Activity levels best reflect functional capacity of back pain patients

By Lauretta Ihonor

The level of physical activity displayed by an elderly individual with chronic low back pain (LBP) is a better predictor for functional capacity than psychosocial factors, results from a community-based study indicate.

"Therefore, to achieve progress in functional capacity of elderly patients with chronic LBP, clinical management should include educational intervention that would highlight the benefits of an active lifestyle," say the authors.

They add that "individual levels of psychosocial factors should still be taken into account, but the emphasis may be directed toward physical activity strategies."

The study findings, published in the Journal of Manipulative and Physiological Therapeutics, arise from the assessment of functional capacities in 61 individuals, with a mean age of 70 years, with (n=29) and without (n=32) nonspecific chronic LBP.

Chronic LBP was defined as pain being present on at least half of the days in a 12-month period or recurrent pain occurring on less than half of the days in a 12-month period.

All participants underwent activities designed to measure maximal trunk endurance and force. This was in addition to the completion of questionnaires evaluating psychologic impact of LBP and daily functioning.

Specifically, physical activity levels were assessed using the Baecke Physical Activity Questionnaire, difficulties in executing daily activities were measured using the Oswestry Disability Index, and pain-related fear of movement and reinjury was assessed via the Tampa Scale of Kinesiophobia.

Martin Descarreaux (University of Québec at Trois-Rivières, Canada) and colleagues report that LBP patients had a significantly lower endurance time and peak force than those without back pain.

For example, the mean maximum number of isometric trunk extensions (measure of endurance) achieved by LBP patients was 92, whereas a mean of 222 extensions was observed among individuals without LBP.

Psychologic factors, including pain-related fear of movement, pain catastrophizing, and depression were more pronounced among LBP patients than in pain-free controls. However, when these findings were adjusted for the effects of disability and physical activity, the observed variations in patient functioning were noted to be independent of psychologic factors.

This, say Descarreaux et al, suggests that psychologic factors, such as fear of falling and confidence in performing common daily activities influence the eagerness of a LBP patient to carry out physical exercise, but do not affect true ability.

The authors conclude that such barriers to physical activity should be addressed if functional capacity among such patients is to be maximized.

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