Factors Associated with the Persistence and Disability of Nonspecific Low Back Pain in Older Adults: Longitudinal Data from the BACE-Brazil Cohort

Factors Associated with the Persistence and Disability of Nonspecific Low Back Pain in Older Adults: Longitudinal Data from the BACE-Brazil Cohort | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Factors Associated with the Persistence and Disability of Nonspecific Low Back Pain in Older Adults: Longitudinal Data from the BACE-Brazil Cohort ELEN MATA, ANGELICA TIBURCIO, LARISSA CORREA, SILVIA SILVA, AMANDA LEOPOLDINO, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6960323/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: Nonspecific low back pain (LBP) is common among older adults and often leads to functional disability and persistent symptoms. Objective: To investigate factors associated with pain persistence and disability 12 months after an acute episode of LBP in Brazilian older adults. Materials and Methods: This prospective cohort study used data from the international Back Complaints in the Elders consortium (BACE-Brazil). The outcomes assessed were the persistence of LBP and disability after 12 months, as well as the associated clinical, sociodemographic, and functional factors. Results: A total of 602 participants (mean age, 67.6 ±7 years) were followed at baseline, and 448 were reassessed after 12 months. Overall, 56% of the participants reported persistent pain, and 40% disability. The factors associated with the persistence of LBP after 12 months included physical inactivity (0.83 [95% CI, 0.64–0.97]), negative beliefs (0.97 [95% CI, 0.96–0.98]), moderate pain (5.64 [95% CI, 4.07–7.81]), severe pain (5.60 [95% CI, 4.05–7.76]), moderate numbness (1.25 [95% CI, 1.09–1.43]), and severe numbness (1.18 [95% CI, 1.03–1.35]). Disability after 12 months was associated with comorbidities (1.20 [95% CI, 1.01–1.42]), negative beliefs (0.98 [95% CI, 0.97–0.99]), daily pain (1.23 [95% CI, 1.07–1.42]), constant pain (1.20 [95% CI, 1.06–1.36]), moderate weakness (1.21 [95% CI, 1.08–1.35]), and recurrent falls (1.23 [95% CI, 1.09–1.39]). Conclusion: The persistence of LBP and disability after 12 months revealed multifactorial factors associated with these outcomes, emphasizing the importance of multidimensional and individualized care strategies. Low back pain Aged Activities of Daily Living Chronic Pain Disability Evaluation Figures Figure 1 Introduction Population aging is a global, progressive, and heterogeneous phenomenon. Sociocultural and economic inequities differently affect the perception of pain intensity and disability in older adults with low back pain (LBP) [ 1 , 2 ]. According to the 2022 Census, 15.1% of the Brazilian population is aged 60 years or older, reflecting a shift in the age structure and an increase in chronic conditions associated with aging [ 3 ]. LBP is the leading cause of years lived with disability worldwide, affecting more than 619 million people in 2020 [ 4 ]. In older adults, LBP is associated with an increased risk of falls and functional decline [ 5 ]. Recent reviews indicate that the prevalence of LBP is between 21% and 75% in individuals aged 60 years or older [ 6 ]. Nonspecific LBP is multifactorial, lacking a clearly defined cause, making its diagnosis and management more complex when the evaluated population consists of older adults. Moreover, studies have identified multiple trajectories of pain intensity and disability in older adults [ 7 ]. Longitudinal studies conducted with representative samples of older adults with nonspecific LBP in developing countries are still scarce. A 2022 meta-analysis, conducted with more than 31,000 older adults, identified several risk factors for LBP, including female sex, obesity, depression, negative health perceptions, comorbidities, degenerative changes in the spine, and previous falls. On the other hand, physical activity and social participation were identified as protective factors. Importantly, no articles from developing countries were included in this review, and no Brazilian studies were mentioned. There is limited evidence and few quality prospective studies on factors associated with LBP due to the aging population [ 2 ]. This study also did not characterize the factors associated with pain persistence. The International Association for the Study of Pain (IASP) defines pain as an unpleasant sensory and emotional experience associated with or resembling that associated with actual or potential tissue injury [ 8 ]. Thus, pain is different from nociception, and reports of pain in older adults should be considered. From this perspective, pain reports in older adults are more complex, as they may be confused with cognitive, affective, sensory, and communicative alterations, among others [ 9 ]. On the other hand, a systematic review with meta-analysis revealed that the aging process involves modifications in the physiological mechanisms of pain, from the perception and transduction of pain stimuli to a diminished inhibitory pain response [ 10 ]. Aging directly affects pain perception, modulation, and response. Changes in the peripheral nervous system (reduction in myelinated fibers and nerve conduction) and the central nervous system (neuronal loss and lower neurotransmitter availability) impair inhibitory modulation. Chronic pain persistence in older adults is associated with sleep disturbances, mood changes, functional impairment, and social isolation [ 11 ]. Acute pain serves a protective function, whereas chronic pain involves changes in neural modulation, resulting in structural and functional changes in the brain, such as reduced cortical thickness and gray matter. It is now considered an independent clinical condition, not just a symptom. Repeated nociceptive stimuli can provoke maladaptive neuroplasticity and central sensitization, which are associated with markers of brain aging [ 12 ]. In addition, the process of inflammaging, a chronic inflammatory process resulting from immunosenescence with an increase in inflammatory cytokines, contributes to muscle catabolism and sarcopenia, sensitizes nociceptors, and causes LBP to differ from that in young adults [ 13 ]. Nonspecific low back pain is the most common pain, representing up to 84% of all cases and 23% of chronic cases [ 14 ]. It is characterized by pain, stiffness, or tension between the last ribs and the gluteal region, with or without radiation to the lower limbs [ 15 ]. It is classified as acute ( 12 weeks) and is specific and nonspecific [ 4 ]. Disability caused by LBP is frequent. It is estimated that 26% of older adults have limitations in basic activities of daily living and 45% in instrumental activities, with LBP being a significant factor [ 16 ]. The Roland‒Morris Disability Questionnaire (RMDQ) used in this study is internationally recognized and validated and assesses the disability of participants in performing daily and social functional activities [ 17 ]. Despite the high prevalence and impact of chronic LBP in older adults, this population remains underrepresented in clinical trials and longitudinal studies [ 18 ]. The aim of this study was to investigate the factors associated with the persistence of LBP and disability after an acute pain episode in elderly Brazilian individuals 12 months after the event. Methods Study Design Observational study of a prospective cohort from the international Back Complaints in the Elders consortium. The international protocol was previously published by Scheele et al. [ 19 ]. The project was approved by the Research Ethics Committee of UFMG (approval no. ETIC0100.0.0.203.000–11). The study was conducted between 2011 and 2012. The research followed the guidelines of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). Participants Participants aged 55 years and older with a new episode of nonspecific LBP (duration < 6 weeks) without seeking medical care in the last six months were included. Participants with significant cognitive impairment, as stratified by education level via the Mini Mental State Examination (MMSE) [ 20 ], specific LBP, or neoplasms were excluded. Participants were recruited from public and private services in the metropolitan region of Belo Horizonte, interviewed in person and followed up by telephone. Sample size On the basis of estimates of chronic low back pain incidence and disability, a minimum sample size of 600 participants was defined, ensuring 80% statistical power and a 5% significance level to detect 12% differences between groups. A total of 602 elderly participants were included at baseline, with 446 reassessed after 12 months. Dependent variables: Pain persistence and disability after 12 months. Independent variables: Age, sex, education, marital status, treatment, comorbidities, smoking status, and use of pain medications. Used Instruments Pain was assessed using the Numeric Pain Scale (0–10), which has been validated in the Brazilian context. CCI: ≥ 0.95 [ 21 ]. Pain intensity was categorized as 0 (no pain), 1–3 (mild), 4–6 (moderate), or 7–10 (severe). Functional disability was measured via the Roland‒Morris Disability Questionnaire (RMDQ), which has 24 items and scores ranging from 0 to 24. CCI: 0.95 [ 21 ]. Higher scores indicate greater levels of disability. Individuals with scores greater than 14 were considered disabled [ 22 ]. Physical activity was assessed via the Active Australia Questionnaire (AAQ), which categorizes participants as insufficiently active if they engage in less than 150 minutes of physical activity per week. The CCI was 0.84 [ 23 ]. Pain beliefs were assessed via the Brazilian version of the Back Beliefs Questionnaire (BBQ-Br), CCI: 0.84. The score obtained for each item is reversed; the higher the score is, the less the individual demonstrates fear and false hopes, with no defined cutoff point [ 24 ]. Fear of falling was measured via the Brazilian version of the Falls Efficacy Scale-International (FES-I Brazil), CCI: 0.84, with cutoffs > 23 for occasional falls and > 31 for recurrent falls [ 25 ]. Depressive symptoms were assessed via the CES-D scale. CCI: 0.83. The final score ranges from 0–60, with a cutoff score of > 11 [ 26 ]. Comorbidities were assessed via the Self-Administered Comorbidity Questionnaire (SCQ). CCI: 0.90. Multiple comorbidities were defined as > 2 comorbidities [ 27 ]. Additional information on the radiation of pain to the lower limbs, the frequency of pain, and the use of pharmacological and nonpharmacological treatments was collected. Pain persistence was defined as the presence of self-reported pain at the time of the assessment after 12 months. Data collection procedures The interviews were conducted by trained evaluators. The database was structured in Microsoft Excel®, with quality control and blind data entry. Calibration meetings were conducted bimonthly. Statistical analysis Descriptive analysis was performed for the participants profiles, and McNemar’s test was used for comparisons between baseline and follow-up. Poisson models with robust variance were used to estimate associations between exposures and outcomes in the baseline analysis. The significance level adopted was 5% (p ≤ 0.05; R statistical software version 4.3.1). Results The majority of the sample consisted of women (84.8%), with a median age of 67 years, who were married (44.2%), and who had completed elementary education (55.7%). A high frequency of pain medication use in the past 3 months was observed (74.0%), and few nonpharmacological treatments were used (3% physiotherapy, 1% psychotherapy). Other behaviors and conditions are presented in Table 1. Table 1. Sociodemographic and Health Characteristics of the Study Population at Baseline Variables n (%) Gender Female 511 (84.8) Male 91 (15.2) Age (in years) Mean (SD) 67.6 (7.0) Median (1st and 3rd quartiles) 67 (62 - 72) Minimum & Maximum 55 – 94 Marital Status Single 103 (17.1) Married 266 (44.2) Divorced 70 (11.6) Widowed 158 (26.2) Lives with partner 4 (0.6) Education No schooling 41 (6.8) Elementary school 335 (55.7) High school 133 (22.1) Higher education 92 (15.3) Pain Medication Yes No 446 (74.0) 156 (26.0) Physical Therapy Yes No 18 (3.0) 584 (97.0) Psychological Therapy Yes No 1 (0.02) 601 (99.8) Smoking No Yes Quit and stopped 406 (67.4) 36 (6.0) 160 (26.6) Physical Activity Less than 150 min per week More than 150 min per week 106 (17.6) 496 (82.4) Depression Up to 15 points (no depression risk) More than 16 points (increased risk) 190 (31.5) 412 (68.5) Multimorbidity (two or more diseases) No Yes 68 (11.3) 534 (88.7) Personal Beliefs Mean (SD) 23.7 (6.8) Median (1st and 3rd quartiles) 23 (19 - 29) Minimum & Maximum 0 – 45 Abbreviations: n = number; % = percentage; Kg = kilogram; m² = square meters; DP = standard deviation After 12 months, considering pain characteristics, a statistically significant reduction (p < 0.01) was found in the prevalence of moderate and severe pain, daily pain, and pain most of the time. There was a reduction in the incidence of occasional falls. Disability, the study's dependent variable, presented a prevalence of 40% after 12 months, and the prevalence of pain persistence was 56%. Disability was greater among participants who reported more than two comorbidities at baseline, negative beliefs, daily pain for a few minutes or most of the time, moderate lower limb weakness, and recurrent fall risk. The presence of disability at baseline was also associated with higher scores after 1 year, as shown in Table 2. Table 2. Associations Between Exposures at Baseline and Disability After 12 Months, Controlled for Disability at Baseline Variables Model 1 RP (CI 95%) Roland-Morris baseline 1.03 (1.02; 1.04) Gender Female 1.00 Male 0.98 (0.81; 1.18) Age (in years) 1.00 (0.99; 1.01) Education No schooling 1.00 Elementary school 1.00 (0.85; 1.18) High school 0.95 (0.79; 1.14) Higher education 1.00 (0.81; 1.25) Physical activity, >150 minutes (active) 0.91 (0.80; 1.02) Depression, yes 1.09 (0.96; 1.25) Multimorbidity, yes 1.20 (1.01; 1.42) Personal beliefs 0.98 (0.97; 0.99) Pain intensity None/Mild 1.00 Moderate 0.98 (0.86; 1.12) Severe 1.09 (0.96; 1.23) Pain frequency Once a week or less 1.00 Pain every day for some minutes 1.23 (1.07; 1.42) Pain every day or most of the time 1.20 (1.06; 1.36) Leg or foot weakness None/Mild 1.00 Moderate 1.21 (1.08; 1.35) Severe/Very Severe 1.05 (0.92; 1.20) Numbness in lower limbs None/Mild 1.00 Moderate 1.07 (0.96; 1.18) Severe/Very Severe 1.03 (0.90; 1.17) Occasional falls, > 24 1.10 (0.93; 1.30) Recurrent falls, > 32 1.23 (1.09; 1.39) The Poisson model with robust variance was performed via a cross-sectional approximation adjusted for all variables associated with baseline and disability at baseline. Abbreviations: PR = prevalence ratio, 95% CI = 95% confidence interval. Poisson models revealed factors associated with pain persistence after 12 months, considering baseline fixed variables, including negative beliefs and a lower prevalence among those considered active (Model 1). In Model 2, when baseline variables that changed during follow-up were considered, the highest prevalence of pain persistence was found among participants who reported high pain intensity and severe numbness in the lower limbs (Model 2). Finally, when the same variables were applied during follow-up, the prevalence of pain persistence was greater among those with moderate to severe pain intensity and moderate to severe numbness in the lower limbs 12 months after the first event, as demonstrated in Table 3 (Model 3). Table 3. Associations between baseline exposures and pain persistence after 12 months Variables Model 1 RP (CI 95%) Model 2 RP (CI 95%) Model 3* RP (CI 95%) Gender Female 1.00 Male 1.01 (0.77; 1.32) Age (in years) 0.99 (0.98; 1.01) Marital status Single 1.00 - - Married 0.87 (0.70; 1.10) Divorced 1.10 (0.81; 1.48) Widowed 0.94 (0.73; 1.20) Lives with partner 1.33 (0.79; 2.24) Education - - No schooling 1.00 Elementary school 1.06 (0.76; 1.48) High school 0.92 (0.63; 1.35) Higher education 1.00 (0.67; 1.49) Pain medication, yes 1.07 (0.88; 1.30) - - Physical therapy, yes 1.32 (0.95; 1.85) - - Smoking 0.91 (0.63; 1.31) - - No 1.00 Yes 0.87 (0.60;1.26) Quit smoking 0.98 (0.81;1.19) Physical activity, >150 minutes (active) 0.83 (0.64; 0.97) 0.86 (0.71; 1.04) - Depression, yes 1.17 (0.95; 1.45) - Multimorbidity, yes 1.10 (0.81; 1.48) - Personal beliefs 0.97 (0.96; 0.98) 0.98 (0.97;0.99) 0.99 (0.98, 1.00) Pain intensity None/Mild 1.00 1.00 Moderate 1.00 (0.79; 1.27) 5,64 (4.07; 7.81) Severe 128 (1.04; 1.57) 5,60 (4.05; 7.76) Pain frequency Once a week or less 1.00 - Pain every day for some minutes 1.24 (0.98;1.56) Pain every day or most of the time 1.21 (0.98;1.48) Leg or foot weakness None/Mild 1.00 Moderate 1.06 (0.88;1.29) Severe/Very Severe 1.04 (0.85;1.26) Numbness in lower limbs None/Mild 1.00 1.00 Moderate 1.14 (0.94; 1.39) 1.25 (1.09; 1.43) Severe/Very Severe 1.24 (1.02; 1.49) 1.18 (1.03; 1.35) Occasional falls, > 24 0.94 (0.73; 1.21) - Recurrent falls, > 32 1.17 (0.95; 1.45) - The Poisson model with robust variance was used. Model 1: Adjusted for variables measured only at baseline. Model 2: Adjusted for time-varying variables, considering only the baseline and variables associated with Model 1 Model 3: Adjusted for variables associated at baseline, considering their changes over time, retaining those that remained associated since baseline * PR values at follow-up Abbreviations: PR = prevalence ratio, CI95% = 95% confidence interval Discussion After 12 months of an episode of nonspecific acute LBP in Brazilian older adults, the prevalence of persistent low back pain was 56%, and the prevalence of functional disability was 40%. These findings align with previous studies indicating a tendency for pain persistence in aging populations, highlighting the relevance of low back pain as a public health issue, especially in developing countries [16]. The characteristics of nonspecific LBP after 12 months presented differently: there was a statistically significant reduction in the prevalence of moderate pain and pain most of the time (from 33.7% to 18.3%; from 42.9% to 22.4%, respectively). However, there was an increase in mild pain, sustained severe pain, and an increase in occasional pain after 12 months. The persistence of severe pain in a significant portion of participants, along with an increase in mild and occasional pain, suggests that the condition remains active. Moreover, the reduction in moderate pain may reflect spontaneous resolution effects, as well as behavioral and neural adaptation. This scenario reinforces the heterogeneous nature of nonspecific low back pain progression in older adults, emphasizing the importance of longitudinal and individualized follow-up. A greater intensity of pain at baseline was a strong predictor of its persistence after 12 months. A meta-analysis revealed that moderate or severe initial pain is associated with a greater risk of chronicity [28]. This result is concerning, as previous studies have reported central nervous system changes in older adults s with chronic and persistent LBP, indicating the need for immediate management of such pain [29]. Studies have suggested that pain persistence may accelerate brain aging beyond chronological age compared with older adults without such manifestations [30]. A study with data from 356,000 individuals in a population cohort with chronic LBP revealed that 4,959 participants developed dementia after 13 years of follow-up, with a hazard ratio (HR) of 1.08 (95% CI, 1.05–1.11). The more quickly LBP is addressed, the lower the risk of developing dementia [31]. The majority of the sample consisted of women with low education, high pain medication use (74%), and low adherence to nonpharmacological treatments. These data suggest a care model centered on medication use, despite the multidisciplinary approaches demonstrated in previous studies [32]. Older adults in low-income countries present greater LBP intensity and disability, influenced by social conditions and limited access to healthcare, as shown in this cohort that compared LBP progression data in older adults from Brazil and the Netherlands [1]. The relationship between persistent pain and falls also stands out, supporting findings from longitudinal studies that indicated a higher risk of domestic accidents among older adults with chronic pain [33]. On the other hand, pain persistence may increase the induction of inflammatory cytokines characteristic of inflammaging, causing muscle catabolism and consequent sarcopenia with functional loss. This cycle of persistent pain may trigger postural changes, instability, and falls [34]. The presence of moderate or severe numbness at baseline was also associated with pain persistence, possibly reflecting neuropathic symptoms or structural impairment [35]. Aging directly interferes with the mechanisms of pain perception, modulation, and response [36]. After 12 months, functional disability was associated with multiple comorbidities, depressive symptoms, frequent or daily pain, lower limb weakness, and a history of recurrent falls. These factors highlight the multifactorial nature of disability, which is influenced by clinical, emotional, and functional conditions [7]. In older adults with chronic pain, functionality is not always impaired. Many retain the capacity for daily activities by adjusting their movement patterns in response to pain and using adaptive strategies [37]. The presence of depressive symptoms was associated with disability at baseline but not after 12 months, suggesting that acute factors at the time of pain may more strongly influence the emotional state [28]. Physical inactivity, present in 17.6% of the sample, was associated with a higher prevalence of persistent pain and functional disability. This finding is consistent with evidence that physical activity is a protective factor against chronic pain in older adults, with a positive impact on functionality [38]. Exercise training in older adults significantly reduces the levels of inflammatory markers such as IL-6, TNF-α, and CRP, resulting in anti-inflammatory effects, especially in participants with chronic diseases [39]. Negative beliefs were also associated with persistent pain and functional disability. Previous evidence has shown that low scores on the Back Beliefs Questionnaire indicate a greater degree of fear and negative expectations about LBP, which may limit treatment adherence and hinder functional recovery [2]. The heterogeneity, individuality, and impact of senescence and senility on the progression of nonspecific LBP in older adults make studies on this topic more complex. However, with aging, studies that can contribute to clarifying the issues presented and enable better management of these symptoms for a population with low socioeconomic and cultural conditions are necessary [40]. Conclusion The prevalence of persistent low back pain and functional disability in older adults after 12 months of follow-up was high, and different factors associated with these dysfunctions were identified, many of which are modifiable. Prevention and management strategies based on multidimensional approaches in the care of nonspecific LBP in older adults may be more effective than medication alone. These findings offer relevant insights to guide clinical practices and public policies aimed at promoting functionality and healthy aging, especially in developing countries. Declarations Author Contribution E.C.M., L.R.C., and A.M.F.P.T. contributed to the study design, literature review, and initial drafting of the manuscript. S.L.A.S. conducted the statistical analysis. L.S.M.P., D.S., and A.A.O.L. critically reviewed and revised the manuscript for important intellectual content. All authors participated in data interpretation, contributed to the writing process, and reviewed and approved the final version of the manuscript. References Jesus-Moraleida FR, Ferreira PH, Ferreira ML, Silva JP, Maher CG, Enthoven WTM et al (2017) Back Complaints in the Elders in Brazil and the Netherlands: a cross-sectional comparison. 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Cad Saúde Públic;35(8):e00230818. 10.1590/0102-311X00230818 Wallwork SB, Braithwaite FA, O'Keeffe M, Travers MJ, Summers SJ, Lange B et al (2024) The clinical course of acute, subacute and persistent low back pain: a systematic review and meta-analysis. CMAJ 196(2):E29–E46. 10.1503/cmaj.230542 Zeng X, Sun Y, Zhiying Z, Hua L, Yuan (2025) Chronic pain-induced functional and structural alterations in the brain: A multi-modal meta-analysis. J Pain 28:104740. 10.1016/j.jpain.2024.104740 Wu SH, Lin CF, Lu IC, Yeh MS, Hsu CC, Yang YH (2023) Association between pain and cognitive and daily functional impairment in older institutional residents: a cross-sectional study. BMC Geriatr 23(1):756. 10.1186/s12877-023-04337-8 Tian J, Jones G, Lin X, Zhou Y, King A, Vickers J, Pan F (2023) Association between chronic pain and risk of incident dementia: findings from a prospective cohort. BMC Med 21(1):169. 10.1186/s12916-023-02875-x Turner BJ, Rodriguez N, Valerio MA, Liang Y, Winkler P, Jackson L (2017) Less Exercise and More Drugs: How a Low-Income Population Manages Chronic Pain. Arch Phys Med Rehabil 112111–2117. 10.1016/j.apmr.2017.02.016 Bell T, Pope C, Fazeli P, Crowe M, Ball K (2021) The Association of Persistent Low Back Pain With Older Adult Falls and Collisions: A Longitudinal Analysis. J Appl Gerontol 40(11):1455–1464. 10.1177/0733464820966517 Queiroz B, de Z NM, Pereira DS, Lopes RA, Leopoldino AAO, Thomasini RL et al (2020) Inflammatory mediators and the risk of falls among older women with acute low back pain: data from Back Complaints in the Elders (BACE)-Brazil. Eur Spine J 29(3):549–555. 10.1007/s00586-019-06168-x Nicol AL, Adams MCB, Gordon DB, Mirza S, Dickerson D, Mackey S et al (2020) AAAPT Diagnostic Criteria for Acute Low Back Pain with and Without Lower Extremity Pain. Pain Med 21(11):2661–2675. 10.1093/pm/pnaa239 Gibson SJ, Farrell M (2004) A review of age differences in the neurophysiology of nociception and the perceptual experience of pain. Clin J Pain 20(4):227–239. 10.1097/00002508-200407000-00004 Singh A, Akkala S, Nayak M, Kotlo A, Poondla N, Raza S et al (2024) Impact of Pain on Activities of Daily Living in Older Adults: A Cross-Sectional Analysis of Korean Longitudinal Study of Aging (KLoSA). Geriatr (Basel) 9(3):65. 10.3390/geriatrics9030065 Li Y, Yan L, Hou L, Zhang X, Zhao H, Yan C, Li X et al (2023) Exercise intervention for patients with chronic low back pain: a systematic review and network meta-analysis. Front Public 11:1155225. 10.3389/fpubh.2023.1155225 Khalafi M, Akbari A, Symonds ME, Pourvaghar MJ, Rosenkranz SK, Tabari E (2023) Influence of different modes of exercise training on inflammatory markers in older adults: a systematic review and meta-analysis. Ageing Res Rev 80:101742. 10.1016/j.arr.2023.101742 Wong AYL, Karppinen J, Samartzis D (2017) Low back pain in older adults: Risk factors, management options and future directions. Scoliosis Spinal Disord 12:14. 10.1186/s13013-017-0121-3 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6960323","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":475436019,"identity":"9d2bd189-3182-4c62-a010-1402d4f38061","order_by":0,"name":"ELEN MATA","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+0lEQVRIiWNgGAWjYDCCA0D8gIGBsQHMqwBiZuYGwloSIFqA+AxICyMpWhjbQEIEtPDdPvzwQULFHdn+aYefP/g5rzaavx2o5UfFNpxaJM+lGRsknHlmPON2mmFj77bjuTMOA23rOXMbpxaDMwxmEolthxMbbicYNvBuO5bbANTCzNiGTwv79x+J/w4nzr+d/rHx75xjufMJa+ExY0hsOJy44XaOYTNvQ03uBkJaJM/wFEskHDtsvPF2TuFsmWMHcjcCtRzE5xe+M+wbP3yoOSw773b6ho9vaupy550/fPDBjwrcWtDBYTB5gGj1QFBHiuJRMApGwSgYIQAANHhqKK8K+qcAAAAASUVORK5CYII=","orcid":"","institution":"Faculdade de Ciências Médicas de Minas Gerais","correspondingAuthor":true,"prefix":"","firstName":"ELEN","middleName":"","lastName":"MATA","suffix":""},{"id":475436020,"identity":"6814c32b-0482-422f-83e3-82b06f14859c","order_by":1,"name":"ANGELICA TIBURCIO","email":"","orcid":"","institution":"Faculdade de Ciências Médicas de Minas Gerais","correspondingAuthor":false,"prefix":"","firstName":"ANGELICA","middleName":"","lastName":"TIBURCIO","suffix":""},{"id":475436021,"identity":"3cd312d8-b4be-46fe-9a7c-19fcabe179cd","order_by":2,"name":"LARISSA CORREA","email":"","orcid":"","institution":"Universidade Federal de Minas Gerais","correspondingAuthor":false,"prefix":"","firstName":"LARISSA","middleName":"","lastName":"CORREA","suffix":""},{"id":475436022,"identity":"a85e3e00-ac1e-49f4-9e14-9e31ebf231a8","order_by":3,"name":"SILVIA SILVA","email":"","orcid":"","institution":"Universidade Federal de Juiz de Fora","correspondingAuthor":false,"prefix":"","firstName":"SILVIA","middleName":"","lastName":"SILVA","suffix":""},{"id":475436023,"identity":"2ae2ea1a-3e2c-41d5-a8dd-fc440874e907","order_by":4,"name":"AMANDA LEOPOLDINO","email":"","orcid":"","institution":"Faculdade de Ciências Médicas de Minas Gerais","correspondingAuthor":false,"prefix":"","firstName":"AMANDA","middleName":"","lastName":"LEOPOLDINO","suffix":""},{"id":475436024,"identity":"c24e38e8-bee5-436c-be6c-cbecca3dc60f","order_by":5,"name":"DANIEL STEFFENS","email":"","orcid":"","institution":"The University of Sydney","correspondingAuthor":false,"prefix":"","firstName":"DANIEL","middleName":"","lastName":"STEFFENS","suffix":""},{"id":475436025,"identity":"7a6e647b-63fa-46ba-be3d-787068196ca3","order_by":6,"name":"LEANI PEREIRA","email":"","orcid":"","institution":"Faculdade de Ciências Médicas de Minas Gerais","correspondingAuthor":false,"prefix":"","firstName":"LEANI","middleName":"","lastName":"PEREIRA","suffix":""}],"badges":[],"createdAt":"2025-06-24 00:53:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6960323/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6960323/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":85617711,"identity":"274815a3-c7ff-45f4-a424-3a0664a5f6d8","added_by":"auto","created_at":"2025-06-29 14:47:19","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":36221,"visible":true,"origin":"","legend":"\u003cp\u003eRecruitment flowchart\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6960323/v1/fdef72e18e08cf6f8e56e506.png"},{"id":93348209,"identity":"80987792-c242-4b09-9ad2-6aed54d9cf36","added_by":"auto","created_at":"2025-10-12 17:16:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1060036,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6960323/v1/f78ecaa6-1b66-413f-ad6c-a7c7de81478a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Factors Associated with the Persistence and Disability of Nonspecific Low Back Pain in Older Adults: Longitudinal Data from the BACE-Brazil Cohort","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePopulation aging is a global, progressive, and heterogeneous phenomenon. Sociocultural and economic inequities differently affect the perception of pain intensity and disability in older adults with low back pain (LBP) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. According to the 2022 Census, 15.1% of the Brazilian population is aged 60 years or older, reflecting a shift in the age structure and an increase in chronic conditions associated with aging [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLBP is the leading cause of years lived with disability worldwide, affecting more than 619\u0026nbsp;million people in 2020 [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In older adults, LBP is associated with an increased risk of falls and functional decline [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Recent reviews indicate that the prevalence of LBP is between 21% and 75% in individuals aged 60 years or older [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNonspecific LBP is multifactorial, lacking a clearly defined cause, making its diagnosis and management more complex when the evaluated population consists of older adults. Moreover, studies have identified multiple trajectories of pain intensity and disability in older adults [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLongitudinal studies conducted with representative samples of older adults with nonspecific LBP in developing countries are still scarce. A 2022 meta-analysis, conducted with more than 31,000 older adults, identified several risk factors for LBP, including female sex, obesity, depression, negative health perceptions, comorbidities, degenerative changes in the spine, and previous falls. On the other hand, physical activity and social participation were identified as protective factors. Importantly, no articles from developing countries were included in this review, and no Brazilian studies were mentioned. There is limited evidence and few quality prospective studies on factors associated with LBP due to the aging population [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. This study also did not characterize the factors associated with pain persistence.\u003c/p\u003e \u003cp\u003eThe International Association for the Study of Pain (IASP) defines pain as an unpleasant sensory and emotional experience associated with or resembling that associated with actual or potential tissue injury [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Thus, pain is different from nociception, and reports of pain in older adults should be considered. From this perspective, pain reports in older adults are more complex, as they may be confused with cognitive, affective, sensory, and communicative alterations, among others [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOn the other hand, a systematic review with meta-analysis revealed that the aging process involves modifications in the physiological mechanisms of pain, from the perception and transduction of pain stimuli to a diminished inhibitory pain response [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Aging directly affects pain perception, modulation, and response. Changes in the peripheral nervous system (reduction in myelinated fibers and nerve conduction) and the central nervous system (neuronal loss and lower neurotransmitter availability) impair inhibitory modulation. Chronic pain persistence in older adults is associated with sleep disturbances, mood changes, functional impairment, and social isolation [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAcute pain serves a protective function, whereas chronic pain involves changes in neural modulation, resulting in structural and functional changes in the brain, such as reduced cortical thickness and gray matter. It is now considered an independent clinical condition, not just a symptom. Repeated nociceptive stimuli can provoke maladaptive neuroplasticity and central sensitization, which are associated with markers of brain aging [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In addition, the process of inflammaging, a chronic inflammatory process resulting from immunosenescence with an increase in inflammatory cytokines, contributes to muscle catabolism and sarcopenia, sensitizes nociceptors, and causes LBP to differ from that in young adults [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNonspecific low back pain is the most common pain, representing up to 84% of all cases and 23% of chronic cases [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. It is characterized by pain, stiffness, or tension between the last ribs and the gluteal region, with or without radiation to the lower limbs [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. It is classified as acute (\u0026lt;\u0026thinsp;6 weeks), subacute (6\u0026ndash;12 weeks), or chronic (\u0026gt;\u0026thinsp;12 weeks) and is specific and nonspecific [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDisability caused by LBP is frequent. It is estimated that 26% of older adults have limitations in basic activities of daily living and 45% in instrumental activities, with LBP being a significant factor [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The Roland‒Morris Disability Questionnaire (RMDQ) used in this study is internationally recognized and validated and assesses the disability of participants in performing daily and social functional activities [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Despite the high prevalence and impact of chronic LBP in older adults, this population remains underrepresented in clinical trials and longitudinal studies [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe aim of this study was to investigate the factors associated with the persistence of LBP and disability after an acute pain episode in elderly Brazilian individuals 12 months after the event.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eObservational study of a prospective cohort from the international Back Complaints in the Elders consortium. The international protocol was previously published by Scheele et al. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The project was approved by the Research Ethics Committee of UFMG (approval no. ETIC0100.0.0.203.000\u0026ndash;11). The study was conducted between 2011 and 2012. The research followed the guidelines of the \u003cem\u003eStrengthening the Reporting of Observational Studies in Epidemiology\u003c/em\u003e (STROBE).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eParticipants\u003c/h3\u003e\n\u003cp\u003eParticipants aged 55 years and older with a new episode of nonspecific LBP (duration\u0026thinsp;\u0026lt;\u0026thinsp;6 weeks) without seeking medical care in the last six months were included. Participants with significant cognitive impairment, as stratified by education level via the Mini Mental State Examination (MMSE) [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], specific LBP, or neoplasms were excluded. Participants were recruited from public and private services in the metropolitan region of Belo Horizonte, interviewed in person and followed up by telephone.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eSample size\u003c/h3\u003e\n\u003cp\u003eOn the basis of estimates of chronic low back pain incidence and disability, a minimum sample size of 600 participants was defined, ensuring 80% statistical power and a 5% significance level to detect 12% differences between groups. A total of 602 elderly participants were included at baseline, with 446 reassessed after 12 months. Dependent variables: Pain persistence and disability after 12 months. Independent variables: Age, sex, education, marital status, treatment, comorbidities, smoking status, and use of pain medications.\u003c/p\u003e\n\u003ch3\u003eUsed Instruments\u003c/h3\u003e\n\u003cp\u003ePain was assessed using the Numeric Pain Scale (0\u0026ndash;10), which has been validated in the Brazilian context. CCI: \u0026ge; 0.95 [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Pain intensity was categorized as 0 (no pain), 1\u0026ndash;3 (mild), 4\u0026ndash;6 (moderate), or 7\u0026ndash;10 (severe).\u003c/p\u003e \u003cp\u003eFunctional disability was measured via the Roland‒Morris Disability Questionnaire (RMDQ), which has 24 items and scores ranging from 0 to 24. CCI: 0.95 [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Higher scores indicate greater levels of disability. Individuals with scores greater than 14 were considered disabled [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePhysical activity was assessed via the Active Australia Questionnaire (AAQ), which categorizes participants as insufficiently active if they engage in less than 150 minutes of physical activity per week. The CCI was 0.84 [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePain beliefs were assessed via the Brazilian version of the Back Beliefs Questionnaire (BBQ-Br), CCI: 0.84. The score obtained for each item is reversed; the higher the score is, the less the individual demonstrates fear and false hopes, with no defined cutoff point [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFear of falling was measured via the Brazilian version of the Falls Efficacy Scale-International (FES-I Brazil), CCI: 0.84, with cutoffs\u0026thinsp;\u0026gt;\u0026thinsp;23 for occasional falls and \u0026gt;\u0026thinsp;31 for recurrent falls [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDepressive symptoms were assessed via the CES-D scale. CCI: 0.83. The final score ranges from 0\u0026ndash;60, with a cutoff score of \u0026gt;\u0026thinsp;11 [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eComorbidities were assessed via the Self-Administered Comorbidity Questionnaire (SCQ). CCI: 0.90. Multiple comorbidities were defined as \u0026gt;\u0026thinsp;2 comorbidities [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAdditional information on the radiation of pain to the lower limbs, the frequency of pain, and the use of pharmacological and nonpharmacological treatments was collected. Pain persistence was defined as the presence of self-reported pain at the time of the assessment after 12 months.\u003c/p\u003e\n\u003ch3\u003eData collection procedures\u003c/h3\u003e\n\u003cp\u003eThe interviews were conducted by trained evaluators. The database was structured in Microsoft Excel\u0026reg;, with quality control and blind data entry. Calibration meetings were conducted bimonthly.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eDescriptive analysis was performed for the participants profiles, and McNemar\u0026rsquo;s test was used for comparisons between baseline and follow-up. Poisson models with robust variance were used to estimate associations between exposures and outcomes in the baseline analysis. The significance level adopted was 5% (p\u0026thinsp;\u0026le;\u0026thinsp;0.05; R statistical software version 4.3.1).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe majority of the sample consisted of women (84.8%), with a median age of 67 years, who were married (44.2%), and who had completed elementary education (55.7%). A high frequency of pain medication use in the past 3 months was observed (74.0%), and few nonpharmacological treatments were used (3% physiotherapy, 1% psychotherapy). Other behaviors and conditions are presented in Table 1.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e\u0026nbsp; Sociodemographic and Health Characteristics of the Study Population at Baseline\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e511 (84.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e91 (15.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (in years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eMean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e67.6 (7.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eMedian (1st and 3rd quartiles)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e67 (62 - 72)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eMinimum \u0026amp; Maximum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e55 \u0026ndash; 94\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e103 (17.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e266 (44.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e70 (11.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e158 (26.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eLives with partner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4 (0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eNo schooling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e41 (6.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eElementary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e335 (55.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eHigh school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e133 (22.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eHigher education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e92 (15.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003ePain Medication\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eYes\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e446 (74.0)\u003c/p\u003e\n \u003cp\u003e156 (26.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003ePhysical Therapy\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eYes\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e18 (3.0)\u003c/p\u003e\n \u003cp\u003e584 (97.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003ePsychological Therapy\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Yes\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;1 (0.02)\u003c/p\u003e\n \u003cp\u003e601 (99.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eSmoking\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eNo\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Yes\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Quit and stopped\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e406 (67.4)\u003c/p\u003e\n \u003cp\u003e36 (6.0)\u003c/p\u003e\n \u003cp\u003e160 (26.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003ePhysical Activity\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e Less than 150 min per week\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; More than 150 min per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e106 (17.6)\u003c/p\u003e\n \u003cp\u003e496 (82.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDepression\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Up to 15 points (no depression risk)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; More than 16 points (increased risk)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e190 (31.5)\u003c/p\u003e\n \u003cp\u003e412 (68.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMultimorbidity (two or more diseases)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eNo\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e68 (11.3)\u003c/p\u003e\n \u003cp\u003e534 (88.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003ePersonal Beliefs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eMean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e23.7 (6.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eMedian (1st and 3rd quartiles)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e23 (19 - 29)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eMinimum \u0026amp; Maximum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0 \u0026ndash; 45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: n = number; % = percentage; Kg = kilogram; m\u0026sup2; = square meters; DP = standard deviation\u003c/p\u003e\n\u003cp\u003eAfter 12 months, considering pain characteristics, a statistically significant reduction (p \u0026lt; 0.01) was found in the prevalence of moderate and severe pain, daily pain, and pain most of the time. There was a reduction in the incidence of occasional falls. Disability, the study\u0026apos;s dependent variable, presented a prevalence of 40% after 12 months, and the prevalence of pain persistence was 56%.\u003c/p\u003e\n\u003cp\u003eDisability was greater among participants who reported more than two comorbidities at baseline, negative beliefs, daily pain for a few minutes or most of the time, moderate lower limb weakness, and recurrent fall risk. The presence of disability at baseline was also associated with higher scores after 1 year, as shown in Table 2.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 528px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 2.\u0026nbsp;\u003c/strong\u003e Associations Between Exposures at Baseline and Disability After 12 Months, Controlled for Disability at Baseline\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 49.6323%;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.8686%;\"\u003e\n \u003cp\u003eModel 1\u003c/p\u003e\n \u003cp\u003eRP (CI 95%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 49.6323%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRoland-Morris baseline\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.8686%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.03 (1.02; 1.04)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49.6323%;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26.8686%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49.6323%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.4457%;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49.6323%;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.4457%;\"\u003e\n \u003cp\u003e0.98 (0.81; 1.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49.6323%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (in years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.4457%;\"\u003e\n \u003cp\u003e1.00 (0.99; 1.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49.6323%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.4457%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49.6323%;\"\u003e\n \u003cp\u003eNo schooling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.4457%;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49.6323%;\"\u003e\n \u003cp\u003eElementary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.4457%;\"\u003e\n \u003cp\u003e1.00 (0.85; 1.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49.6323%;\"\u003e\n \u003cp\u003eHigh school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.4457%;\"\u003e\n \u003cp\u003e0.95 (0.79; 1.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49.6323%;\"\u003e\n \u003cp\u003eHigher education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.4457%;\"\u003e\n \u003cp\u003e1.00 (0.81; 1.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49.6323%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePhysical activity, \u0026gt;150 minutes (active)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.4457%;\"\u003e\n \u003cp\u003e0.91 (0.80; 1.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.6323%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDepression, yes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.4457%;\"\u003e\n \u003cp\u003e1.09 (0.96; 1.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.6323%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMultimorbidity, yes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.4457%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.20 (1.01; 1.42)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49.6323%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePersonal beliefs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.4457%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.98 (0.97; 0.99)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.6323%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePain intensity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.4457%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.6323%;\"\u003e\n \u003cp\u003eNone/Mild\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.4457%;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.6323%;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.4457%;\"\u003e\n \u003cp\u003e0.98 (0.86; 1.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.6323%;\"\u003e\n \u003cp\u003eSevere\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.4457%;\"\u003e\n \u003cp\u003e1.09 (0.96; 1.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.6323%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePain frequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.4457%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.6323%;\"\u003e\n \u003cp\u003eOnce a week or less\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.4457%;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.6323%;\"\u003e\n \u003cp\u003ePain every day for some minutes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.4457%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.23 (1.07; 1.42)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.6323%;\"\u003e\n \u003cp\u003ePain every day or most of the time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.4457%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.20 (1.06; 1.36)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.6323%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLeg or foot weakness\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.4457%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.6323%;\"\u003e\n \u003cp\u003eNone/Mild\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.4457%;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.6323%;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.4457%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.21 (1.08; 1.35)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.6323%;\"\u003e\n \u003cp\u003eSevere/Very Severe\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.4457%;\"\u003e\n \u003cp\u003e1.05 (0.92; 1.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.6323%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumbness in lower limbs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.4457%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.6323%;\"\u003e\n \u003cp\u003eNone/Mild\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.4457%;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.6323%;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.4457%;\"\u003e\n \u003cp\u003e1.07 (0.96; 1.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.6323%;\"\u003e\n \u003cp\u003eSevere/Very Severe\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.4457%;\"\u003e\n \u003cp\u003e1.03 (0.90; 1.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49.6323%;\"\u003e\n \u003cp\u003eOccasional falls, \u003cu\u003e\u0026gt;\u003c/u\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.4457%;\"\u003e\n \u003cp\u003e1.10 (0.93; 1.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49.6323%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRecurrent falls, \u003cu\u003e\u0026gt;\u003c/u\u003e32\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.4457%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.23 (1.09; 1.39)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe Poisson model with robust variance was performed via a cross-sectional approximation adjusted for all variables associated with baseline and disability at baseline. Abbreviations: PR = prevalence ratio, 95% CI = 95% confidence interval.\u003c/p\u003e\n\u003cp\u003ePoisson models revealed factors associated with pain persistence after 12 months, considering baseline fixed variables, including negative beliefs and a lower prevalence among those considered active (Model 1). In Model 2, when baseline variables that changed during follow-up were considered, the highest prevalence of pain persistence was found among participants who reported high pain intensity and severe numbness in the lower limbs (Model 2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFinally, when the same variables were applied during follow-up, the prevalence of pain persistence was greater among those with moderate to severe pain intensity and moderate to severe numbness in the lower limbs 12 months after the first event, as demonstrated in Table 3 (Model 3).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"614\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 614px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 3.\u003c/strong\u003e Associations between baseline exposures and pain persistence after 12 months\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003eModel 1\u003c/p\u003e\n \u003cp\u003eRP (CI 95%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eModel 2\u003c/p\u003e\n \u003cp\u003eRP (CI 95%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003eModel 3*\u003c/p\u003e\n \u003cp\u003eRP (CI 95%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e1.01 (0.77; 1.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (in years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e0.99 (0.98; 1.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 119px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 115px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e0.87 (0.70; 1.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e1.10 (0.81; 1.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e0.94 (0.73; 1.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003eLives with partner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e1.33 (0.79; 2.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 119px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 115px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003eNo schooling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003eElementary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e1.06 (0.76; 1.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003eHigh school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e0.92 (0.63; 1.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003eHigher education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e1.00 (0.67; 1.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePain medication, yes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e1.07 (0.88; 1.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePhysical therapy, yes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e1.32 (0.95; 1.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSmoking\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e0.91 (0.63; 1.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e0.87 (0.60;1.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eQuit smoking\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e0.98 (0.81;1.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePhysical activity, \u0026gt;150 minutes (active)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.83 (0.64; 0.97)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e0.86 (0.71; 1.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDepression, yes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e1.17 (0.95; 1.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMultimorbidity, yes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e1.10 (0.81; 1.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePersonal beliefs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.97 (0.96; 0.98)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.98 (0.97;0.99)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e0.99 (0.98, 1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePain intensity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003eNone/Mild\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e1.00 (0.79; 1.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5,64 (4.07; 7.81)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003eSevere\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e128 (1.04; 1.57)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5,60 (4.05; 7.76)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePain frequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 257px;\"\u003e\n \u003cp\u003eOnce a week or less\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 257px;\"\u003e\n \u003cp\u003ePain every day for some minutes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e1.24 (0.98;1.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 257px;\"\u003e\n \u003cp\u003ePain every day or most of the time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e1.21 (0.98;1.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLeg or foot weakness\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003eNone/Mild\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e1.06 (0.88;1.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003eSevere/Very Severe\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e1.04 (0.85;1.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumbness in lower limbs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003eNone/Mild\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e1.14 (0.94; 1.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.25 (1.09; 1.43)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003eSevere/Very Severe\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.24 (1.02; 1.49)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.18 (1.03; 1.35)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccasional falls, \u003cu\u003e\u0026gt;\u003c/u\u003e24\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e0.94 (0.73; 1.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 257px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRecurrent falls, \u003cu\u003e\u0026gt;\u003c/u\u003e32\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e1.17 (0.95; 1.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe Poisson model with robust variance was used.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eModel 1:\u0026nbsp;\u003c/strong\u003eAdjusted for variables measured only at baseline.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eModel 2:\u003c/strong\u003e Adjusted for time-varying variables, considering only the baseline and variables associated with Model 1\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eModel 3:\u003c/strong\u003e Adjusted for variables associated at baseline, considering their changes over time, retaining those that remained associated since baseline\u003c/p\u003e\n\u003cp\u003e* PR values at follow-up\u003c/p\u003e\n\u003cp\u003eAbbreviations: PR = prevalence ratio, CI95% = 95% confidence interval\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAfter 12 months of an episode of nonspecific acute LBP in Brazilian older adults, the prevalence of persistent low back pain was 56%, and the prevalence of functional disability was 40%. These findings align with previous studies indicating a tendency for pain persistence in aging populations, highlighting the relevance of low back pain as a public health issue, especially in developing countries [16].\u003c/p\u003e\n\u003cp\u003eThe characteristics of nonspecific LBP after 12 months presented differently: there was a statistically significant reduction in the prevalence of moderate pain and pain most of the time (from 33.7% to 18.3%; from 42.9% to 22.4%, respectively). However, there was an increase in mild pain, sustained severe pain, and an increase in occasional pain after 12 months. The persistence of severe pain in a significant portion of participants, along with an increase in mild and occasional pain, suggests that the condition remains active.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMoreover, the reduction in moderate pain may reflect spontaneous resolution effects, as well as behavioral and neural adaptation. This scenario reinforces the heterogeneous nature of nonspecific low back pain progression in older adults, emphasizing the importance of longitudinal and individualized follow-up.\u003c/p\u003e\n\u003cp\u003eA greater intensity of pain at baseline was a strong predictor of its persistence after 12 months. A meta-analysis revealed that moderate or severe initial pain is associated with a greater risk of chronicity [28]. This result is concerning, as previous studies have reported central nervous system changes in older adults s with chronic and persistent LBP, indicating the need for immediate management of such pain [29].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStudies have suggested that pain persistence may accelerate brain aging beyond chronological age compared with older adults without such manifestations [30]. A study with data from 356,000 individuals in a population cohort with chronic LBP revealed that 4,959 participants developed dementia after 13 years of follow-up, with a hazard ratio (HR) of 1.08 (95% CI, 1.05\u0026ndash;1.11). The more quickly LBP is addressed, the lower the risk of developing dementia [31].\u003c/p\u003e\n\u003cp\u003eThe majority of the sample consisted of women with low education, high pain medication use (74%), and low adherence to nonpharmacological treatments. These data suggest a care model centered on medication use, despite the multidisciplinary approaches demonstrated in previous studies [32]. Older adults in low-income countries present greater LBP intensity and disability, influenced by social conditions and limited access to healthcare, as shown in this cohort that compared LBP progression data in older adults from Brazil and the Netherlands [1].\u003c/p\u003e\n\u003cp\u003eThe relationship between persistent pain and falls also stands out, supporting findings from longitudinal studies that indicated a higher risk of domestic accidents among older adults with chronic pain [33]. On the other hand, pain persistence may increase the induction of inflammatory cytokines characteristic of inflammaging, causing muscle catabolism and consequent sarcopenia with functional loss. This cycle of persistent pain may trigger postural changes, instability, and falls [34].\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; The presence of moderate or severe numbness at baseline was also associated with pain persistence, possibly reflecting neuropathic symptoms or structural impairment [35]. Aging directly interferes with the mechanisms of pain perception, modulation, and response [36].\u003c/p\u003e\n\u003cp\u003eAfter 12 months, functional disability was associated with multiple comorbidities, depressive symptoms, frequent or daily pain, lower limb weakness, and a history of recurrent falls. These factors highlight the multifactorial nature of disability, which is influenced by clinical, emotional, and functional conditions [7].\u003c/p\u003e\n\u003cp\u003eIn older adults with chronic pain, functionality is not always impaired. Many retain the capacity for daily activities by adjusting their movement patterns in response to pain and using adaptive strategies [37].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe presence of depressive symptoms was associated with disability at baseline but not after 12 months, suggesting that acute factors at the time of pain may more strongly influence the emotional state [28].\u003c/p\u003e\n\u003cp\u003ePhysical inactivity, present in 17.6% of the sample, was associated with a higher prevalence of persistent pain and functional disability. This finding is consistent with evidence that physical activity is a protective factor against chronic pain in older adults, with a positive impact on functionality [38]. Exercise training in older adults significantly reduces the levels of inflammatory markers such as IL-6, TNF-\u0026alpha;, and CRP, resulting in anti-inflammatory effects, especially in participants with chronic diseases [39].\u003c/p\u003e\n\u003cp\u003eNegative beliefs were also associated with persistent pain and functional disability. Previous evidence has shown that low scores on the Back Beliefs Questionnaire indicate a greater degree of fear and negative expectations about LBP, which may limit treatment adherence and hinder functional recovery [2].\u003c/p\u003e\n\u003cp\u003eThe heterogeneity, individuality, and impact of senescence and senility on the progression of nonspecific LBP in older adults make studies on this topic more complex. However, with aging, studies that can contribute to clarifying the issues presented and enable better management of these symptoms for a population with low socioeconomic and cultural conditions are necessary [40].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe prevalence of persistent low back pain and functional disability in older adults after 12 months of follow-up was high, and different factors associated with these dysfunctions were identified, many of which are modifiable.\u003c/p\u003e\n\u003cp\u003ePrevention and management strategies based on multidimensional approaches in the care of nonspecific LBP in older adults may be more effective than medication alone. These findings offer relevant insights to guide clinical practices and public policies aimed at promoting functionality and healthy aging, especially in developing countries.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eE.C.M., L.R.C., and A.M.F.P.T. contributed to the study design, literature review, and initial drafting of the manuscript. S.L.A.S. conducted the statistical analysis. L.S.M.P., D.S., and A.A.O.L. critically reviewed and revised the manuscript for important intellectual content. All authors participated in data interpretation, contributed to the writing process, and reviewed and approved the final version of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eJesus-Moraleida FR, Ferreira PH, Ferreira ML, Silva JP, Maher CG, Enthoven WTM et al (2017) Back Complaints in the Elders in Brazil and the Netherlands: a cross-sectional comparison. 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Ageing Res Rev 80:101742. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.arr.2023.101742\u003c/span\u003e\u003cspan address=\"10.1016/j.arr.2023.101742\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWong AYL, Karppinen J, Samartzis D (2017) Low back pain in older adults: Risk factors, management options and future directions. Scoliosis Spinal Disord 12:14. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s13013-017-0121-3\u003c/span\u003e\u003cspan address=\"10.1186/s13013-017-0121-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Low back pain, Aged, Activities of Daily Living, Chronic Pain, Disability Evaluation","lastPublishedDoi":"10.21203/rs.3.rs-6960323/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6960323/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction:\u003c/strong\u003e Nonspecific low back pain (LBP) is common among older adults and often leads to functional disability and persistent symptoms.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003eTo investigate factors associated with pain persistence and disability 12 months after an acute episode of LBP in Brazilian older adults.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and Methods:\u003c/strong\u003e This prospective cohort study used data from the international Back Complaints in the Elders consortium (BACE-Brazil). The outcomes assessed were the persistence of LBP and disability after 12 months, as well as the associated clinical, sociodemographic, and functional factors.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eA total of\u003cstrong\u003e \u003c/strong\u003e602 participants (mean age, 67.6 ±7 years) were followed at baseline, and 448 were reassessed after 12 months. Overall, 56% of the participants reported persistent pain, and 40% disability. The factors associated with the persistence of LBP after 12 months included physical inactivity (0.83 [95% CI, 0.64–0.97]), negative beliefs (0.97 [95% CI, 0.96–0.98]), moderate pain (5.64 [95% CI, 4.07–7.81]), severe pain (5.60 [95% CI, 4.05–7.76]), moderate numbness (1.25 [95% CI, 1.09–1.43]), and severe numbness (1.18 [95% CI, 1.03–1.35]). Disability after 12 months was associated with comorbidities (1.20 [95% CI, 1.01–1.42]), negative beliefs (0.98 [95% CI, 0.97–0.99]), daily pain (1.23 [95% CI, 1.07–1.42]), constant pain (1.20 [95% CI, 1.06–1.36]), moderate weakness (1.21 [95% CI, 1.08–1.35]), and recurrent falls (1.23 [95% CI, 1.09–1.39]).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The persistence of LBP and disability after 12 months revealed multifactorial factors associated with these outcomes, emphasizing the importance of multidimensional and individualized care strategies.\u003c/p\u003e","manuscriptTitle":"Factors Associated with the Persistence and Disability of Nonspecific Low Back Pain in Older Adults: Longitudinal Data from the BACE-Brazil Cohort","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-29 14:47:14","doi":"10.21203/rs.3.rs-6960323/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"defafa4f-569d-4c54-b7cc-6fd657dd34b8","owner":[],"postedDate":"June 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-12T17:08:28+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-29 14:47:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6960323","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6960323","identity":"rs-6960323","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}