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Volume 28, Issue 4, Pages 228-237 (May 2005)


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Chronic Disease Self-Management Program for Low Back Pain in the Elderly

Mitchell Haas, DCaCorresponding Author Informationemail address, Elyse Groupp, PhDb, John Muench, MD, MPHc, Dale Kraemer, PhDd, Ken Brummel-Smith, MDe, Rajiv Sharma, PhDf, Bonnie Gangerg, Michael Attwoodh, Alisa Fairweather, MPHi

Received 7 July 2004; received in revised form 20 August 2004

Abstract 

Objective

To evaluate the effectiveness of Stanford's Chronic Disease Self-Management Program (CDSMP) for chronic low back pain (LBP) in older Americans.

Design

Randomized controlled trial.

Setting

Community-based program offered at 12 locations.

Subjects

Community-dwelling seniors (n = 109) aged 60 and older with chronic LBP of mechanical origin.

Methods

Patients were randomly allocated to the CDSMP or to a 6-month, wait-list control group. The program included one 2.5-hour session per week for 6 weeks. Outcomes evaluated at 6 months included 100-point modified Von Korff pain and disability scales; days with pain and disability; SF-36 general health, energy-fatigue, and emotional well-being scales; 2 scales from the Arthritis Self-Efficacy Scale, self-care attitudes/behaviors, and health services utilization.

Results

For pain at 6 months, the primary outcome, the adjusted mean difference between the program and control, was −1.0 (P = .835). There was a sizable advantage for the program in disability averaged over the course of the entire 6-month study (−9.2, P = .027), but not at the 6-month follow-up (−5.8, P = .278). There was an interaction between intervention and baseline disability days favoring the program for higher baseline values (P = .007). The CDSMP affected emotional well-being (7.6, P = .037) and energy-fatigue (5.1, P = .274). There were no differences for self-efficacy, pain days, and general health.

Conclusion

There was no advantage for the CDSMP over a wait-list control for improving pain, general health, self-efficacy, and self-care attitudes in older Americans with chronic LBP. A benefit was suggested for emotional well-being, fatigue, functional disability, and days with disability.

a Professor and Dean of Research, Center for Outcomes Studies, Western States Chiropractic College, Portland, Ore

b Formerly Research Associate, Center for Outcomes Studies, Western States Chiropractic College, Portland, Ore

c Assistant Professor, Department of Family Medicine, Oregon Health and Science University, Portland, Ore

d Associate Professor, College of Pharmacy, Oregon Health and Science University, Portland, Ore

e Professor and Chair, Department of Geriatrics, Florida State University, Tallahassee, Fla

f Assistant Professor, Department of Economics, Portland State University, Portland, Ore

g Research Coordinator and Project Manager, Center for Outcomes Studies, Western States Chiropractic College, Portland, Ore

h IT Director, National College of Naturopathic Medicine (formerly from the Center for Outcomes Studies, Western States Chiropractic College), Portland, Ore

i Director of Academic Program Development, Western States Chiropractic College, Portland, Ore

Corresponding Author InformationSubmit requests for reprints to: Mitchell Haas, DC, Western States Chiropractic College, 2900 NE 132nd Avenue, Portland, OR 97230

 Sources of support: Funding was provided through a grant from the Health Resources and Services Administration, US Department of Health and Human Services (R18 HP10012).

PII: S0161-4754(05)00087-4

doi:10.1016/j.jmpt.2005.03.010


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