Chronic Disease Self-Management Program for Low Back Pain in the Elderly
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.
aProfessor and Dean of Research, Center for Outcomes Studies, Western States Chiropractic College, Portland, Ore
bFormerly Research Associate, Center for Outcomes Studies, Western States Chiropractic College, Portland, Ore
cAssistant Professor, Department of Family Medicine, Oregon Health and Science University, Portland, Ore
dAssociate Professor, College of Pharmacy, Oregon Health and Science University, Portland, Ore
eProfessor and Chair, Department of Geriatrics, Florida State University, Tallahassee, Fla
fAssistant Professor, Department of Economics, Portland State University, Portland, Ore
gResearch Coordinator and Project Manager, Center for Outcomes Studies, Western States Chiropractic College, Portland, Ore
hIT Director, National College of Naturopathic Medicine (formerly from the Center for Outcomes Studies, Western States Chiropractic College), Portland, Ore
iDirector of Academic Program Development, Western States Chiropractic College, Portland, Ore
Submit 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).
ABSTRACT