Associations of Multiple Chronic Conditions With Physical Performance and Falls Among Older Adults With Back Pain: A Longitudinal, Population-based Study.
Sean D Rundell, Amol Karmarkar, Michael Nash and 1 others
PMID 33901438WHAT IT FOUND
Older adults with back pain and multiple chronic conditions experienced faster physical decline and higher fall risk over six years.
Arthritis was the most consistent predictor of worsening function and falls. Screen for arthritis and multimorbidity to identify patients at highest risk of mobility loss.
Key findings
01Having 2-3 or more than 4 chronic conditions was associated with lower physical performance scores and a greater decline in function over time compared to having 0 or 1 condition.
02Arthritis was the only individual comorbidity associated with increased odds of recurrent falls at every round of the study.
03Participants with 2 to 3 other conditions had Short Physical Performance Battery scores 1.22 points lower than those with 0-1 conditions by Round 6, indicating a more rapid decline.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
Chronic conditions were based on self-report, which can lead to misclassification. The 'arthritis' category was heterogeneous and non-specific, including rheumatoid, knee, and hand osteoarthritis, which may have different impacts on function. Participants with lumbar spine arthritis may have been misclassified as having comorbid arthritis, potentially inflating the association with back pain outcomes. The study excluded non-ambulatory individuals (those requiring wheelchairs or scooters), so results do not apply to more severely disabled patients.
Declared interests
The authors reported no conflicts of interest.
The easy way to misread this
Do not assume that depression or anxiety alone are the primary drivers of physical decline in this population. The study found that arthritis was the only individual condition consistently associated with lower physical performance and higher fall risk over the entire six-year period, whereas the effects of anxiety and depression waned over time.