Background & Aims

The 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.

Methods

Data 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.

Results

The 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.

Conclusions

Socioeconomic 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.

References

1. Wong, C. K., Mak, R. Y., Kwok, T. S., Tsang, J. S., Leung, M. Y., Funabashi, M., Macedo, L. G., Dennett, L., & Wong, A. Y. (2022). Prevalence, Incidence, and Factors Associated With Non-Specific Chronic Low Back Pain in Community-Dwelling Older adults Aged 60 Years and Older: A Systematic Review and Meta-Analysis. The journal of pain, 23(4), 509–534. https://doi.org/10.1016/j.jpain.2021.07.012

2. Wong, A. Y. L., Karppinen, J., & Samartzis, D. (2017). Low back pain in older adults: risk factors, management options and future directions. Scoliosis and spinal disorders, 12, 14. https://doi.org/10.1186/s13013-017-0121-3

3. Hartvigsen, J., Hancock, M. J., Kongsted, A., Louw, Q., Ferreira, M. L., Genevay, S., Hoy, D., Karppinen, J., Pransky, G., Sieper, J., Smeets, R. J., Underwood, M., & Lancet Low Back Pain Series Working Group (2018). What low back pain is and why we need to pay attention. Lancet (London, England), 391(10137), 2356–2367. https://doi.org/10.1016/S0140-6736(18)30480-X

4. de Souza, I. M. B., Sakaguchi, T. F., Yuan, S. L. K., Matsutani, L. A., do Espírito-Santo, A. S., Pereira, C. A. B., & Marques, A. P. (2019). Prevalence of low back pain in the elderly population: a systematic review. Clinics (Sao Paulo, Brazil), 74, e789. https://doi.org/10.6061/clinics/2019/e789

5. Spijker-Huiges, A., Groenhof, F., Winters, J. C., van Wijhe, M., Groenier, K. H., & van der Meer, K. (2015). Radiating low back pain in general practice: incidence, prevalence, diagnosis, and long-term clinical course of illness. Scandinavian journal of primary health care, 33(1), 27–32. https://doi.org/10.3109/02813432.2015.1006462

6. Aguiar, A. R. S. A., Ribeiro-Samora, G. A., Pereira, L. S. M., Godinho, L. B., & Assis, M. G. (2017). Disability in older adults with acute low back pain: the study Back Complaints in the Elderly – (Brazil). Brazilian journal of physical therapy, 21(5), 365–371. https://doi.org/10.1016/j.bjpt.2017.06.008

7. Buchbinder, R., van Tulder, M., Öberg, B., Costa, L. M., Woolf, A., Schoene, M., Croft, P., & Lancet Low Back Pain Series Working Group (2018). Low back pain: a call for action. Lancet (London, England), 391(10137), 2384–2388. https://doi.org/10.1016/S0140-6736(18)30488-4

8. Shiri, R., Falah-Hassani, K., Heliövaara, M., Solovieva, S., Amiri, S., Lallukka, T., Burdorf, A., Husgafvel-Pursiainen, K., & Viikari-Juntura, E. (2019). Risk Factors for Low Back Pain: A Population-Based Longitudinal Study. Arthritis care & research, 71(2), 290–299. https://doi.org/10.1002/acr.23710

9. Ferrer-Peña, R., Calvo-Lobo, C., Aiguadé, R., & Fernández-Carnero, J. (2018). Which Seems to Be Worst? Pain Severity and Quality of Life between Patients with Lateral Hip Pain and Low Back Pain. Pain research & management, 2018, 9156247. https://doi.org/10.1155/2018/9156247

10. Iguti, A. M., Guimarães, M., & Barros, M. B. A. (2021). Health-related quality of life (SF-36) in back pain: a population-based study, Campinas, São Paulo State, Brazil. Cadernos de saude publica, 37(2), e00206019. https://doi.org/10.1590/0102-311X00206019

11. Jiménez Buñuales, M. T., González Diego, P., & Martín Moreno, J. M. (2002). La clasificación internacional del funcionamiento de la discapacidad y de la salud (CIF) 2001 [International classification of functioning, disability and health (ICF) 2001]. Revista espanola de salud publica, 76(4), 271–279. https://doi.org/10.1590/s1135-57272002000400002

12. Jarvik, J. G., Comstock, B. A., Heagerty, P. J., Turner, J. A., Sullivan, S. D., Shi, X., Nerenz, D. R., Nedeljkovic, S. S., Kessler, L., James, K., Friedly, J. L., Bresnahan, B. W., Bauer, Z., Avins, A. L., & Deyo, R. A. (2014). Back pain in seniors: the Back pain Outcomes using Longitudinal Data (BOLD) cohort baseline data. BMC musculoskeletal disorders, 15, 134. https://doi.org/10.1186/1471-2474-15-134

13. Selvamani, Y., & Singh, P. (2018). Socioeconomic patterns of underweight and its association with self-rated health, cognition and quality of life among older adults in India. PloS one, 13(3), e0193979.
https://doi.org/10.1371/journal.pone.0193979
14. Bansal, D., Asrar, M. M., Ghai, B., & Pushpendra, D. (2020). Prevalence and Impact of Low Back Pain in a Community-Based Population in Northern India. Pain physician, 23(4), E389–E398.

15. Stewart Williams, J., Ng, N., Peltzer, K., Yawson, A., Biritwum, R., Maximova, T., Wu, F., Arokiasamy, P., Kowal, P., & Chatterji, S. (2015). Risk Factors and Disability Associated with Low Back Pain in Older Adults in Low- and Middle-Income Countries. Results from the WHO Study on Global AGEing and Adult Health (SAGE). PloS one, 10(6), e0127880. https://doi.org/10.1371/journal.pone.0127880

16. Jesus-Moraleida, F. R., Ferreira, P. H., Ferreira, M. L., Silva, J. P., Maher, C. G., Enthoven, W. T. M., Bierma-Zeinstra, S. M. A., Koes, B. W., Luijsterburg, P. A. J., & Pereira, L. S. M. (2017). Back Complaints in the Elders in Brazil and the Netherlands: a cross-sectional comparison. Age and ageing, 46(3), 476–481. https://doi.org/10.1093/ageing/afw230

17. Phyo, A. Z. Z., Gonzalez-Chica, D. A., Stocks, N. P., Woods, R. L., Fisher, J., Tran, T., Owen, A. J., Ward, S. A., Britt, C. J., Ryan, J., Freak-Poli, R., & ASPREE Study Group (2022). Impact of economic factors, social health and stressful life events on physical health-related quality of life trajectories in older Australians. Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation, 31(5), 1321–1333. https://doi.org/10.1007/s11136-021-03021-x

18. Wettstein, M., Eich, W., Bieber, C., & Tesarz, J. (2019). Pain Intensity, Disability, and Quality of Life in Patients with Chronic Low Back Pain: Does Age Matter?. Pain medicine (Malden, Mass.), 20(3), 464–475.
https://doi.org/10.1093/pm/pny062

19. Scheele, J., Luijsterburg, P. A., Ferreira, M. L., Maher, C. G., Pereira, L., Peul, W. C., van Tulder, M. W., Bohnen, A. M., Berger, M. Y., Bierma-Zeinstra, S. M., & Koes, B. W. (2011). Back complaints in the elders (BACE); design of cohort studies in primary care: an international consortium. BMC musculoskeletal disorders, 12, 193. https://doi.org/10.1186/1471-2474-12-193

20. Vandenbroucke, J. P., von Elm, E., Altman, D. G., Gøtzsche, P. C., Mulrow, C. D., Pocock, S. J., Poole, C., Schlesselman, J. J., Egger, M., & STROBE Initiative (2014). Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. International journal of surgery (London, England), 12(12), 1500–1524.
https://doi.org/10.1016/j.ijsu.2014.07.014

21. Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of psychiatric research, 12(3), 189–198. https://doi.org/10.1016/0022-3956(75)90026-6

22. Brucki, S. M., Nitrini, R., Caramelli, P., Bertolucci, P. H., & Okamoto, I. H. (2003). Sugestões para o uso do mini-exame do estado mental no Brasil [Suggestions for utilization of the mini-mental state examination in Brazil]. Arquivos de neuro-psiquiatria, 61(3B), 777–781. https://doi.org/10.1590/s0004-282×2003000500014

23. Husky, M. M., Ferdous Farin, F., Compagnone, P., Fermanian, C., & Kovess-Masfety, V. (2018). Chronic back pain and its association with quality of life in a large French population survey. Health and quality of life outcomes, 16(1), 195. https://doi.org/10.1186/s12955-018-1018-4

24. Ciconelli, R.M., Ferraz, M.B., Santos, W., Meinão, I. and Quaresma, M.R. (1999) Tradução para a língua portuguesa e validação do questionário genérico de avaliação de qualidade de vida SF-36 (Brasil SF-26). Revista Brasileira de Reumatologia, 39, 143-150. https://www.scielo.br/pdf/csc/v16n7/10.pdf

25. Laguardia, J., Campos, M. R., Travassos, C., Najar, A. L., Anjos, L. A., & Vasconcellos, M. M. (2013). Brazilian normative data for the Short Form 36 questionnaire, version 2. Revista brasileira de epidemiologia = Brazilian journal of epidemiology, 16(4), 889–897.
https://doi.org/10.1590/s1415-790×2013000400009

26. Williamson, A., & Hoggart, B. (2005). Pain: a review of three commonly used pain rating scales. Journal of clinical nursing, 14(7), 798–804.
https://doi.org/10.1111/j.1365-2702.2005.01121.x

27. Pain: clinical manual for nursing practice Pain: clinical manual for nursing practice Margo McCaffery Alexander Beebe Mosby Yearbook UK £17.25 0 7234 1992 2. (1994). Nursing standard (Royal College of Nursing (Great Britain) : 1987), 9(11), 55. https://doi.org/10.7748/ns.9.11.55.s69

28. Nusbaum, L., Natour, J., Ferraz, M. B., & Goldenberg, J. (2001). Translation, adaptation and validation of the Roland-Morris questionnaire–Brazil Roland-Morris. Brazilian journal of medical and biological research = Revista brasileira de pesquisas medicas e biologicas, 34(2), 203–210.
https://doi.org/10.1590/s0100-879×2001000200007

29. Roland, M., & Morris, R. (1983). 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, 8(2), 141–144. https://doi.org/10.1097/00007632-198303000-00004

30. Stratford, P. W., Binkley, J., Solomon, P., Finch, E., Gill, C., & Moreland, J. (1996). Defining the minimum level of detectable change for the Roland-Morris questionnaire. Physicaltherapy, 76(4),359–368. https://doi.org/10.1093/ptj/76.4.359
31. Macedo, L. G., Maher, C. G., Latimer, J., Hancock, M. J., Machado, L. A., & McAuley, J. H. (2011). Responsiveness of the 24-, 18- and 11-item versions of the Roland Morris Disability Questionnaire. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 20(3), 458–463. https://doi.org/10.1007/s00586-010-1608-2

32. Gomes, C. D. S., Guerra, R. O., Wu, Y. Y., Barbosa, J. F. S., Gomez, F., Sousa, A. C. P. A., & Pirkle, C. M. (2018). Social and Economic Predictors of Worse Frailty Status Occurrence Across Selected Countries in North and South America and Europe. Innovation in aging, 2(3), igy037. https://doi.org/10.1093/geroni/igy037

33. Jenks, A., Hoekstra, T., van Tulder, M., Ostelo, R. W., Rubinstein, S. M., & Chiarotto, A. (2022). Roland-Morris Disability Questionnaire, Oswestry Disability Index, and Quebec Back Pain Disability Scale: Which Has Superior Measurement Properties in Older Adults With Low Back Pain?. The Journal of orthopaedic and sports physical therapy, 52(7), 457–469. https://doi.org/10.2519/jospt.2022.10802

34. Ludwig, C., Luthy, C., Allaz, A. F., Herrmann, F. R., & Cedraschi, C. (2018). The impact of low back pain on health-related quality of life in old age: results from a survey of a large sample of Swiss elders living in the community. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 27(5), 1157–1165. https://doi.org/10.1007/s00586-017-5427-6

35. Ginnerup-Nielsen, E., Harreby, M., Christensen, R., Bliddal, H., & Henriksen, M. (2022). The correlation between illness perception, pain intensity and quality of life in elderly with low back pain in Denmark: a cross-sectional study. PeerJ, 10, e14129. https://doi.org/10.7717/peerj.14129

36. Rapti, E., Damigos, D., Apostolara, P., Roka, V., Tzavara, C., & Lionis, C. (2019). Patients with chronic pain: evaluating depression and their quality of life in a single center study in Greece. BMC psychology, 7(1), 86. https://doi.org/10.1186/s40359-019-0366-0

37. Cedraschi, C., Luthy, C., Allaz, A. F., Herrmann, F. R., & Ludwig, C. (2016). Low back pain and health-related quality of life in community-dwelling older adults. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 25(9), 2822–2832.
https://doi.org/10.1007/s00586-016-4483-7

38. Wallace, B., Varcoe, C., Holmes, C., Moosa-Mitha, M., Moor, G., Hudspith, M., & Craig, K. D. (2021). Towards health equity for people experiencing chronic pain and social marginalization. International journal for equity in health, 20(1), 53. https://doi.org/10.1186/s12939-021-01394-6

39. Programa das Nações Unidas para o Desenvolvimento (PNUD) Atlas do IDHM. New York: PNUD; 2019

40. Phillips, S. P., Auais, M., Belanger, E., Alvarado, B., & Zunzunegui, M. V. (2016). Life-course social and economic circumstances, gender, and resilience in older adults: The longitudinal International Mobility in Aging Study (IMIAS). SSM – population health, 2, 708–717.

https://doi.org/10.1016/j.ssmph.2016.09.007

41. https://www.oecdbetterlifeindex.org/

42. Instituto Brasileiro de Geografia e Estatística (IBGE) Cidades. Rio de Janeiro: IBGE; 2017

43. Lau, S. Y. Z., Guerra, R. O., Barbosa, J. F. de S., & Phillips, S. P. (2018). Impact of resilience on health in older adults: a cross-sectional analysis from the International Mobility in Aging Study (IMIAS). BMJ Open, 8(11), e023779. https://doi.org/10.1136/bmjopen-2018-023779

44. Wettstein, M., Eich, W., Bieber, C., & Tesarz, J. (2019). Profiles of Subjective Well-being in Patients with Chronic Back Pain: Contrasting Subjective and Objective Correlates. Pain medicine (Malden, Mass.), 20(4), 668–680. https://doi.org/10.1093/pm/pny162

45. Carmona-Torres, J. M., Rodríguez-Borrego, M. A., Laredo-Aguilera, J. A., López-Soto, P. J., Santacruz-Salas, E., & Cobo-Cuenca, A. I. (2019). Disability for basic and instrumental activities of daily living in older individuals. PloS one, 14(7), e0220157. https://doi.org/10.1371/journal.pone.0220157

46. Silva, J. P. D., de Jesus-Moraleida, F. R., Felício, D. C., Andrade, A. G. P., Pereira, D. S., Ferreira, M. L., & Pereira, L. S. M. (2022). Trajectories of pain and disability in older adults with acute low back pain: Longitudinal data of the BACE-Brazil cohort. Brazilian journal of physical therapy, 26(1), 100386. https://doi.org/10.1016/j.bjpt.2021.100386

47. Yabe, Y., Hagiwara, Y., Sugawara, Y., & Tsuji, I. (2022). Association between low back pain and functional disability in the elderly people: a 4-year longitudinal study after the great East Japan earthquake. BMC geriatrics, 22(1), 930. https://doi.org/10.1186/s12877-022-03655-7

Presenting Author

Adriana Estela de Oliveira Grigorini

Poster Authors

Adriana Grigorini

Master degree

Faculdade Ciências Médicas de Minas Gerais

Lead Author

E-mail

Leani Souza Máximo Pereira PhD

Universidade Federal de Minas Gerais

Lead Author

E-mail

Bart Koes PhD

Erasmus MC

Lead Author

E-mail

Silvia Lanzioti Azevedo da Silva PhD

Universidade Federal de Juiz de Fira

Lead Author

E-mail

Alessandro Chiarotto

Erasmus MC/Vrije Universiteit Amsterdam

Lead Author

E-mail

Diogo Carvalho Felicio PhD

Universidade Federal de Juiz de Fora

Lead Author

E-mail

Amanda Aparecida Oliveira Lepoldino PhD

Faculdade Ciências Médicas de Minas Gerais

Lead Author

E-mail

Topics

  • Models: Musculoskeletal