ABSTRACT BACKGROUND: Patients with low back pain frequently undergo a variety of diagnostic and therapeutic interventions, but some of these have uncertain effectiveness. This highlights the importance of the association of healthcare services and therapeutic measures relating to disability. OBJECTIVE: To analyze the use of healthcare services and therapeutic measures among Brazilian older adults with disability-related low back pain. DESIGN AND SETTING: Observational cross-sectional study on baseline assessment data from the Back Complaints in the Elders - Brazil (BACE-B) cohort. METHODS: The main analyses were based on a consecutive sample of 602 older adult participants in BACE-B (60 years of age and over). The main outcome measurement for disability-related low back pain was defined as a score of 14 points or more in the Roland Morris Questionnaire. RESULTS: Visits to doctors in the previous six weeks (odds ratio, OR = 1.82; 95% confidence interval, CI 1.22-2.71) and use of analgesics in the previous three months (OR = 1.57; 95% CI 1.07-2.31) showed statistically significant associations with disability-related low back pain. The probability of disability-related low back pain had an additive effect to the combination of use of healthcare services and therapeutic measures (OR = 2.57; 95% CI 1.52-4.36). The analyses showed that this association was significant among women, but not among men. CONCLUSIONS: Occurrence of the combined of consultations and medication use was correlated with higher chance of severe disability among these elderly people with nonspecific low back pain. This suggested that overuse and “crowding-in” effects were present in medical services for elderly people.

Resumo: O estudo teve como objetivo investigar a evolução da intensidade da dor lombar (DL) ao longo de 12 meses em idosos com e sem cinesiofobia. Este foi um estudo multicêntrico internacional. A intensidade da DL foi avaliada com a Numerical Pain Scale na linha de base e ao longo de 5 períodos de seguimento. As crenças e os medos dos pacientes foram medidos com o Fear-Avoidance Beliefs Questionnaire. O estudo incluiu 532 idosos (sem cinesiofobia = 227; com cinesiofobia = 305). Os idosos apresentavam dor moderada na linha de base, com uma diferença significativa entre os grupos. Os participantes mostraram melhora rápida nas primeiras seis semanas, seguida por melhoras menores nos meses seguintes. Entretanto, persistiu uma diferença significativa entre os grupos durante o período de seguimento. A cinesiofobia é um fator prognóstico importante e independente. Os achados sugerem a importância da triagem de fatores psicossociais no manejo de pacientes idosos com DL. Implicações práticas: os pacientes devem ser advertidos que a dor pode ser perpetuada por comportamentos inadequados de evitação, podendo à incapacidade no longo prazo.

Abstract: This study aimed to investigate the course of low back pain (LBP) intensity over a period of 12 months in older people with and without kinesiophobia.This was an international multicenter study. LBP intensity was examined by using the Numerical Pain Scale at baseline and over five follow-up periods. The Fear-Avoidance Beliefs Questionnaire was used to measure patients’ beliefs and fears. The study included 532 older adults (non kinesiophobic = 227; kinesiophobic = 305). The individuals had moderate pain at baseline, with a significant difference observed between the groups. Participants showed a rapid improvement in the first 6 weeks, followed by minor improvements in the succeeding months. However, a significant difference between groups remained during the follow-up period. Independently, kinesiophobia is a significant prognostic factor. These findings suggest the importance of screening for psychosocial factors in the management of older patients with LBP. Practice implications: patients need to be warned that pain can be perpetuated by inappropriate avoidance behaviors that may later lead to disability.

Resumen: El objetivo fue investigar el curso de la intensidad del dolor lumbar (LBP), durante un período de 12 meses, en personas ancianas con y sin quinesofobia. Se trata de un estudio multicéntrico internacional. La intensidad del LBP se evaluó usando la Escala Numérica de Dolor en una base de referencia y sobre 5 períodos de seguimiento. Con el fin de medir las creencias y temores de los pacientes, usamos el Fear-Avoidance Beliefs Questionnaire. El estudio incluyó a 532 ancianos (no quinesofóbicos = 227; quinesofóbicos = 305). Los ancianos sufrieron un dolor moderado en la base de referencia, con una significativa diferencia observada entre grupos. Los participantes mostraron una rápida mejora durante las 6 primeras semanas, seguidas por mejoras menores en los meses siguientes. No obstante, se mantuvo una diferencia significativa entre grupos durante el período de seguimiento. Independientemente, la quinesofobia es un factor pronóstico importante. Estos resultados sugieren la importancia de monitorear factores psicosociales en la gestión de pacientes ancianos con LBP. Implicaciones clínicas: los pacientes necesitan ser avisados de que el dolor puede perpetuarse por comportamientos inapropiados de prevención que quizás más tarde conduzcan a la discapacidad.

Resumo: O estudo teve como objetivo investigar a evolução da intensidade da dor lombar (DL) ao longo de 12 meses em idosos com e sem cinesiofobia. Este foi um estudo multicêntrico internacional. A intensidade da DL foi avaliada com a Numerical Pain Scale na linha de base e ao longo de 5 períodos de seguimento. As crenças e os medos dos pacientes foram medidos com o Fear-Avoidance Beliefs Questionnaire. O estudo incluiu 532 idosos (sem cinesiofobia = 227; com cinesiofobia = 305). Os idosos apresentavam dor moderada na linha de base, com uma diferença significativa entre os grupos. Os participantes mostraram melhora rápida nas primeiras seis semanas, seguida por melhoras menores nos meses seguintes. Entretanto, persistiu uma diferença significativa entre os grupos durante o período de seguimento. A cinesiofobia é um fator prognóstico importante e independente. Os achados sugerem a importância da triagem de fatores psicossociais no manejo de pacientes idosos com DL. Implicações práticas: os pacientes devem ser advertidos que a dor pode ser perpetuada por comportamentos inadequados de evitação, podendo à incapacidade no longo prazo.

Abstract: This study aimed to investigate the course of low back pain (LBP) intensity over a period of 12 months in older people with and without kinesiophobia.This was an international multicenter study. LBP intensity was examined by using the Numerical Pain Scale at baseline and over five follow-up periods. The Fear-Avoidance Beliefs Questionnaire was used to measure patients’ beliefs and fears. The study included 532 older adults (non kinesiophobic = 227; kinesiophobic = 305). The individuals had moderate pain at baseline, with a significant difference observed between the groups. Participants showed a rapid improvement in the first 6 weeks, followed by minor improvements in the succeeding months. However, a significant difference between groups remained during the follow-up period. Independently, kinesiophobia is a significant prognostic factor. These findings suggest the importance of screening for psychosocial factors in the management of older patients with LBP. Practice implications: patients need to be warned that pain can be perpetuated by inappropriate avoidance behaviors that may later lead to disability.

Resumen: El objetivo fue investigar el curso de la intensidad del dolor lumbar (LBP), durante un período de 12 meses, en personas ancianas con y sin quinesofobia. Se trata de un estudio multicéntrico internacional. La intensidad del LBP se evaluó usando la Escala Numérica de Dolor en una base de referencia y sobre 5 períodos de seguimiento. Con el fin de medir las creencias y temores de los pacientes, usamos el Fear-Avoidance Beliefs Questionnaire. El estudio incluyó a 532 ancianos (no quinesofóbicos = 227; quinesofóbicos = 305). Los ancianos sufrieron un dolor moderado en la base de referencia, con una significativa diferencia observada entre grupos. Los participantes mostraron una rápida mejora durante las 6 primeras semanas, seguidas por mejoras menores en los meses siguientes. No obstante, se mantuvo una diferencia significativa entre grupos durante el período de seguimiento. Independientemente, la quinesofobia es un factor pronóstico importante. Estos resultados sugieren la importancia de monitorear factores psicosociales en la gestión de pacientes ancianos con LBP. Implicaciones clínicas: los pacientes necesitan ser avisados de que el dolor puede perpetuarse por comportamientos inapropiados de prevención que quizás más tarde conduzcan a la discapacidad.

Abstract Background: The World Health Organization reports that one of the main incapacitating conditions in older adults is osteomusculoskeletal disorders, and among these is low back pain. There are few instruments translated and transculturally adapted with psychometric properties evaluated for older adults with this health condition in Brazil. The Pain Response to Activity and Positioning (PRAP) questionnaire enables classification of older adults through functional performance. The objective of this study was to perform a cross-cultural adaptation and verify the reliability of the PRAP for older Brazilian people with chronic low back pain. Methods: A cross-sectional methodological study from the international study “Back Complaints in the Elders”. We included individuals aged ≥60 years, with chronic lumbar pain complaints lasting ≥3 months. The transcultural translation and adaptation process followed the criteria proposed by Beaton and Guilhemeim, 1993. Reliability was tested using an unweighted Cohen's Kappa. Results: Thirty-six (36) older adults participated in the study (71.15 ± 7.23 years, 94.4% female). The intra-rater reliability for Low Back Pain (LBP) was between 0.50-1.00 and 0.23-0.84 for lower limbs, while the inter-rater reliability for LBP was between 0.25-0.63 and between 0.18-0.53 for lower limbs. The criteria for low back pain diagnosis showed intra and inter-rater agreement of 0.52 and 0.47, respectively. Conclusion: The Brazilian version of the instrument showed adequate reliability and ability to classify older adults in the diagnosis of LBP by reporting the performance of daily activities, and is indicated for use in the context of research and clinical practice. Trial registration: There is no trial registration. This is a methodological study.