Research Paper

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

Vigdal, Ørjan Nesse^a,*; Storheim, Kjersti^a,b; Killingmo, Rikke Munk^a; Småstuen, Milada Cvancarova^a; Grotle, Margreth^a,b

Author Information

^aDepartment of Physiotherapy, Faculty of Health Science, OsloMet—Oslo Metropolitan University, Oslo, Norway

^bResearch and Communication Unit for Musculoskeletal Health (FORMI), Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway

^*Corresponding author. Address: OsloMet—Oslo Metropolitan University, Post Box 4, St. Olavs plass, 0130 Oslo, Norway. Tel.: +47 414 59 314. E-mail address: [email protected] (Ø. N. Vigdal).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

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PAIN 164(4):p e207-e216, April 2023. | DOI: 10.1097/j.pain.0000000000002779

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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.