Jaclyn Sions - Academia.edu (original) (raw)

Papers by Jaclyn Sions

Pain Medicine, Mar 21, 2023

Objective Movement-evoked pain (MeP) may predispose the geriatric chronic low back pain (LBP) pop... more Objective Movement-evoked pain (MeP) may predispose the geriatric chronic low back pain (LBP) population to health decline. As there are differing operational definitions for MeP, the question remains as to whether these different definitions have similar associations with health outcomes in older adults with chronic LBP. Design Cross-sectional analysis of an observational study. Setting Clinical research laboratory. Subjects 226 older adults with chronic LBP. Methods This secondary analysis used baseline data from a prospective cohort study (n = 250). LBP intensity was collected before and after the repeated chair rise test, stair climbing test, and 6-minute walk test; MeP change scores (ie, sum of pretest pain subtracted from posttest pain) and aggregated posttest pain (ie, sum of posttest pain) variables were calculated. LBP-related disability and self-efficacy were measured by the Quebec Back Pain Disability Scale (QBPDS) and Low Back Activity Confidence Scale (LOBACS), respectively. Physical function was measured with the Health ABC Performance Battery. Robust regression with HC3 standard errors was used to evaluate adjusted associations between both MeP variables and disability, self-efficacy, and physical function. Results Greater aggregated posttest MeP was independently associated with worse disability (b = 0.593, t = 2.913, P = .004), self-efficacy (b = –0.870, t = –3.110, P = .002), and physical function (b = –0.017, t = –2.007, P = .039). MeP change scores were not associated with any outcome (all P > .050). Conclusions Aggregate posttest MeP was linked to poorer health outcomes in older adults with chronic LBP, but MeP change scores were not. Future studies should consider that the construct validity of MeP paradigms partially depends on the chosen operational definition.

Journal of Geriatric Physical Therapy, Feb 24, 2023

Physical therapy, Nov 8, 2021

Objective. Chronic low back pain (CLBP) is a disabling and costly condition for older adults that... more Objective. Chronic low back pain (CLBP) is a disabling and costly condition for older adults that is difficult to properly classify and treat. In a cohort study, a subgroup of older adults with CLBP who had elevated hip pain and hip muscle weakness was identified; this subgroup differentiated itself by being at higher risk for future mobility decline. The primary purpose of this clinical trial is to evaluate whether a hip-focused low back pain (LBP) treatment provides better disability and physical performance outcomes for this at-risk group compared with a spine-focused LBP treatment. Methods. This study is a multisite, single-blinded, randomized controlled, parallel arm, Phase II trial conducted across 3 clinical research sites. A total of 180 people aged between 60 and 85 years with CLBP and hip pain are being recruited. Participants undergo a comprehensive baseline assessment and are randomized into 1 of 2 intervention arms: hip-focused or spine-focused. They are treated twice weekly by a licensed physical therapist for 8 weeks and undergo follow-up assessments at 8 weeks and 6 months after randomization. Primary outcome measures include the Quebec Low Back Disability Scale and the 10-Meter Walk Test, which are measures of self-report and performance-based physical function, respectively. Impact. This multicenter, randomized clinical trial will determine whether a hip-focused or spine-focused physical therapist intervention results in improved disability and physical performance for a subgroup of older adults with CLBP and hip pain who are at increased risk of mobility decline. This trial will help further the development of effective interventions for this subgroup of older adults with CLBP.

ACR open rheumatology, Sep 15, 2021

ObjectiveThe objective of this study was to investigate whether poor hip range of motion (ROM) an... more ObjectiveThe objective of this study was to investigate whether poor hip range of motion (ROM) and strength predict 12‐month physical function decline among older adults with chronic low back pain (LBP) and whether hip osteoarthritis modifies those relationships.MethodsAt baseline, passive ROM and strength measurements were taken for hip flexion, extension, abduction, adduction, internal rotation, and external rotation; ultrasound images and self‐reported symptoms were used to evaluate hip osteoarthritis presence (eg, osteophytes and hip pain). At baseline and 12 months, performance‐based (repeated chair rise, self‐selected gait speed, 6‐minute walk test [6MWT]) and self‐reported (Quebec LBP Disability Questionnaire, Late‐Life Function & Disability Instrument [LLFDI] basic and advanced lower extremity scales) physical function outcomes were assessed. Regression models were constructed for each outcome predicted by baseline hip ROM and strength measures, with adjustment for potential covariates. To avoid collinearity, hip ROM and strength measures with the strongest unadjusted correlations were included in final models. The hip osteoarthritis presence by hip ROM/strength interaction was also explored.ResultsHip abduction strength predicted repeated chair rise (β = −0.297, P < 0.001), gait speed (β = 0.160, P = 0.003), 6MWT (β = 0.159, P ≤ 0.001), Quebec LBP Disability Questionnaire (β = −0.152, P = 0.003), and LLFDI basic lower extremity scale (β = 0.171, P = 0.005) outcomes. Regarding hip ROM, extension predicted repeated chair rise (β = −0.110, P = 0.043) and LLFDI advanced lower extremity scale (β = 0.090, P = 0.007) outcomes, external rotation predicted gait speed (β = 0.122, P = 0.004) outcomes, and abduction predicted LLFDI basic lower extremity scale (β = 0.114, P = 0.026) outcomes. The hip osteoarthritis interaction was not significant for any model.ConclusionReduced hip strength and ROM predict physical function decline; hip osteoarthritis presence may not modify these relationships.

American Journal of Physical Medicine & Rehabilitation, Apr 4, 2019

Objective:For individuals with lower-limb loss (LLL), functional mobility (i.e. K-level) classifi... more Objective:For individuals with lower-limb loss (LLL), functional mobility (i.e. K-level) classification can be subjective. Performance-based outcome measures (OM) improve the objectivity of K-level assignment; therefore, this study aimed to determine differences in functional strength- and dynamic balance-based OM performance between K3- and K4-classified adults with LLL.Design:Prosthetists used subjective information and prosthetic componentry to determine K-levels prior to OM testing for adults with a unilateral transtibial (n=50) or transfemoral amputation (n=17). OM [i.e., 5-Times Sit-to-Stand Test (5xSTS), Figure-of-8 Walk Test (F8WT), 360° Turn Test (360TT), and modified Four-Square Step Test (mFSST)] were administered by a blinded examiner. Univariate analyses of variance (ANOVAs) were used to evaluate between-subgroup differences.Results:K4-classified participants with a unilateral transfemoral amputation performed better on all outcome measures when compared with K3-classified peers, whereas K4-classified individuals with a transtibial amputation performed better on the modified Four-Square Step Test compared with K3-classified peers (P < 0.050).Conclusion:K4-classified individuals demonstrated greater lower-extremity functional strength and better dynamic balance compared to K3-classified peers. To assist with K-level classification, clinicians should consider selecting OM that objectively differentiate between K-levels (i.e., mFSST for those with a unilateral transtibial or transfemoral amputation; 5xSTS, F8WT, and 360TT for those with a transfemoral amputation).

Archives of Physical Medicine and Rehabilitation, 2017

Objective-The purpose of this study was to determine if multifidi size and/or intramuscular fat w... more Objective-The purpose of this study was to determine if multifidi size and/or intramuscular fat were associated with self-reported and performance-based physical function in older adults with and without chronic LBP. Design-Case-control study Setting-Individuals participated in a standardized evaluation in a clinical laboratory and underwent magnetic resonance imaging (MRI) of the lumbar spine at a nearby facility. Patient Sample-A volunteer sample of 106 community-dwelling older adults, aged 60-85 years, with (n=57) and without (n=49) chronic LBP were included in this secondary data analysis. Intervention-Average right-left, L5 multifidi relative, i.e. total, cross-sectional area (rCSA); muscle-fat infiltration index (MFI), i.e. a measure of intramuscular fat; and relative muscle crosssectional area (rmCSA), i.e. total CSA minus intramuscular fat CSA, were determined from MRIs. Linear regression modeling was performed with physical function measures as the dependent variables. Age, sex, and body mass index were entered as covariates. The main effects of L5 multifidi MFI and rmCSA, as well as their interaction with group assignment, were compared as independent variables.

Journal of Geriatric Physical Therapy, Sep 16, 2022

The Journal of frailty & aging, 2015

The purpose of this secondary analysis was to explore the differences in proportions of frailty c... more The purpose of this secondary analysis was to explore the differences in proportions of frailty criteria, pre-frailty, and frailty in older adults with and without chronic low back pain (CLBP). Among individuals with CLBP, we also explored whether the proportions of these outcomes differed based on pain intensity status. Using measures to determine weakness, slowness, and exhaustion, we determined that older adults with CLBP had higher proportions of frailty criteria and were more likely to be classified as pre-frail. Older adults with high intensity CLBP had greater proportions of weakness and pre-frailty compared to those with low intensity CLBP. These preliminary findings suggest older adults with CLBP may be at a higher risk for frailty than those without pain; pain intensity may be an important factor in assessing risk of frailty in this population.

Journal of Geriatric Physical Therapy, 2015

Background and Purpose-Ultrasound imaging (USI) has been shown to be a reliable measure for direc... more Background and Purpose-Ultrasound imaging (USI) has been shown to be a reliable measure for direct assessment of the lumbar multifidi among younger adults. However, given ageand chronic low back pain (CLBP)-related spinal changes, similar studies are needed prior to clinical use of USI among older adults with CLBP. The goals of this study were to evaluate intraand inter-examiner reliability for USI assessment of multifidi thickness at rest and during a contraction and to determine standard error of measurement values (SEMs) and minimal detectable change values (MDCs) among older adults with CLBP. Methods-Thirty-one adults, aged 60 to 85 years, with CLBP were recruited. Two examiners performed USI assessments of multifidus thickness at rest and during a contralateral lower extremity lift. Intraclass correlation coefficients (ICCs) were used to estimate inter-and intraexaminer reliability. SEMs and MDCs were calculated. Results-All USI measurement techniques demonstrated excellent within-day, inter-examiner procedural reliability (ICCs: 0.82-0.85) and good-to-excellent between-days, inter-examiner procedural reliability (ICCs: 0.72-0.79). SEMs ranged from 0.36-0.46 centimeters (cm); MDCs ranged from 1.01-1.26 cm. Regardless of the measurement technique, examiner 1, the more experienced examiner, demonstrated lower SEMs and MDCs than examiner 2. Discussion-Lower ICCs, greater SEMs, and greater MDCs for USI multifidus thickness assessment in older adults with CLBP when compared to previously published, procedural reliability results for younger adults with and without low back pain, may indicate that imaging is

Osteoarthritis and Cartilage, Apr 1, 2016

Physiotherapy Theory and Practice, Apr 4, 2018

Among older adults, low back pain (LBP) is common, costly, and disabling. Trunk muscle training (... more Among older adults, low back pain (LBP) is common, costly, and disabling. Trunk muscle training (TMT) and neuromuscular electrical stimulation (NMES) have both been found to be effective in reducing LBP, but studies among older adults have been limited. An 83 year-old female with left-sided chronic LBP participated in a randomized controlled trial consisting of supervised TMT and NMES to the paraspinal muscles two times per week for twelve weeks. She also participated in a home exercise program. At the end of the intervention, she reported reduced LBP and LBP-related disability per the modified Oswestry Disability Index (i.e. 60% at baseline to 40% at 12-weeks). Her Short Physical Performance Battery summary score improved from 4/12 at baseline to 10/12 at 12-weeks, while her Timed Up and Go test improved from 17.21 to 15.20 seconds and her Repetitive Trunk Rotation test from 2.72 to 1.93 seconds/right-left rotation. This case demonstrates a positive short-term treatment response to TMT supplemented with NMES of the paraspinal muscles in an older adult with chronic LBP. A packaged intervention of TMT plus NMES may be a means of addressing not only LBP, but also impaired physical function and resultant disability.

Osteoarthritis and Cartilage, Apr 1, 2016

Gait & Posture, Jun 1, 2017

Previous studies in older adults have identified that chronic low back pain (CLBP) is associated ... more Previous studies in older adults have identified that chronic low back pain (CLBP) is associated with slower gait speed. Given that slower gait speed is a predictor of greater morbidity and mortality among older adults, it is important to understand the underlying spatiotemporal characteristics of gait among older adults with CLBP. The purposes of this study were to determine (1) if there are differences in spatiotemporal parameters of gait between older adults with and without CLBP during self-selected and fast walking and (2) whether any of these gait characteristics are correlated with performance of a challenging walking task, e.g. stair negotiation. Spatiotemporal characteristics of gait were evaluated using a computerized walkway in 54 community-dwelling older adults with CLBP and 54 age-and sex-matched healthy controls. Older adults with CLBP walked slower than their pain-free peers during self-selected and fast walking. After controlling for body mass index and gait speed, step width was significantly greater in the CLBP group during the fast walking condition. Within the CLBP group, step width and double limb support time are significantly correlated with stair ascent/descent times. From a clinical perspective, these gait characteristics, which may be indicative of balance performance, may need to be addressed to improve overall gait speed, as well as stair-climbing performance. Future longitudinal studies confirming our findings are needed, as well as investigations focused on developing interventions to improve gait speed and decrease subsequent risk of mobility decline.

Journal of Orthopaedic & Sports Physical Therapy, Jun 1, 2014

Study Design-Intraand inter-examiner, within-and between-days, reliability study Objectives-To co... more Study Design-Intraand inter-examiner, within-and between-days, reliability study Objectives-To compare the intra and inter-examiner procedural reliability of ultrasound imaging (USI) thickness measurements of the lumbar multifidus muscle at rest and during a contralateral lower limb lift (CLL) between older (60-85 years) and younger (18-40 years) adults. Background-Among younger adults, USI has been shown to be reliable and valid for assessing multifidi thickness. Older adults present with age-related changes that may impact assessment. To our knowledge, no USI studies have focused on establishing reliability for multifidi thickness assessments in older adults. Methods-Two examiners performed assessments of lumbar multifidi thickness at rest and during a CLL in 30 older and 31 younger adults. Intraclass correlation coefficients (ICCs) with 95% confidence intervals (CI), standard error of measurement (SEMs), and 95% minimal detectable change (MDCs) for resting, CLL, and percent thickness change were calculated. Results-Within-day, inter-examiner procedural reliability for multifidus thickness measurements were similar amongst younger (ICCs=.90-.92) and older adults (ICCs=.86-.90) as was, between-days intra-examiner and inter-examiner reliability (younger ICCs=.84-.94; older ICCs=.86-.93). Throughout, estimates of percent thickness change were inconsistent (ICCs=.31-. 86) and SEMs and MDCs were larger for older adults. Conclusions-USI reliability for measurements of multifidi thickness at rest and during a CLL amongst older adults is consistent with previously published findings for younger adults. Among older adults, it may be preferable to have a single examiner conduct USI assessments.

Archives of Physical Medicine and Rehabilitation, Mar 1, 2022

Objective:To investigate if clinically observable aberrant lumbopelvic movements are associated w... more Objective:To investigate if clinically observable aberrant lumbopelvic movements are associated with physical function at 12-month follow-up in older adults with chronic low back pain (CLBP), both directly and indirectly through baseline physical function.Design:Secondary analysis of a yearlong prospective cohort study.Setting:Clinical Research Laboratory.Participants:Community-dwelling older adults with CLBP.Interventions:Not applicable.Main Outcome Measures:Data from 239 participants were analyzed. Participants were screened at baseline for aberrant lumbopelvic movements during active trunk flexion; total observable aberrant movements were recorded and summed (range 0–4). Latent constructs of physical function were developed from an array of perception-based and performance-based outcome measures at baseline and 12-months, respectively. Structural Equation Modeling was used to assess the direct effect of baseline aberrant movement score on the latent construct of 12-month physical function, and its indirect effect through baseline physical function.Results:Aberrant movements were present in the majority of participants (64.9%) and had a significant negative total effect on 12-month physical function (γ= −0.278, p<.001). Aberrant movement score’s direct effect and indirect effect, through baseline functioning, were significantly negatively associated with physical function at 12-months, after adjusting for covariates (γ=−0.068, p=.038; γ= −0.210, p<.001, respectively).Conclusion:Aberrant lumbopelvic movements are associated with decreased physical function at 12-month follow-up in older adults with CLBP, independent of baseline physical function and covariates. Future studies should evaluate if screening for aberrant movements may inform prognostic and interventional efforts in this patient population.

Archives of Physical Medicine and Rehabilitation, Nov 1, 2018

Objectives-To investigate the impact that the presence of chronic low back pain with radiculopath... more Objectives-To investigate the impact that the presence of chronic low back pain with radiculopathy (CLBPR) may have on 1) energy efficiency and 2) energy capacity among community-dwelling older adults. Design-Matched case-control study. Setting-Clinical research laboratory. Participants-38 community-dwelling older adults (60-85 years) with (n=19) and without (n=19) CLBPR were included in this analysis. Participants were matched between-groups on age (± 5 years), sex, and diabetic status. Interventions-Not applicable. Main Outcome Measures-Energy cost of walking at self-selected speed (i.e. energy efficiency) and Peak Walking VO2 (i.e. energy capacity). Results-Older adults with CLBPR had a higher energy cost of walking at self-selected speed (p=.009) and lower Peak Walking VO2 (p=.050), compared to those without pain. Conclusions-Older adults with CLBPR may benefit from specific rehabilitative interventions that target these potentially modifiable energetic outcomes, thereby reducing the risk of mobility

Scandinavian Journal of Pain, Feb 1, 2022

Objectives: This study's primary purpose was to determine if the extent of bodily pain, as evalua... more Objectives: This study's primary purpose was to determine if the extent of bodily pain, as evaluated with pain body diagrams, is associated with prosthetic-related activity restrictions, adjustment, and satisfaction among adults with a major unilateral lower-limb amputation. A secondary objective was to evaluate between-days, testretest reliability for pain body diagrams among adults with lower-limb amputation. Methods: Adults with a lower-limb amputation that occurred ≥1 year prior participated in an online, crosssectional research study. Outcome measures included pain body diagrams and the Trinity Amputation and Prosthesis Experience Scales-Revised, which evaluates post-amputation activity restrictions, psychosocial adjustment, and prosthesis satisfaction. Linear regression modeling was used to evaluate associations between the number of painful body regions and prosthetic outcomes, after considering covariates (alpha ≤ 0.010). A subset of participants recompleted pain body diagrams to evaluate between-days, test-retest reliability. Results: Data from 74 participants (n = 32 female; n = 42 transtibial-level; n = 27 traumatic etiology) were available. Beyond covariates (i.e., age, sex, amputation level), the total number of painful body regions was significantly associated with all Trinity Amputation and Prosthesis Experience Scales-Revised subscales (p < 0.001-0.006), with the exception of Social Adjustment (p = 0.764). The total number of painful body regions explained 14.5, 11.8, 11.6, and 7.4% of the variance in Functional Satisfaction with the Prosthesis, Adjustment to Limitation, General Adjustment, and Activity Restriction, respectively. In a subset (n = 54), test-retest reliability for total number of painful body regions per body diagrams was good [intraclass correlation coefficient (ICC) 3,1 = 0.84]. Conclusions: A greater number of painful body regions is associated with greater activity restriction, worse adjustment, and lower prosthesis satisfaction, supporting the need to enhance post-amputation pain management and both amputated-and secondary-site pain prevention. Ethical committee number: IRB #1611862.

Pain Medicine, Jun 26, 2016

Objective. To explore potential differences in lumbar mobility between older adults with and with... more Objective. To explore potential differences in lumbar mobility between older adults with and without chronic low back pain, and to determine if lumbar mobility contributes to physical performance in both groups. We hypothesized that older adults with pain would have greater lumbar mobility impairments than pain-free peers, and that lumbar mobility would be associated with performance in both groups, with stronger relationships among those with pain. Design. Matched case-control. Setting. Research laboratory. Patients. Community-dwelling older adults, aged 60-85 years, with (N 5 54) and without (N 5 54) chronic low back pain. Methods. Inclinometer-measured maximal angles of lumbar flexion, extension, and average sidebending, as well as time to complete performance measures, Repeated Chair Rise and Timed-Up-and-Go, were measured in both groups. Analysis of variance was used to explore the difference in lumbar mobility between groups. Adjusted linear regression was used to assess the independent relationship between lumbar mobility and physical function in both groups. Results. Those with pain had smaller angles of flexion (P 5 0.029) and extension (P 5 0.013). In the pain group, flexion explained 19% (P 5 0.001) and 8.9% (P 5 0.006) of the variance for time to complete the Repeated Chair Rise and Timed Up-and-Go tests, respectively. In the pain-free group, extension explained 12.7% (P 5 0.007) and 10.3% (P 5 0.008) of the variance for time to complete Repeated Chair Rise and Timed Up-and-Go tests, respectively. Conclusion. Older adults with chronic low back pain have more lumbar mobility impairments. Lumbar mobility may be a contributing factor to decreased performance in older adults. Flexion may be most important to performance in those with pain, while extension may be vital in those without pain.

Scandinavian Journal of Pain, 2022

Objectives This study’s primary purpose was to determine if the extent of bodily pain, as evaluat... more Objectives This study’s primary purpose was to determine if the extent of bodily pain, as evaluated with pain body diagrams, is associated with prosthetic-related activity restrictions, adjustment, and satisfaction among adults with a major unilateral lower-limb amputation. A secondary objective was to evaluate between-days, test-retest reliability for pain body diagrams among adults with lower-limb amputation. Methods Adults with a lower-limb amputation that occurred ≥1 year prior participated in an online, cross-sectional research study. Outcome measures included pain body diagrams and the Trinity Amputation and Prosthesis Experience Scales-Revised, which evaluates post-amputation activity restrictions, psychosocial adjustment, and prosthesis satisfaction. Linear regression modeling was used to evaluate associations between the number of painful body regions and prosthetic outcomes, after considering covariates (alpha ≤ 0.010). A subset of participants recompleted pain body diagra...

Archives of Physical Medicine and Rehabilitation, 2021

OBJECTIVE To investigate if clinically observable aberrant lumbopelvic movements are associated w... more OBJECTIVE To investigate if clinically observable aberrant lumbopelvic movements are associated with physical function at 12-month follow-up in older adults with chronic low back pain (CLBP), both directly and indirectly through baseline physical function. DESIGN Secondary analysis of a yearlong prospective cohort study. SETTING Clinical Research Laboratory. PARTICIPANTS Community-dwelling older adults with CLBP. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Data from 239 participants were analyzed. Participants were screened at baseline for aberrant lumbopelvic movements during active trunk flexion; total observable aberrant movements were recorded and summed (range 0-4). Latent constructs of physical function were developed from an array of perception-based and performance-based outcome measures at baseline and 12-months, respectively. Structural Equation Modeling was used to assess the direct effect of baseline aberrant movement score on the latent construct of 12-month physical function, and its indirect effect through baseline physical function. RESULTS Aberrant movements were present in the majority of participants (64.9%) and had a significant negative total effect on 12-month physical function (γ= -0.278, p<.001). Aberrant movement score's direct effect and indirect effect, through baseline functioning, were significantly negatively associated with physical function at 12-months, after adjusting for covariates (γ=-0.068, p=.038; γ= -0.210, p<.001, respectively). CONCLUSION Aberrant lumbopelvic movements are associated with decreased physical function at 12-month follow-up in older adults with CLBP, independent of baseline physical function and covariates. Future studies should evaluate if screening for aberrant movements may inform prognostic and interventional efforts in this patient population.

Pain Medicine, Mar 21, 2023

Objective Movement-evoked pain (MeP) may predispose the geriatric chronic low back pain (LBP) pop... more Objective Movement-evoked pain (MeP) may predispose the geriatric chronic low back pain (LBP) population to health decline. As there are differing operational definitions for MeP, the question remains as to whether these different definitions have similar associations with health outcomes in older adults with chronic LBP. Design Cross-sectional analysis of an observational study. Setting Clinical research laboratory. Subjects 226 older adults with chronic LBP. Methods This secondary analysis used baseline data from a prospective cohort study (n = 250). LBP intensity was collected before and after the repeated chair rise test, stair climbing test, and 6-minute walk test; MeP change scores (ie, sum of pretest pain subtracted from posttest pain) and aggregated posttest pain (ie, sum of posttest pain) variables were calculated. LBP-related disability and self-efficacy were measured by the Quebec Back Pain Disability Scale (QBPDS) and Low Back Activity Confidence Scale (LOBACS), respectively. Physical function was measured with the Health ABC Performance Battery. Robust regression with HC3 standard errors was used to evaluate adjusted associations between both MeP variables and disability, self-efficacy, and physical function. Results Greater aggregated posttest MeP was independently associated with worse disability (b = 0.593, t = 2.913, P = .004), self-efficacy (b = –0.870, t = –3.110, P = .002), and physical function (b = –0.017, t = –2.007, P = .039). MeP change scores were not associated with any outcome (all P &gt; .050). Conclusions Aggregate posttest MeP was linked to poorer health outcomes in older adults with chronic LBP, but MeP change scores were not. Future studies should consider that the construct validity of MeP paradigms partially depends on the chosen operational definition.

Journal of Geriatric Physical Therapy, Feb 24, 2023

Physical therapy, Nov 8, 2021

Objective. Chronic low back pain (CLBP) is a disabling and costly condition for older adults that... more Objective. Chronic low back pain (CLBP) is a disabling and costly condition for older adults that is difficult to properly classify and treat. In a cohort study, a subgroup of older adults with CLBP who had elevated hip pain and hip muscle weakness was identified; this subgroup differentiated itself by being at higher risk for future mobility decline. The primary purpose of this clinical trial is to evaluate whether a hip-focused low back pain (LBP) treatment provides better disability and physical performance outcomes for this at-risk group compared with a spine-focused LBP treatment. Methods. This study is a multisite, single-blinded, randomized controlled, parallel arm, Phase II trial conducted across 3 clinical research sites. A total of 180 people aged between 60 and 85 years with CLBP and hip pain are being recruited. Participants undergo a comprehensive baseline assessment and are randomized into 1 of 2 intervention arms: hip-focused or spine-focused. They are treated twice weekly by a licensed physical therapist for 8 weeks and undergo follow-up assessments at 8 weeks and 6 months after randomization. Primary outcome measures include the Quebec Low Back Disability Scale and the 10-Meter Walk Test, which are measures of self-report and performance-based physical function, respectively. Impact. This multicenter, randomized clinical trial will determine whether a hip-focused or spine-focused physical therapist intervention results in improved disability and physical performance for a subgroup of older adults with CLBP and hip pain who are at increased risk of mobility decline. This trial will help further the development of effective interventions for this subgroup of older adults with CLBP.

ACR open rheumatology, Sep 15, 2021

ObjectiveThe objective of this study was to investigate whether poor hip range of motion (ROM) an... more ObjectiveThe objective of this study was to investigate whether poor hip range of motion (ROM) and strength predict 12‐month physical function decline among older adults with chronic low back pain (LBP) and whether hip osteoarthritis modifies those relationships.MethodsAt baseline, passive ROM and strength measurements were taken for hip flexion, extension, abduction, adduction, internal rotation, and external rotation; ultrasound images and self‐reported symptoms were used to evaluate hip osteoarthritis presence (eg, osteophytes and hip pain). At baseline and 12 months, performance‐based (repeated chair rise, self‐selected gait speed, 6‐minute walk test [6MWT]) and self‐reported (Quebec LBP Disability Questionnaire, Late‐Life Function & Disability Instrument [LLFDI] basic and advanced lower extremity scales) physical function outcomes were assessed. Regression models were constructed for each outcome predicted by baseline hip ROM and strength measures, with adjustment for potential covariates. To avoid collinearity, hip ROM and strength measures with the strongest unadjusted correlations were included in final models. The hip osteoarthritis presence by hip ROM/strength interaction was also explored.ResultsHip abduction strength predicted repeated chair rise (β = −0.297, P < 0.001), gait speed (β = 0.160, P = 0.003), 6MWT (β = 0.159, P ≤ 0.001), Quebec LBP Disability Questionnaire (β = −0.152, P = 0.003), and LLFDI basic lower extremity scale (β = 0.171, P = 0.005) outcomes. Regarding hip ROM, extension predicted repeated chair rise (β = −0.110, P = 0.043) and LLFDI advanced lower extremity scale (β = 0.090, P = 0.007) outcomes, external rotation predicted gait speed (β = 0.122, P = 0.004) outcomes, and abduction predicted LLFDI basic lower extremity scale (β = 0.114, P = 0.026) outcomes. The hip osteoarthritis interaction was not significant for any model.ConclusionReduced hip strength and ROM predict physical function decline; hip osteoarthritis presence may not modify these relationships.

American Journal of Physical Medicine & Rehabilitation, Apr 4, 2019

Objective:For individuals with lower-limb loss (LLL), functional mobility (i.e. K-level) classifi... more Objective:For individuals with lower-limb loss (LLL), functional mobility (i.e. K-level) classification can be subjective. Performance-based outcome measures (OM) improve the objectivity of K-level assignment; therefore, this study aimed to determine differences in functional strength- and dynamic balance-based OM performance between K3- and K4-classified adults with LLL.Design:Prosthetists used subjective information and prosthetic componentry to determine K-levels prior to OM testing for adults with a unilateral transtibial (n=50) or transfemoral amputation (n=17). OM [i.e., 5-Times Sit-to-Stand Test (5xSTS), Figure-of-8 Walk Test (F8WT), 360° Turn Test (360TT), and modified Four-Square Step Test (mFSST)] were administered by a blinded examiner. Univariate analyses of variance (ANOVAs) were used to evaluate between-subgroup differences.Results:K4-classified participants with a unilateral transfemoral amputation performed better on all outcome measures when compared with K3-classified peers, whereas K4-classified individuals with a transtibial amputation performed better on the modified Four-Square Step Test compared with K3-classified peers (P < 0.050).Conclusion:K4-classified individuals demonstrated greater lower-extremity functional strength and better dynamic balance compared to K3-classified peers. To assist with K-level classification, clinicians should consider selecting OM that objectively differentiate between K-levels (i.e., mFSST for those with a unilateral transtibial or transfemoral amputation; 5xSTS, F8WT, and 360TT for those with a transfemoral amputation).

Archives of Physical Medicine and Rehabilitation, 2017

Objective-The purpose of this study was to determine if multifidi size and/or intramuscular fat w... more Objective-The purpose of this study was to determine if multifidi size and/or intramuscular fat were associated with self-reported and performance-based physical function in older adults with and without chronic LBP. Design-Case-control study Setting-Individuals participated in a standardized evaluation in a clinical laboratory and underwent magnetic resonance imaging (MRI) of the lumbar spine at a nearby facility. Patient Sample-A volunteer sample of 106 community-dwelling older adults, aged 60-85 years, with (n=57) and without (n=49) chronic LBP were included in this secondary data analysis. Intervention-Average right-left, L5 multifidi relative, i.e. total, cross-sectional area (rCSA); muscle-fat infiltration index (MFI), i.e. a measure of intramuscular fat; and relative muscle crosssectional area (rmCSA), i.e. total CSA minus intramuscular fat CSA, were determined from MRIs. Linear regression modeling was performed with physical function measures as the dependent variables. Age, sex, and body mass index were entered as covariates. The main effects of L5 multifidi MFI and rmCSA, as well as their interaction with group assignment, were compared as independent variables.

Journal of Geriatric Physical Therapy, Sep 16, 2022

The Journal of frailty & aging, 2015

The purpose of this secondary analysis was to explore the differences in proportions of frailty c... more The purpose of this secondary analysis was to explore the differences in proportions of frailty criteria, pre-frailty, and frailty in older adults with and without chronic low back pain (CLBP). Among individuals with CLBP, we also explored whether the proportions of these outcomes differed based on pain intensity status. Using measures to determine weakness, slowness, and exhaustion, we determined that older adults with CLBP had higher proportions of frailty criteria and were more likely to be classified as pre-frail. Older adults with high intensity CLBP had greater proportions of weakness and pre-frailty compared to those with low intensity CLBP. These preliminary findings suggest older adults with CLBP may be at a higher risk for frailty than those without pain; pain intensity may be an important factor in assessing risk of frailty in this population.

Journal of Geriatric Physical Therapy, 2015

Background and Purpose-Ultrasound imaging (USI) has been shown to be a reliable measure for direc... more Background and Purpose-Ultrasound imaging (USI) has been shown to be a reliable measure for direct assessment of the lumbar multifidi among younger adults. However, given ageand chronic low back pain (CLBP)-related spinal changes, similar studies are needed prior to clinical use of USI among older adults with CLBP. The goals of this study were to evaluate intraand inter-examiner reliability for USI assessment of multifidi thickness at rest and during a contraction and to determine standard error of measurement values (SEMs) and minimal detectable change values (MDCs) among older adults with CLBP. Methods-Thirty-one adults, aged 60 to 85 years, with CLBP were recruited. Two examiners performed USI assessments of multifidus thickness at rest and during a contralateral lower extremity lift. Intraclass correlation coefficients (ICCs) were used to estimate inter-and intraexaminer reliability. SEMs and MDCs were calculated. Results-All USI measurement techniques demonstrated excellent within-day, inter-examiner procedural reliability (ICCs: 0.82-0.85) and good-to-excellent between-days, inter-examiner procedural reliability (ICCs: 0.72-0.79). SEMs ranged from 0.36-0.46 centimeters (cm); MDCs ranged from 1.01-1.26 cm. Regardless of the measurement technique, examiner 1, the more experienced examiner, demonstrated lower SEMs and MDCs than examiner 2. Discussion-Lower ICCs, greater SEMs, and greater MDCs for USI multifidus thickness assessment in older adults with CLBP when compared to previously published, procedural reliability results for younger adults with and without low back pain, may indicate that imaging is

Osteoarthritis and Cartilage, Apr 1, 2016

Physiotherapy Theory and Practice, Apr 4, 2018

Among older adults, low back pain (LBP) is common, costly, and disabling. Trunk muscle training (... more Among older adults, low back pain (LBP) is common, costly, and disabling. Trunk muscle training (TMT) and neuromuscular electrical stimulation (NMES) have both been found to be effective in reducing LBP, but studies among older adults have been limited. An 83 year-old female with left-sided chronic LBP participated in a randomized controlled trial consisting of supervised TMT and NMES to the paraspinal muscles two times per week for twelve weeks. She also participated in a home exercise program. At the end of the intervention, she reported reduced LBP and LBP-related disability per the modified Oswestry Disability Index (i.e. 60% at baseline to 40% at 12-weeks). Her Short Physical Performance Battery summary score improved from 4/12 at baseline to 10/12 at 12-weeks, while her Timed Up and Go test improved from 17.21 to 15.20 seconds and her Repetitive Trunk Rotation test from 2.72 to 1.93 seconds/right-left rotation. This case demonstrates a positive short-term treatment response to TMT supplemented with NMES of the paraspinal muscles in an older adult with chronic LBP. A packaged intervention of TMT plus NMES may be a means of addressing not only LBP, but also impaired physical function and resultant disability.

Osteoarthritis and Cartilage, Apr 1, 2016

Gait & Posture, Jun 1, 2017

Previous studies in older adults have identified that chronic low back pain (CLBP) is associated ... more Previous studies in older adults have identified that chronic low back pain (CLBP) is associated with slower gait speed. Given that slower gait speed is a predictor of greater morbidity and mortality among older adults, it is important to understand the underlying spatiotemporal characteristics of gait among older adults with CLBP. The purposes of this study were to determine (1) if there are differences in spatiotemporal parameters of gait between older adults with and without CLBP during self-selected and fast walking and (2) whether any of these gait characteristics are correlated with performance of a challenging walking task, e.g. stair negotiation. Spatiotemporal characteristics of gait were evaluated using a computerized walkway in 54 community-dwelling older adults with CLBP and 54 age-and sex-matched healthy controls. Older adults with CLBP walked slower than their pain-free peers during self-selected and fast walking. After controlling for body mass index and gait speed, step width was significantly greater in the CLBP group during the fast walking condition. Within the CLBP group, step width and double limb support time are significantly correlated with stair ascent/descent times. From a clinical perspective, these gait characteristics, which may be indicative of balance performance, may need to be addressed to improve overall gait speed, as well as stair-climbing performance. Future longitudinal studies confirming our findings are needed, as well as investigations focused on developing interventions to improve gait speed and decrease subsequent risk of mobility decline.

Journal of Orthopaedic & Sports Physical Therapy, Jun 1, 2014

Study Design-Intraand inter-examiner, within-and between-days, reliability study Objectives-To co... more Study Design-Intraand inter-examiner, within-and between-days, reliability study Objectives-To compare the intra and inter-examiner procedural reliability of ultrasound imaging (USI) thickness measurements of the lumbar multifidus muscle at rest and during a contralateral lower limb lift (CLL) between older (60-85 years) and younger (18-40 years) adults. Background-Among younger adults, USI has been shown to be reliable and valid for assessing multifidi thickness. Older adults present with age-related changes that may impact assessment. To our knowledge, no USI studies have focused on establishing reliability for multifidi thickness assessments in older adults. Methods-Two examiners performed assessments of lumbar multifidi thickness at rest and during a CLL in 30 older and 31 younger adults. Intraclass correlation coefficients (ICCs) with 95% confidence intervals (CI), standard error of measurement (SEMs), and 95% minimal detectable change (MDCs) for resting, CLL, and percent thickness change were calculated. Results-Within-day, inter-examiner procedural reliability for multifidus thickness measurements were similar amongst younger (ICCs=.90-.92) and older adults (ICCs=.86-.90) as was, between-days intra-examiner and inter-examiner reliability (younger ICCs=.84-.94; older ICCs=.86-.93). Throughout, estimates of percent thickness change were inconsistent (ICCs=.31-. 86) and SEMs and MDCs were larger for older adults. Conclusions-USI reliability for measurements of multifidi thickness at rest and during a CLL amongst older adults is consistent with previously published findings for younger adults. Among older adults, it may be preferable to have a single examiner conduct USI assessments.

Archives of Physical Medicine and Rehabilitation, Mar 1, 2022

Objective:To investigate if clinically observable aberrant lumbopelvic movements are associated w... more Objective:To investigate if clinically observable aberrant lumbopelvic movements are associated with physical function at 12-month follow-up in older adults with chronic low back pain (CLBP), both directly and indirectly through baseline physical function.Design:Secondary analysis of a yearlong prospective cohort study.Setting:Clinical Research Laboratory.Participants:Community-dwelling older adults with CLBP.Interventions:Not applicable.Main Outcome Measures:Data from 239 participants were analyzed. Participants were screened at baseline for aberrant lumbopelvic movements during active trunk flexion; total observable aberrant movements were recorded and summed (range 0–4). Latent constructs of physical function were developed from an array of perception-based and performance-based outcome measures at baseline and 12-months, respectively. Structural Equation Modeling was used to assess the direct effect of baseline aberrant movement score on the latent construct of 12-month physical function, and its indirect effect through baseline physical function.Results:Aberrant movements were present in the majority of participants (64.9%) and had a significant negative total effect on 12-month physical function (γ= −0.278, p<.001). Aberrant movement score’s direct effect and indirect effect, through baseline functioning, were significantly negatively associated with physical function at 12-months, after adjusting for covariates (γ=−0.068, p=.038; γ= −0.210, p<.001, respectively).Conclusion:Aberrant lumbopelvic movements are associated with decreased physical function at 12-month follow-up in older adults with CLBP, independent of baseline physical function and covariates. Future studies should evaluate if screening for aberrant movements may inform prognostic and interventional efforts in this patient population.

Archives of Physical Medicine and Rehabilitation, Nov 1, 2018

Objectives-To investigate the impact that the presence of chronic low back pain with radiculopath... more Objectives-To investigate the impact that the presence of chronic low back pain with radiculopathy (CLBPR) may have on 1) energy efficiency and 2) energy capacity among community-dwelling older adults. Design-Matched case-control study. Setting-Clinical research laboratory. Participants-38 community-dwelling older adults (60-85 years) with (n=19) and without (n=19) CLBPR were included in this analysis. Participants were matched between-groups on age (± 5 years), sex, and diabetic status. Interventions-Not applicable. Main Outcome Measures-Energy cost of walking at self-selected speed (i.e. energy efficiency) and Peak Walking VO2 (i.e. energy capacity). Results-Older adults with CLBPR had a higher energy cost of walking at self-selected speed (p=.009) and lower Peak Walking VO2 (p=.050), compared to those without pain. Conclusions-Older adults with CLBPR may benefit from specific rehabilitative interventions that target these potentially modifiable energetic outcomes, thereby reducing the risk of mobility

Scandinavian Journal of Pain, Feb 1, 2022

Objectives: This study's primary purpose was to determine if the extent of bodily pain, as evalua... more Objectives: This study's primary purpose was to determine if the extent of bodily pain, as evaluated with pain body diagrams, is associated with prosthetic-related activity restrictions, adjustment, and satisfaction among adults with a major unilateral lower-limb amputation. A secondary objective was to evaluate between-days, testretest reliability for pain body diagrams among adults with lower-limb amputation. Methods: Adults with a lower-limb amputation that occurred ≥1 year prior participated in an online, crosssectional research study. Outcome measures included pain body diagrams and the Trinity Amputation and Prosthesis Experience Scales-Revised, which evaluates post-amputation activity restrictions, psychosocial adjustment, and prosthesis satisfaction. Linear regression modeling was used to evaluate associations between the number of painful body regions and prosthetic outcomes, after considering covariates (alpha ≤ 0.010). A subset of participants recompleted pain body diagrams to evaluate between-days, test-retest reliability. Results: Data from 74 participants (n = 32 female; n = 42 transtibial-level; n = 27 traumatic etiology) were available. Beyond covariates (i.e., age, sex, amputation level), the total number of painful body regions was significantly associated with all Trinity Amputation and Prosthesis Experience Scales-Revised subscales (p < 0.001-0.006), with the exception of Social Adjustment (p = 0.764). The total number of painful body regions explained 14.5, 11.8, 11.6, and 7.4% of the variance in Functional Satisfaction with the Prosthesis, Adjustment to Limitation, General Adjustment, and Activity Restriction, respectively. In a subset (n = 54), test-retest reliability for total number of painful body regions per body diagrams was good [intraclass correlation coefficient (ICC) 3,1 = 0.84]. Conclusions: A greater number of painful body regions is associated with greater activity restriction, worse adjustment, and lower prosthesis satisfaction, supporting the need to enhance post-amputation pain management and both amputated-and secondary-site pain prevention. Ethical committee number: IRB #1611862.

Pain Medicine, Jun 26, 2016

Objective. To explore potential differences in lumbar mobility between older adults with and with... more Objective. To explore potential differences in lumbar mobility between older adults with and without chronic low back pain, and to determine if lumbar mobility contributes to physical performance in both groups. We hypothesized that older adults with pain would have greater lumbar mobility impairments than pain-free peers, and that lumbar mobility would be associated with performance in both groups, with stronger relationships among those with pain. Design. Matched case-control. Setting. Research laboratory. Patients. Community-dwelling older adults, aged 60-85 years, with (N 5 54) and without (N 5 54) chronic low back pain. Methods. Inclinometer-measured maximal angles of lumbar flexion, extension, and average sidebending, as well as time to complete performance measures, Repeated Chair Rise and Timed-Up-and-Go, were measured in both groups. Analysis of variance was used to explore the difference in lumbar mobility between groups. Adjusted linear regression was used to assess the independent relationship between lumbar mobility and physical function in both groups. Results. Those with pain had smaller angles of flexion (P 5 0.029) and extension (P 5 0.013). In the pain group, flexion explained 19% (P 5 0.001) and 8.9% (P 5 0.006) of the variance for time to complete the Repeated Chair Rise and Timed Up-and-Go tests, respectively. In the pain-free group, extension explained 12.7% (P 5 0.007) and 10.3% (P 5 0.008) of the variance for time to complete Repeated Chair Rise and Timed Up-and-Go tests, respectively. Conclusion. Older adults with chronic low back pain have more lumbar mobility impairments. Lumbar mobility may be a contributing factor to decreased performance in older adults. Flexion may be most important to performance in those with pain, while extension may be vital in those without pain.

Scandinavian Journal of Pain, 2022

Objectives This study’s primary purpose was to determine if the extent of bodily pain, as evaluat... more Objectives This study’s primary purpose was to determine if the extent of bodily pain, as evaluated with pain body diagrams, is associated with prosthetic-related activity restrictions, adjustment, and satisfaction among adults with a major unilateral lower-limb amputation. A secondary objective was to evaluate between-days, test-retest reliability for pain body diagrams among adults with lower-limb amputation. Methods Adults with a lower-limb amputation that occurred ≥1 year prior participated in an online, cross-sectional research study. Outcome measures included pain body diagrams and the Trinity Amputation and Prosthesis Experience Scales-Revised, which evaluates post-amputation activity restrictions, psychosocial adjustment, and prosthesis satisfaction. Linear regression modeling was used to evaluate associations between the number of painful body regions and prosthetic outcomes, after considering covariates (alpha ≤ 0.010). A subset of participants recompleted pain body diagra...

Archives of Physical Medicine and Rehabilitation, 2021

OBJECTIVE To investigate if clinically observable aberrant lumbopelvic movements are associated w... more OBJECTIVE To investigate if clinically observable aberrant lumbopelvic movements are associated with physical function at 12-month follow-up in older adults with chronic low back pain (CLBP), both directly and indirectly through baseline physical function. DESIGN Secondary analysis of a yearlong prospective cohort study. SETTING Clinical Research Laboratory. PARTICIPANTS Community-dwelling older adults with CLBP. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Data from 239 participants were analyzed. Participants were screened at baseline for aberrant lumbopelvic movements during active trunk flexion; total observable aberrant movements were recorded and summed (range 0-4). Latent constructs of physical function were developed from an array of perception-based and performance-based outcome measures at baseline and 12-months, respectively. Structural Equation Modeling was used to assess the direct effect of baseline aberrant movement score on the latent construct of 12-month physical function, and its indirect effect through baseline physical function. RESULTS Aberrant movements were present in the majority of participants (64.9%) and had a significant negative total effect on 12-month physical function (γ= -0.278, p<.001). Aberrant movement score's direct effect and indirect effect, through baseline functioning, were significantly negatively associated with physical function at 12-months, after adjusting for covariates (γ=-0.068, p=.038; γ= -0.210, p<.001, respectively). CONCLUSION Aberrant lumbopelvic movements are associated with decreased physical function at 12-month follow-up in older adults with CLBP, independent of baseline physical function and covariates. Future studies should evaluate if screening for aberrant movements may inform prognostic and interventional efforts in this patient population.