The influence of comorbidities on outcomes for older people with back pain:BACE-D cohort study

Background: Comorbidities are common in older people with back pain but little is known about the influence of comorbidities on outcomes. Objectives: To explore the influence of the most prevalent comorbidities, and the number of comorbidities, on short (at 3 months) and long-term (at 12 months) outcomes of back pain in older people. Methods: We analyzed data from the ‘Back Complaints in the Elders’ Dutch study cohort (BACE-D) and included participants aged &gt;55 years. We used the modified Self-Administered Comorbidities Questionnaire (SCQ), the Numeric Rating Scale (NRS) and the Roland–Morris Disability Questionnaire (RMDQ) to assess the number of comorbidities, pain intensity and back-related physical functioning, respectively. We conducted separate linear regression models to analyze the association between comorbidities and outcomes including potential confounders of age, sex, body mass index, smoking and alcoholic drinking status, back pain history, and baseline NRS and RMDQ scores. Results: Our study included 669 participants with a mean age of 66.5 (SD 7.7) years of whom 394 were female. More comorbidities were positively associated with higher pain intensity (3-month regression coefficient (β) =0.27, 95% CI 0.14–0.39; 12-month β = 0.31, 95% CI 0.17–0.45) and worse physical functioning (3-month β = 0.54, 95% CI 0.31–0.77; 12-month β = 0.64, 95% CI 0.37–0.92). Four of the 5 commonest comorbidities were musculoskeletal problems. Older participants with musculoskeletal comorbidities had higher pain intensity (3-month β = 0.89 95% CI 0.41–1.37; 12-month β = 1.17, 95% CI 0.65–1.69), and worse physical functioning (3-month β = 1.61, 95% CI 0.71–2.52; 12-month β = 1.85, 95% CI 0.82–2.89, P-value &lt; 0.001) compared to participants without musculoskeletal comorbidities. Conclusions: More comorbidities are associated with worse back pain outcomes in older adults. Participants with musculoskeletal comorbidities had worse back pain outcomes than those without.</p

Nonoperative treatment improves pain irrespective of radiographic severity:a cohort study of 1,414 patients with knee osteoarthritis

BACKGROUND AND PURPOSE: The discrepancy between symptoms and radiographic severity of knee osteoarthritis (OA) is well described. However, little is known about whether radiographic severity is predictive of the clinical result of nonoperative treatment. We investigated whether radiographic severity and treatment type were associated with improvements in pain after nonoperative treatment of patients with knee OA. PATIENTS AND METHODS: A 5-year consecutive series of patients deemed not eligible for total knee arthroplasty (TKA) by an experienced orthopedic surgeon was contacted 1–5 years later. Radiographic severity, age, sex, and BMI were registered at the consultation. At follow-up, patients were asked to answer a questionnaire on type of treatment and improvements in pain after treatment. RESULTS: Of 1,848 patients who were not eligible for TKA, 1,414 (77%) completed the follow-up questionnaire (mean age 66 (24–96) years; 55% women). Radiographic severity was not associated with improvements in pain even after adjusting for treatment type, age, sex, and BMI (p > 0.1). The odds ratio of improvement was higher by a factor of 2 in patients who received physiotherapy or multimodal treatment than in patients who did not. INTERPRETATION: Radiographic severity was not associated with improvements in pain after nonoperative treatment. Patients who are not eligible for TKA can confidently be referred to nonoperative treatment even if they have severe radiographic OA. The treatment should preferably be multimodal, including physiotherapy, as recommended in Danish and international clinical guidelines

Effect of in person-delivered behavioural interventions in people with multimorbidity : systematic review and meta-analysis

European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (MOBILIZE, grant agreement No 801790), Næstved, Slagelse and Ringsted Hospitals’ Research Fund, and The Association of Danish Physiotherapists Research Fund. The funding source was not involved in any aspect of this systematic review protocol.Peer reviewedPostprin