Five-Year Trajectories of Disability in Older Adults Seeking Care for Back Pain in the Netherlands: BACE-Dutch Cohort.

BACKGROUND: Investigating trajectories in older people with back pain (BP) is informative for estimating prognosis and initiating personalized treatment. We aimed to identify 5-year trajectories of BP-related disability in older adults, and baseline factors associated with trajectory membership. METHODS: We used data from the BACE-Dutch cohort, which included older adults (≥ 55 years) seeking primary care for BP. Disability was measured with the Roland Morris Disability Questionnaire (RMDQ) at baseline, 6 weeks, 3, 6, 9 months and annually to 5 years. Latent class growth analysis (LCGA) identified trajectories; multinomial regression examined baseline predictors. RESULTS: We included 669 participants. A four-class LCGA model provided the best fit and identified four trajectories: "Recovery trajectory" (38.5%; mean baseline RMDQ = 5.4; improved), "Incomplete recovery trajectory" (28.1%; mean baseline RMDQ = 9.6; improved), "Persistent moderate disability" (22.3%; mean baseline RMDQ = 13.3; stable), and "Persistent high disability" (11.1%; mean baseline RMDQ = 17.7; stable). Most disability improvement occurred within the first 6 months, and 66.6% of participants followed improved trajectories. Older age, higher BMI, higher pain intensity, presence of depressive symptoms, less optimistic back pain beliefs, BP history, and radiating leg pain were associated with membership to worse trajectories. CONCLUSIONS: We identified four distinct 5-year trajectories of disability in older people with BP. Most patients followed a trajectory with very low disability, while the smallest group followed a high disability trajectory. Baseline age, BMI, pain intensity, BP history, radiating leg pain, depression, and negative expectations were associated with trajectory membership. SIGNIFICANCE STATEMENT: In Dutch primary care, older adults with back pain show four distinct disability trajectories. Baseline characteristics associated with subgroup membership help identify patients at risk of poorer outcomes, providing input for risk stratification and a personalized care approach.