episode of BP from the Back Complaints in Elders (BACE) consortium. For the present study, a cross section was used. Pain intensity and disability were assessed using the Numerical Rating Scale (NRS) and the Roland-Morris Disability Questionnaire (RMDQ), respectively. HRQoL was assessed using the Short Form Health Survey (SF-36) quality of life questionnaire. Age, sex, and education were descriptive variables. Pain intensity (NPS score) and country were the independent variables and quality of life assessed by each SF domain − 36 was the dependent variable. Analysis of models at the individual level was performed to verify the association between pain and disability, also HRQoL in Netherlands and Brazil in the total sample. The multilevel model was used to verify whether the older adults person’s country of residence influenced this relationship.ResultsThe average age of the participants was 67.00 (7.33) years. In the total sample, linear regression analysis adjusted for sex and age showed a significant association between BP intensity scores and HRQoL, for all domains. There was no association between disability and HRQoL. In the multilevel analysis, there was an association between BP intensity and HRQoL in all domains and an association between the country of residence and HRQoL, influencing the effect of pain, in all domains, except for the physical functioning.ConclusionSocioeconomic and cultural aspects of different countries can affect the perception of the elderly about their HRQoL in the presence of BP. Pain and disability in Brazilian and Dutch older adults ones are experienced differently in relation to their HRQoL.

Identifying latent subgroups in the older population seeking primary health care for a new episode of back pain – findings from the BACE-N cohort

BackgroundBack pain is the number one condition contributing to years lived with disability worldwide, and one of the most common reasons for seeking primary care. Research on this condition in the ageing population is sparse. Further, the heterogeneity of patients with back pain complicates the management in clinical care. It is possible that subgrouping people with similar characteristics would improve management. This paper aimed to identify latent classes based on demographics, pain characteristics, psychosocial behavior, and beliefs and attitudes about back pain, among older patients seeking primary care with a new episode of back pain, and to examine if there were differences regarding the classes’ first point-of-contact.MethodsThe study was part of the international BACE (Back complaints in elders) consortium and included 435 patients aged ≥ 55 years seeking primary care (general practitioners, physiotherapists, and chiropractors) in Norway from April 2015 to March 2020. A latent class analysis was performed to identify latent classes. The classes were described in terms of baseline characteristics and first point-of-contact in primary care.ResultsFour latent classes were identified. The mean age was similar across groups, as were high expectations towards improvement. Class 1 (n = 169, 39%), the “positive” class, had more positive attitudes and beliefs, less pain catastrophizing and shorter duration of current pain episode. Class 2 (n = 31, 7%), the “fearful” class, exhibited the most fear avoidance behavior, and had higher mean pain intensity. Class 3 (n = 33, 8%), the “distressed” class, had the highest scores on depression, disability, and catastrophizing. Finally, class 4 (n = 202, 46%), the “hopeful” class, showed the highest expectations for recovery, although having high pain intensity. The identified four classes showed high internal homogeneity, sufficient between-group heterogeneity and were considered clinically meaningful. The distribution of first point-of-contact was similar across classes, except for the positive class where significantly more patients visited chiropractors compared to general practitioners and physiotherapists.ConclusionsThe identified classes may contribute to targeting clinical management of these patients. Longitudinal research on these latent classes is needed to explore whether the latent classes have prognostic value. Validation studies are needed to evaluate external validity.Trial registrationClinicaltrials.gov NCT04261309.

External validation and updating of prognostic prediction models for nonrecovery among older adults seeking primary care for back pain.

Prognostic prediction models for 3 different definitions of nonrecovery were developed in the Back Complaints in the Elders study in the Netherlands. The models' performance was good (optimism-adjusted area under receiver operating characteristics [AUC] curve ≥0.77, R2 ≥0.3). This study aimed to assess the external validity of the 3 prognostic prediction models in the Norwegian Back Complaints in the Elders study. We conducted a prospective cohort study, including 452 patients aged ≥55 years, seeking primary care for a new episode of back pain. Nonrecovery was defined for 2 outcomes, combining 6- and 12-month follow-up data: Persistent back pain (≥3/10 on numeric rating scale) and persistent disability (≥4/24 on Roland-Morris Disability Questionnaire). We could not assess the third model (self-reported nonrecovery) because of substantial missing data (>50%). The models consisted of biopsychosocial prognostic factors. First, we assessed Nagelkerke R2 , discrimination (AUC) and calibration (calibration-in-the-large [CITL], slope, and calibration plot). Step 2 was to recalibrate the models based on CITL and slope. Step 3 was to reestimate the model coefficients and assess if this improved performance. The back pain model demonstrated acceptable discrimination (AUC 0.74, 95% confidence interval: 0.69-0.79), and R2 was 0.23. The disability model demonstrated excellent discrimination (AUC 0.81, 95% confidence interval: 0.76-0.85), and R2 was 0.35. Both models had poor calibration (CITL <0, slope <1). Recalibration yielded acceptable calibration for both models, according to the calibration plots. Step 3 did not improve performance substantially. The recalibrated models may need further external validation, and the models' clinical impact should be assessed.

The one-year clinical course of back-related disability and the prognostic value of comorbidity among older adults with back pain in primary care.

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.

Modifiable prognostic factors of high costs related to healthcare utilization among older people seeking primary care due to back pain: an identification and replication study

BackgroundBack pain is an extensive burden to our healthcare system, yet few studies have explored modifiable prognostic factors associated with high costs related to healthcare utilization, especially among older back pain patients. The aims of this study were to identify modifiable prognostic factors for high costs related to healthcare utilization among older people seeking primary care with a new episode of back pain; and to replicate the identified associations in a similar cohort, in a different country.MethodsData from two cohort studies within the BACE consortium were used, including 452 and 675 people aged ≥55 years seeking primary care with a new episode of back pain. High costs were defined as costs in the top 25th percentile. Healthcare utilization was self-reported, aggregated for one-year of follow-up and included: primary care consultations, medications, examinations, hospitalization, rehabilitation stay and operations. Costs were estimated based on unit costs collected from national pricelists. Nine potential modifiable prognostic factors were selected based on previous literature. Univariable and multivariable binary logistic regression models were used to identify and replicate associations (crude and adjusted for selected covariates) between each modifiable prognostic factor and high costs related to healthcare utilization.ResultsFour modifiable prognostic factors associated with high costs related to healthcare utilization were identified and replicated: a higher degree of pain severity, disability, depression, and a lower degree of physical health-related quality of life. Kinesiophobia and recovery expectations showed no prognostic value. There were inconsistent results across the two cohorts with regards to comorbidity, radiating pain below the knee and mental health-related quality of life.ConclusionThe factors identified in this study may be future targets for intervention with the potential to reduce high costs related to healthcare utilization among older back pain patients.Trial registrationClinicalTrials.gov NCT04261309, 07 February 2020. Retrospectively registered.

Healthcare utilization and related costs among older people seeking primary care due to back pain: findings from the BACE-N cohort study

ObjectivesTo describe healthcare utilization and estimate associated costs during 1 year of follow-up among older people seeking primary care due to a new episode back pain and to describe healthcare...

Long-term effectiveness of epidural steroid injections after new episodes of low back pain in older adults.

There is limited research on the long-term effectiveness of epidural steroid injections (ESI) in older adults despite the high prevalence of back and leg pain in this age group. We tested the hypotheses that older adults undergoing ESI, compared to patients not receiving ESI: (1) have worse pain, disability and quality of life ('outcomes') pre-ESI, (2) have improved outcomes after ESI and (3) have improved outcomes due to a specific ESI effect. We prospectively studied patients ≥65 years old presenting to primary care with new episodes of back pain in three US healthcare systems (BOLD registry). Outcomes were leg and back pain intensity, disability and quality of life, assessed at baseline and 3-, 6-, 12- and 24-month follow-ups. We categorized participants as: (1) ESI within 6 months from the index visit (n=295); (2) no ESI within 6 months (n=4809); (3) no ESI within 6 months, propensity-score matched to group 1 (n=483). We analysed the data using linear regression and Generalized Estimating Equations. Pain intensity, disability and quality of life at baseline were significantly worse at baseline in ESI patients (group 1) than in group 2. The improvement from baseline to 24months in all outcomes was statistically significant for group 1. However, no statistically significant differences were observed between outcome trajectories for the propensity-score matched groups 1 and 3. Older adults treated with ESI have long-term improvement. However, the improvement is unlikely the result of a specific ESI effect. In this large, two-year, prospective study in older adults with a new episode of low back pain, back pain, leg pain, disability and quality of life improved after epidural steroid injections; however, propensity-score matching revealed that the improvement was unlikely the result of a specific effect of the injections, indicating that epidural steroids are unlikely to provide long-term benefits in older adults with new episodes of back and leg pain.

Pain and cervical disability among public workers who use data visualization display terminals

Work-related neck/shoulder disorders are considered an important health issue. This study is aimed at establishing the pain and cervical disability patterns of workers with visual display terminals, as well as at determining the factors that mostly affect the onset of a new episode of back pain. A descriptive, correlational study was carried out on a sample of 88 workers who use visual display terminals, of the Ministry of Health (Xunta de Galicia). The workers completed the following questionnaires: "Neck Disability Index Scale," "Visual Analog Scale," "12-item Short Form Health Survey," and an individual postural analysis was conducted. For the comparative analysis, the Student's t-test, and the Mann-Whitney U test were performed. A binary logistic regression analysis was used to extract a predictive model of a cervical pain episode, and 58% reported cervical pain. There were no differences between men and women. The variables that best predict the onset of a new episode of pain are the level of disability, and the quality of physical life. Study results indicate that a worker who uses visual display terminals, with high levels of cervical disability and low values of physical quality of life, is more likely to suffer an episode of back pain.

Characteristics of older adults with back pain associated with choice of first primary care provider: a cross-sectional analysis from the BACE-N cohort study

ObjectivesTo describe characteristics of older adults with back pain in primary care, and to assess associations between patient characteristics and type of first primary care provider (general practitioner (GP), physiotherapist...

Development and internal validation of a clinical prediction model for non-recovery in older adults with back pain

Purpose: Back pain is the leading cause of disability globally and it is highly prevalent in older adults. In this population, spinal osteoarthritis (OA) may be a primary cause of back complaints. Nevertheless, evidence on prognostic factors in older adults with back pain in primary care is limited, and no clinical prediction models have been developed for this population. The aim of this study was to develop clinical prediction models for non-recovery in older adults presenting with a new episode of back pain.

Older adults with back pain and spinal morning stiffness longer than 30 minutes are more at risk of developing long-term physical functioning limitations

Purpose: Spinal osteoarthritis (OA) is related to various signs and symptoms such as back pain, spinal morning stiffness, restricted/painful spinal range of motion (ROM) and lumbar disc degeneration (LDD). However, it is not known if patients with these signs and symptoms experience more limitations in physical functioning, and if these features are prognostic for long-term physical functioning limitations. Therefore, the aims of this study were to assess the following associations in older patients with back pain: 1) Morning stiffness, spinal ROM, and radiographic LDD with physical functioning at baseline, and 2) Morning stiffness, spinal ROM, and radiographic LDD with physical functioning after 1 year. Methods: For this prospective observational study data from the BACE cohort was used. Patients aged >55 years visiting a general practitioner with a new episode of back pain were included. Presence and duration of spinal morning stiffness were assessed with single-item patient-reported questions. Low back ROM was investigated through physical examination by an experienced research assistant, evaluating limitations and pain during lateroflexion, rotations and anteflexion of the spine. Osteophytes and disc space narrowing were considered LDD features, and they were investigated with lumbar lateral X-rays. The 4-grade Lane Atlas classification was used (i.e. grade 0= none, grade 1= mild, grade 2= moderate, grade 3= severe); osteophytes grade 2 or higher at two or more levels for L1-2 to L5-S1 and disc space narrowing grade 1 or higher at two or more levels from L1-2 to L5-S1 were defined as LDD presence. Outcomes were physical functioning limitations at baseline and physical functioning limitations at 1-year follow-up; physical functioning was measured with the Roland Morris Disability Questionnaire (RMDQ, range 0-24, 0 = no physical functioning limitation, 24 = maximum physical functioning limitation). The associations between morning stiffness, spinal ROM and radiographic features of LDD and back-related physical functioning at baseline and 1-year follow-up were assessed with multivariable linear regression models. Adjustments were made for age, sex, BMI, back pain severity, recent episodes of back pain, kinesiophobia and depressive symptoms. Results: This study included 543 patients, with mean age 67 years (SD 8), and 59% female. In multivariable adjusted analyses, presence of spinal morning stiffness (β=1.78, 95%CI 0.93-2.63), morning stiffness longer than 30 minutes (β=1.04, 95%CI 0.04-2.02), and pain during anteflexion (β=1.54, 95%CI 0.71-2.37) were independently associated with worse physical functioning at baseline. Morning stiffness longer than 30 minutes (β=1.54, 95%CI 0.22-2.86) was the only spinal OA feature independently associated with worse physical functioning at 1-year follow-up. Conclusions: Presence of morning stiffness, morning stiffness longer than 30 minutes and pain with anteflexion are associated with the level of physical functioning. Additionally, morning stiffness longer than 30 minutes is a prognostic factor for worse physical functioning at 1 year follow-up, independently of other already known prognostic factors (e.g. previous back pain episodes, physical functioning at baseline, and depression). Hence, older patients with back pain and spinal morning stiffness longer than 30 minutes are more at risk of having future back-related physical activity limitations.

Back beliefs among elderly seeking health care due to back pain; psychometric properties of the Norwegian version of the back beliefs questionnaire

BackgroundThe Back Beliefs Questionnaire (BBQ) is a 14-item patient-reported questionnaire that measures attitudes and beliefs about the consequences of back pain. The BBQ has recently been translated into Norwegian, but its psychometric properties have not yet been tested. The aim of this study is to evaluate the reliability and construct validity of the BBQ when used on elderly patients with back pain.MethodA prospective cohort study with a test-retest design among 116 elderly patients (> 55 years of age) seeking primary care for a new episode of back pain. Test-retest, standard error of measurement (SEM), minimal detectable change (MDC), internal consistency and construct validity by a priori hypotheses (Spearman’s- and Pearson correlation coefficient) were tested.ResultsA total of 116 patients, mean age (SD) 67.7 (8.3), were included and 63 patients responded to the test-retest assessment. The mean (SD) BBQ sum scores (range 9–45) were 29.8 (7.0) and 29.2 (6.7) for the test and retest respectively. The test-retest was acceptable with an intraclass correlation coefficient of 0.71 (95% CI, 0.54–0.82), SEM was 3.8 and MDC 10.5. Internal consistency with Cronbach’s alpha was good (0.82) and acceptable construct validity was supported by the confirmation of 75% of the a priori hypotheses.ConclusionThe Norwegian version of the BBQ demonstrated acceptable test-retest reliability and good construct validity and can be used to assess pessimistic beliefs in elderly patients with back pain.

Risk factors for episodes of back pain in emerging adults. A systematic review

The transition from adolescence to adulthood is a sensitive period in life for health outcomes, including back pain. The objective was to synthesize evidence on risk factors for new episodes of back pain in emerging adults (18-29years). The protocol was registered in PROSPERO (CRD42016046635). We searched Medline; EMBASE; AMED and other databases up to September 2018 for prospective cohort studies that estimated the association between risk factor(s) and self-reported back pain. Risk factors could be measured before or during the age range 18-29years, and back pain could be measured during or after this age range, with at least 12months between assessments. Risk factors assessed in ≥3 studies were summarized. Risk of bias was assessed using a 6-item checklist. Forty-nine studies were included with more than 150 different risk factors studied. Nine studies had low risk of bias, 26 had moderate and 14 had high risk of bias. Age, sex, height, body mass index (BMI), smoking, physical activity level, a history of back pain, job satisfaction and structural imaging findings were investigated in three or more studies. History of back pain was the only risk factor consistently associated with back pain after adjustment (nine studies). There is moderate quality evidence that a history of back pain is a risk factor for back pain. There are inconsistent associations for age, sex, height, BMI, smoking and activity level. No associations were found between job satisfaction and structural imaging findings and back pain. Emerging adulthood is a transitional period of life with changes in life style, potentially influencing future musculoskeletal health. This systematic review included 49 articles evaluating more than 150 potential risk factors for back pain, one of the most prevalent musculoskeletal disorders. No consistent results were found for life style factors such as physical activity level or BMI, both highlighted as important risk factors in previous literature. Importantly, a previous episode of back pain was a consistent risk factor for a new episode of back pain across several studies, and further investigation of risk factors for the first back pain episode is needed.

New episodes of back pain among employed people in primary care, sickness certification and rtw

New episodes of back pain among employed people in primary care, sickness certification and rtw

Back Complaints in the Elders in Brazil and the Netherlands: a cross-sectional comparison

although back pain is most prevalent in older adults, there is a paucity of studies investigating back pain in older people. Our objective was to characterize and compare Brazilian and Dutch older adults presenting to primary care with a new episode of back pain. We also aimed to investigate whether socio-demographic characteristics were associated with pain severity and disability. we sourced data on 602 Brazilian and 675 Dutch participants aged ≥55 years with a new episode of back pain from the Back Complaints in the Elders consortium. We analyzed country differences in participants' characteristics, and associations between socio-demographic/clinical characteristics and pain severity and pain-related disability. the two populations differed in most characteristics. More Dutch participants were smokers, heavy drinkers, and reported back stiffness. More Brazilian participants were less educated, had higher prevalence of comorbidities; higher levels of pain intensity, disability and psychological distress. When controlling for the effect of country, being female and having altered quality of sleep were associated with higher pain intensity. Altered quality of sleep, having two or more comorbidities and physical inactivity were associated with higher disability. Higher educational levels were negatively associated with both pain and disability outcomes. back pain is disabling in the older population. Our country comparison has shown that country of residence is an important determinant of higher disability and pain in older people with back pain. Irrespective of country, women with poor sleep quality, comorbidities, low education and who are physically inactive report more severe symptoms.

Clinical outcomes of early and later physical therapist services for older adults with back pain

Background contextThe timing of physical therapy (PT) services and its association with later function and pain are not clear, especially in older adults. PurposeThe purpose of this study was to compare clinical outcomes of patients receiving early or later PT services with those not receiving PT among older adults presenting to primary care for a new visit for back pain. Study design/settingProspective cohort study using the Back Pain Outcomes Using Longitudinal Data registry. Patient sampleA total of 3,705 adults 65 years and older with a new visit for back pain were included. Outcome measuresThe outcome measures were Roland-Morris Disability Questionnaire (RMDQ), Pain Numerical Rating Scales, and EuroQol-5D. MethodsWe studied two phases of PT utilization: early (0–28 days) and later (3–6 months). At baseline, we selected the participants with complete 12 months of patient-reported outcomes and electronic medical record data. Early PT was defined as initiating PT less than or equal to 28 days from the index visit for back pain. The no early PT group consisted of patients with no PT, no injections, no surgery, and no chiropractic within 28 days. We restricted the later phase analysis to patients with pain greater than 2 of 10 and an RMDQ score greater than 4 to create a subsample of patients with continuing clinically important back pain. We defined later PT as initiating PT between 3 and 6 months after the index visit. The no later PT group consisted of patients without any PT during this time. We used propensity score matching followed by multiple linear regression to estimate the mean difference in outcome. Sensitivity analysis examined clinically important change and dose of PT use among the early PT group. ResultsThe early PT group had better functional status with an adjusted mean RMDQ of 1.1 points less than the no early PT group (95% confidence interval: –2.2, –0.1) and less back pain of –0.5 (–0.9, –0.1) at 12 months. There was no difference between early PT groups at 3 and 6 months. The odds of a 30% improvement in function or pain were not different between these matched groups at 12 months, but the early PT group had increased odds of a 50% improvement in function at 12 months (odds ratio: 1.58, 95% confidence interval: 1.04, 2.40). There was no difference between later groups at 12 months. Greater dose of PT use within the early PT group was associated with better functional status (p= .01). ConclusionsWe found that among older adults presenting to their primary care providers for a new episode of back pain, early referral to PT resulted in no or minimal differences in pain, function, or health-related quality at 3, 6, or 12 months compared with a matched group that did not receive early PT. Secondary analysis show that patients initiating early PT may be somewhat more likely to experience 50% improvement in function at 12 months.

(156) Predictors of persistent back pain and persistent disability in older adults with new episodes of back pain

Many studies have investigated predictors of poor outcome for back pain in younger adults. However, there is little information on risk factors for persistent back pain and disability specifically in older adults. We conducted a prospective cohort study using the Back pain Outcomes using Longitudinal Data (BOLD) registry. BOLD enrolled 5,239 adults ≥65 years with a new primary care visit for back pain. We analyzed 3671 participants with both 12 month outcomes and 24 months of electronic medical record data.

Relationship between Iliotibial Band Tightness and Occurance of Low Back Pain and Sciatica

Back pain is the most frequent and common problem in the society. It is also one of the most frequent presenting symptoms in clinical practice1. The incidence of low back ache (LBA) in the population is increasing rapidly. Among the new episodes of back pain, 80% leads to chronic disability and chronic back pain4. Most of the previous studies have indicated that 70% to 80% of the population has had at least one episode of LBA in their lifetime The mechanical low back pain is the pain, which varies with physical activity [e.g.- prolonged sitting, bending forward] and with time. This pain is located in the lumbosacral region, buttocks and thighs with no radiation to foot or toes. The pain increases or decreases with repeated movement 1. Sciatica refers to a neurotic type of pain along the course of the sciatic nerve. Pain extends down the posterior thigh, lower leg to the sole of the foot and along lateral aspect of the lower leg to the dorsum of the foot. A number of studies have been done to find out the association of these mechanical factors with LBA. Frank R. Ober, performed fasciotomy for patients with LBA and sciatica and found marked diminution in symptoms for majority of patients within twenty four hours following operation. However till date, hardly any studies have been done to find out the correlation of IT band tightness and the occurrence of LBA and sciatica.