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Prevalence and “Red Flags” Regarding Specified Causes of Back Pain in Older Adults Presenting in General Practice

Wendy T.M. Enthoven, Judith Geuze, Jantine Scheele, Sita M.A. Bierma-Zeinstra, Herman J. Bueving, Arthur M. Bohnen, Wilco C. Peul, Maurits W. van Tulder, Marjolein Y. Berger, Bart W. Koes, Pim A.J. Luijsterburg
DOI: 10.2522/ptj.20140525 Published 1 March 2016
Wendy T.M. Enthoven
W.T.M. Enthoven, MD, Department of General Practice, Erasmus MC, University Medical Center, Post Box 2040, 3000 CA Rotterdam, the Netherlands.
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Judith Geuze
J. Geuze, MD, Department of General Practice, Erasmus MC, University Medical Center.
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Jantine Scheele
J. Scheele, PhD, Department of General Practice, Erasmus MC, University Medical Center.
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Sita M.A. Bierma-Zeinstra
S.M.A. Bierma-Zeinstra, PhD, Department of General Practice and Department of Orthopaedics, Erasmus MC, University Medical Center.
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Herman J. Bueving
H.J. Bueving, MD, PhD, Department of General Practice, Erasmus MC, University Medical Center.
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Arthur M. Bohnen
A.M. Bohnen, MD, PhD, Department of General Practice, Erasmus MC, University Medical Center.
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Wilco C. Peul
W.C. Peul, MD, PhD, Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands.
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Maurits W. van Tulder
M.W. van Tulder, PhD, Department of Health Sciences and EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University Amsterdam, the Netherlands.
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Marjolein Y. Berger
M.Y. Berger, MD, PhD, Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
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Bart W. Koes
B.W. Koes, PhD, Department of General Practice, Erasmus MC, University Medical Center.
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Pim A.J. Luijsterburg
P.A.J. Luijsterburg, PhD, Department of General Practice, Erasmus MC, University Medical Center.
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Tables

Table 3.
Table 3.

Univariable and Multivariable Association of “Red Flags” With Vertebral Fractures in Participants Aged >55 Years With Back Paina

  • ↵a All data are presented as numbers unless stated otherwise; missing values ranged from 0% to 13%. OR=odds ratio, CI=confidence interval. Nagelkerke R2=20.3.

  • b Variables with a P value <.05 were included in the multivariable model.

  • c >90 days' use of inhalation or oral corticosteroids.

  • d Measured with the Roland-Morris Disability Questionnaire (range=0–24)24; >17 was indicated severe disability.

Table 2.
Table 2.

General Practitioners' Diagnosis Within 1 Year of Follow-up (N=669)a

  • ↵a All data are presented as number (%); more than one diagnosis per patient could be reported.

Table 1.
Table 1.

Baseline Characteristics of Included Participants Aged >55 Yearsa

  • ↵a All data are presented as number (%), unless stated otherwise. Missing values ranged from 0% to 12%.

  • b Hazardous drinking was measured with the Alcohol Use Disorders Identification Test (AUDIT-C) (range=0–12); ≥3 in women and ≥4 in men is considered risk of hazardous drinking.31,32

  • c Measured with a numeric rating scale as an average of the previous week (range=0–10); 0 indicates “no pain,” 10 indicates “worst pain imaginable.”

  • d Measured with the 36-Item Short-Form Health Survey (range=0–100); higher score indicates higher quality of life.25–27

  • e Measured with the Center for Epidemiologic Studies Depression Scale (CES-D) (range=0–60); higher score indicates more prone to depression.28

  • f Measured with the Pain Catastrophizing Scale (range=0–52); higher score indicates more risk for catastrophizing.29

  • g Measured with the Back Beliefs Questionnaire (range=9–49); higher score indicates more positive thoughts of recovery.30

  • h Oral or inhalation corticosteroid use for >90 days.

  • i Measured with heel bone densitometry.

  • j Measured with the Roland-Morris Disability Questionnaire (range=0–24); 0 indicates no disability.24 A cutoff value of 17 was used to indicate severe disability.

Table 4.
Table 4.

Diagnostic Value (95% Confidence Interval) of “Red Flags” and Other Determinants for Vertebral Fractures (N=33) in Participants Aged >55 Years With Back Pain (N=669)a

  • ↵a Missing values ranged from 0% to 8%. PV+=positive predictive value, PV−=negative predictive value, LR+=positive likelihood ratio, LR−=negative likelihood ratio. Prior probability=.05.

  • b Oral or inhalation corticosteroid use of >90 d.

  • c Measured with the Roland-Morris Disability Questionnaire (range=0–24)24; >17 indicated severe disability.

  • d Included in the model: osteoporosis, age of ≥75 years, trauma, back pain intensity score of ≥7, and thoracic pain. Area under the curve=0.78 (range=0.69–0.87).

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Vol 96 Issue 3 Table of Contents
Physical Therapy: 96 (3)

Issue highlights

  • Physical Therapists and Transformative Practice and Population Management
  • Patients' Perceptions of Physical Therapists' Messages
  • Single- and Dual-Task TUG Performance in Middle-Aged and Older Adults
  • Characteristics of Foreign-Educated Physical Therapists
  • “Red Flags” and Causes of Back Pain in Older Adults
  • Older Adult Responses to Balance Tasks
  • Clinical Balance Tests in the Knee Osteoarthritis Population
  • Reactive Balance in Individuals With Chronic Stroke
  • Enhanced Postural Control in Children
  • “Stepping Up” Activity Poststroke
  • Perceptions of Physical Activity
  • Study of Hyperkyphosis, Exercise and Function (SHEAF) Protocol
  • Pilates for Chronic Low Back Pain
  • Development and Initial Testing of Playskin Lift
  • Diabetic Complications and Balance and Falls
  • Promoting Community Health Through Community-Based Research
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Prevalence and “Red Flags” Regarding Specified Causes of Back Pain in Older Adults Presenting in General Practice
Wendy T.M. Enthoven, Judith Geuze, Jantine Scheele, Sita M.A. Bierma-Zeinstra, Herman J. Bueving, Arthur M. Bohnen, Wilco C. Peul, Maurits W. van Tulder, Marjolein Y. Berger, Bart W. Koes, Pim A.J. Luijsterburg
Physical Therapy Mar 2016, 96 (3) 305-312; DOI: 10.2522/ptj.20140525

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Prevalence and “Red Flags” Regarding Specified Causes of Back Pain in Older Adults Presenting in General Practice
Wendy T.M. Enthoven, Judith Geuze, Jantine Scheele, Sita M.A. Bierma-Zeinstra, Herman J. Bueving, Arthur M. Bohnen, Wilco C. Peul, Maurits W. van Tulder, Marjolein Y. Berger, Bart W. Koes, Pim A.J. Luijsterburg
Physical Therapy Mar 2016, 96 (3) 305-312; DOI: 10.2522/ptj.20140525
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Subjects

  • Geriatrics
    • Geriatrics: Other
  • Musculoskeletal System/Orthopedic
    • Injuries and Conditions: Back
  • Diagnosis/Prognosis
    • Diagnosis/Prognosis: Other
  • Physical Therapist Practice
    • Clinical Decision Making

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