Pain and its negative health consequences disproportionately affect older adults. Physical therapists play a critical role in pain management and many active interventions rely on motor learning principles. Recent evidence shows that motor learning under painful conditions impairs its subsequent retention. However, research to date has focused on young adults even though age-related cognitive decline and reduced endogenous pain inhibition could leave older adults more vulnerable to pain-related motor learning and retention impairments. Therefore, we examined whether pain differentially affects motor learning and retention in younger versus older adults. Thirty younger and thirty older healthy adults were randomized to learn a novel asymmetric walking pattern under either a pain-free control condition or an acute capsaicin-heat pain condition. All participants completed baseline, learning, and retention testing, with learning driven by distorted visual step-length feedback to induce a gait asymmetry of 9%. Experiencing acute pain during learning was associated with reduced learning (Pain: 6.6% ± 0.4, Control: 8.1% ± 0.5, F(1,59)=6.04, p=0.02, η²ₚ=0.10) and reduced 24-hour retention (Pain: 2.6% ± 0.7, Control: 5.9% ± 0.7, F(1,59)=10.22, p<0.01, η²ₚ=0.16) in younger and older adults. Notably, retention deficits were absent in short-term (within-session) retention and emerged only at the 24-hour test (F(1,56)=11.7, p<0.001). Additionally, older adults showed reduced learning compared to their younger counterparts (F(1,59)=4.71, p=0.03, η²ₚ=0.08). These findings demonstrate that acute pain similarly impairs retention of a newly learned gait pattern in younger and older adults, which may reduce the effectiveness of motor learning-based interventions used in rehabilitation. PERSPECTIVE: This article examines the effects of pain on motor learning and retention in younger and older adults. Pain impairs retention across age groups, with deficits emerging after 24 h. Clinicians should recognize that active interventions performed in patients experiencing pain may result in reduced retention of newly learned movement patterns.

IMPORTANCE:Older adults and those with low back pain (LBP) are at increased risk of research-related adverse events (AEs); yet, Cochrane reviews show AE under-reporting in rehabilitation trials. OBJECTIVE:To inform AE practices in future rehabilitation trials, details are provided on novel AE surveillance and reporting practices used in the Manual Therapy and Strengthening for the Hip (MASH) trial. DESIGN:The study design was a secondary analysis of a multisite, single-masked, randomized controlled trial comparing 2 exercise-inclusive interventions. SETTING:The study was conducted at research-based physical therapist sites. PARTICIPANTS:Participants were older adults with moderate-intensity, chronic LBP with hip pain and muscle weakness. INTERVENTIONS OR EXPOSURES:Participants were randomly assigned to receive 16 sessions of hip-focused or spine-focused physical therapy over 8 weeks. Active AE monitoring was facilitated with standardized interviews during each treatment session and at 8-week, 3-, 4-, 5-, and 6-months. Common terminology criteria for AEs classification was used. AEs were adjudicated by a site investigator and reviewed at multisite meetings. MAIN OUTCOMES AND MEASURES:AE classification, relatedness, expectedness, severity, timing, recurrence, duration, and intervention impact were evaluated between interventions. RESULTS:Among 184 participants, there were 243 AEs (n = 128 hip-focused group, n = 115 spine-focused group) in 112 participants; 38.3% were unexpected, with 47 occurring in the hip-focused and 46 in the spine-focused group. AE relatedness, expectedness, and severity were similar between groups. Of the 243 AEs, 157 were mild, 71 were moderate, and 15 were severe/life threatening. Most AEs (80.2%) occurred early and were classified as musculoskeletal and connective tissue disorders (MSKCT), with shorter MSKCT AE duration in the hip-focused group. Within each group, 15 MSKCT AEs resulted in study modification. CONCLUSIONS AND RELEVANCE:This analysis describes a framework to improve upon active AE surveillance during rehabilitation trials to better inform risk-to-benefit analyses. Data can also be used to inform clinical decision-making related to risks from MASH trial interventions.

OBJECTIVE:Although pain quality may be a component of the geriatric chronic pain experience that influences disability, no research has investigated the psychological underpinnings of pain quality in any geriatric chronic pain population. We sought to address this knowledge gap by examining associations between both general (ie, depressive symptoms) and pain-specific psychological risk factors (ie, fear-avoidance beliefs, pain catastrophizing, and kinesiophobia) and prospective pain quality in older adults with chronic low back pain. METHODS:Questionnaires for each psychological factor were collected at baseline, while pain quality was measured by the McGill Pain Questionnaire at baseline and 12 months. Preliminary analyses identified pain catastrophizing as the individual factor with the highest correlation to future pain quality for subsequent analyses. To assess if baseline psychological factors were cumulatively associated with 12-month pain quality, questionnaire values were entered into principal component analysis to yield a combined psychological component score. Robust regression models with HC3 standard errors were used to examine associations between baseline psychological risk factors (both individually and cumulatively) and prospective pain quality. RESULTS:In adjusted analyses, higher baseline pain catastrophizing independently predicted worse pain quality at 12 months ( b =0.342, t =4.225, P <0.001). Similarly, higher baseline psychological component scores were independently associated with worse prospective pain quality after adjustment ( b =3.816, t =4.518, P <0.001). DISCUSSION:The combined psychological component score had comparatively stronger predictive ability than pain catastrophizing alone; however, overall model prediction was modest, suggesting that future research is needed to identify other biopsychosocial variables that may impact pain quality in the geriatric chronic LBP population.

OBJECTIVE:To investigate and compare the clinical profiles of 3 previously established hip-based subgroups of older adults with chronic low back pain (LBP) using data from multiple domains. DESIGN:Cross-sectional analysis of baseline cohort study data. SETTING:Clinical research laboratory. PARTICIPANTS:Two hundred fifty (n=250) community dwelling older adults with chronic LBP. INTERVENTIONS:Not applicable. MAIN OUTCOME MEASURES:Clinical profiles of the previously derived subgroups were established. Pain quality and dispersion were captured with the McGill Pain Questionnaire. Self-efficacy was measured using the Low Back Activity Confidence Scale. Catastrophic thoughts about LBP were captured with the Pain Catastrophizing Scale. Trunk mobility was measured with an inclinometer. Trunk muscle function was captured through standardized muscle endurance testing and ultrasound measures of muscle activity. One-way analysis of variance was used to analyze between-group differences. RESULTS:Each chronic LBP subgroup was named based on the level of hip strength and hip symptoms: weak and symptomatic, weak and nonsymptomatic, and strong and nonsymptomatic. The weak and symptomatic subgroup had distinctly worse levels of pain quality, dispersion, catastrophizing and self-efficacy, compared with the other 2 subgroups. In contrast, the strong and nonsymptomatic subgroup, as compared with the other subgroups, had greater thoracolumbar flexion, greater trunk muscle endurance and better psychological profiles. CONCLUSIONS:The unique clinical profile of each subgroup underscores how important it is to consider the heterogeneous nature of chronic LBP in the geriatric population when developing treatment approaches. The clinical characterization of these subgroups across multiple rehabilitation-focused domains may optimize the development of tailored interventions for each subgroup.

Less is known about recovery from hip fracture in men. We found differences in 25-hydroxyvitamin D and bone biomarkers between men and women during the year after hip fracture, underscoring the importance of vitamin D assessment in older men and pharmaceutical treatment to reduce bone resorption after hip fracture. Less is known about recovery from hip fracture in men compared to women. We examined differences between men and women in 25-hydroxyvitamin D (25OHD) and bone turnover markers, and associations with bone mineral density (BMD) and physical function, during the year after a hip fracture. Community-dwelling, ambulatory adults aged 65 years and over (157 men and 154 women) enrolled in the Baltimore Hip Studies 7th cohort were included. We analyzed 25OHD, C-terminal telopeptide (β-CTX-I), procollagen type I N-terminal propeptide (PINP), PTH, and femoral neck BMD at baseline, 2, 6, and 12 months after hip fracture, and short physical performance battery (SPPB) at 2, 6, and 12 months. During admission for hip fracture, median 25OHD levels were 15.2 ng/mL (IQR 10.0) in men compared with 23.9 ng/mL (IQR 13.4) in women and remained lower in men at 2, 6, and 12 months (all p < 0.001). β-CTX-I was higher in men on admission, and at 2 and 6 months (all p < 0.05), and PINP was higher in men at 6 months (p = 0.04), with no significant differences between men and women in PTH. Higher 25OHD and PINP concentrations in women only and lower β-CTX-I and PTH concentrations in both sexes were associated with greater BMD. Higher 25OHD concentrations were associated with higher SPPB scores in both sexes. These findings underscore the importance of vitamin D assessment in older men and missed opportunities in both sexes for vitamin D supplementation and pharmaceutical treatment to reduce bone resorption after hip fracture.

Though pain sensitivity impairments contribute to chronic pain in younger adults, it is unclear if pain hypersensitivity manifests with aging and is heightened in the geriatric chronic low back pain population. The cross-sectional study preliminarily addressed this gap by measuring pain sensitivity in older adults with chronic low back pain (n = 25) as well as pain-free sex-matched older (n = 25) and younger adults (n = 25). Pain sensitivity was quantified by 8 distinct measures that were subdivided as static (ie, pressure pain thresholds, heat pain thresholds, fixed mechanical pain, and fixed cold pain) and dynamic pain sensitivity (ie, mechanical temporal summation, thermal ramp and hold, heat pain aftersensations, and conditioned pain modulation). Test-retest reliability values for pain sensitivity ranged from moderate to excellent (intraclass correlation coefficients ≥ .500; p's < .05). The main effect for the group was significant (partial η2 = .413, P < .001), revealing between-group differences in pain sensitivity on 5 out of 8 tests (p's ≤ .043). Predominantly, both older adult groups demonstrated increased pain facilitation and decreased pain inhibition during dynamic pain sensitivity testing compared to pain-free younger adults (p's ≤ .044). Despite qualitative differences, static and dynamic pain sensitivity responses were statistically similar between older adults with and without chronic LBP (p's > .05). Findings suggest pain sensitivity can be reliably measured in older adults and that pain hypersensitivity develops with chronological aging, providing partial support for the theory that pain hypersensitivity may impact geriatric chronic pain populations. Further study is needed to more definitively parse out whether pain hypersensitivity is comparatively heightened in older adults with chronic LBP beyond the influence of chronological aging. PERSPECTIVE: This article establishes that surrogate measures of centrally mediated pain sensitization are heightened with aging. Impaired endogenous pain modulation may influence chronic pain development, maintenance, treatment efficacy, and/or ensuing disability, necessitating research to comprehensively characterize how pain hypersensitivity contributes to geriatric chronic pain conditions.

Though chronic low back pain (CLBP) is highly prevalent and debilitating among older adults, geriatric CLBP remains understudied, limiting our understanding of factors like pain sensitivity (i.e., the responsiveness of pain pathways) that may perpetuate pain and disability in this population. Therefore, the purpose of this pilot study was to test associations between multimodal pain sensitivity and various domains of clinical outcomes in older adults with CLBP. Twenty-five older adults with CLBP (mean age 69.4 (±6.2) years: 52% female) underwent static and dynamic pain sensitivity testing across two sessions. Clinical pain (i.e., resting/recall and movement-evoked), disability (i.e., Quebec Back Pain Disability Scale), and physical function (i.e., gait speed and walking endurance) outcomes were averaged across sessions. Univariate relationships between pain sensitivity tests and each outcome were explored via Pearson correlation coefficients; cutoff for further exploration was p≤0.05, and the pain sensitivity test with the highest correlation coefficient was subsequently utilized. Multivariable regression models characterized associations between pain sensitivity and clinical outcomes while controlling for demographic and psychological factors. Pain sensitivity tests predicted unique variance in every outcome in unadjusted models (all p≤0.05, R2 ≥0.163). Pain sensitivity remained associated with worse pain intensity (Beta= -0.542, p=0.023), movement-evoked pain (Beta= -0.668, p=0.002), gait speed (Beta=0.378, p=0,031), and walking endurance (Beta= -0.382, p=0.032) after adjustment. These preliminary findings suggest pain sensitivity is clinically meaningful in geriatric CLBP, warranting future research to elucidate the relative importance of pain sensitivity as a potential driver of persistent pain and disability in this population. Funding: NIH (1F30AG081010-01).

Background and Purpose: Older adults with low back pain (LBP) are at risk for falling, but condition-specific mechanisms are unknown. Trunk neuromuscular function is critical for maintaining balance during mobility tasks and is often impaired in older adults with LBP. The purpose of this study was to assess whether aberrant lumbopelvic movements (or aberrant movements), a clinical index of trunk neuromuscular function, were associated with increased fall risk among older adults with chronic LBP over a 12-month follow-up period. Methods: This study analyzed data from a prospective cohort study of 250 community-dwelling older adults with chronic LBP. Participants were screened for 4 aberrant movements during 3 trials of forward flexion from a standing position: instability catch, painful arc, altered lumbopelvic rhythm, and Gower's sign. Aberrant movements were totaled to yield a summary score (ie, 0-4). Prospective falls were monitored via monthly fall calendars for 12 months. A generalized linear model with Poisson distribution and log link function was used to evaluate the association between aberrant movements and prospective fall risk. Age, sex, body mass index, LBP intensity, dynamic balance performance, prior falls, anxiolytic medication usage, and hip osteoarthritis characteristics were included as covariates in the model. Results: Baseline aberrant movements were independently associated with greater fall risk (risk ratio = 1.249, 95% CI = 1.047-1.491, P = .014); each 1-unit increase in aberrant movement score imparted a 24.9% increase in the risk of falling. Conclusions: Aberrant movements increased the risk of falling among older adults with chronic LBP over a 1-year span.

In younger populations, risk factors from psychologically-focused theoretical models have become accepted as primary drivers behind the persistence of low back pain (LBP), but these risk factors have not been thoroughly assessed in older adult populations (60-85 years). To address this knowledge gap, we sought to examine longitudinal associations between both general and pain-related psychological risk factors and future pain intensity, LBP-related disability, and physical function (gait speed) outcomes in older adults with chronic LBP (n = 250). Questionnaires for general (ie, depressive symptoms) and painrelated psychological risk factors (ie, fear-avoidance beliefs, pain catastrophizing, and kinesiophobia) were collected at baseline. Questionnaire values were entered into principal component analysis to yield a combined psychological component score. LBP intensity (pain thermometers), LBP-related disability (Quebec Back Pain Disability Scale), and gait speed were measured at baseline and 12-month follow-up. Multiple linear regression was used to examine adjusted associations between baseline psychological component scores and each prospective outcome. The baseline psychological component score failed to independently predict 12-month LBP-related disability and gait speed after adjustment for baseline outcomes. Though the psychological component score was associated with 12-month LBP intensity after adjusting for baseline LBP intensity, this association diminished with full adjustment for other baseline characteristics. Cumulatively, general and pain-related psychological risk factors did not independently predict longitudinal pain, disability, and physical function outcomes in this cohort. Compared to younger populations with this condition, general and pain-related psychological risk factors may have less influence on the maintenance of chronic LBP in older adults. Perspective: This article failed to establish consistent independent relationships between psychological factors and worse longitudinal pain, disability, and physical function outcomes in older adults with chronic LBP. The findings highlight a need to determine other age-specific biopsychosocial risk factors that may impact the maintenance of chronic pain in this patient population. (R) 2024 (R) Published by Elsevier Inc. on behalf of United States Association for the Study of Pain, Inc All rights are reserved, including those for text and data mining, AI training, and similar technologies.

BACKGROUND:Previously, we identified a population of older adults with chronic low back pain, hip pain, and hip muscle weakness who had worse 12-month low back pain and functional outcomes than age-matched adults with only low back pain, indicating an increased risk for future mobility decline. We sought to determine whether tailored, hip-focused physical therapy reduced pain and functional limitations in this high-risk population compared with non-tailored, spine-focused physical therapy. METHODS:We did a multicentre, single-masked, randomised controlled trial at three research-based sites in the USA. We recruited older adults (aged 60-85 years) with hip pain and weakness who reported moderate low back pain intensity at least half the days in the last 6 months. Patients were randomly assigned to hip-focused physical therapy or spine-focused physical therapy using permuted blocks with random block size, stratified by site and sex (ie, male or female). The primary outcomes were self-reported disability using the Quebec Back Pain Disability Scale (QBPDS) and performance-based 10-Meter Walk Test (10MWT) at 8 weeks. All analyses were done in the intention-to-treat population. Adverse events were collected by study staff via a possible adverse event reporting form and then adjudicated by site investigators. This trial was registered with ClinicalTrials.gov, NCT04009837. FINDINGS:Between Nov 1, 2019, and April 30, 2022, 184 participants were randomly assigned to receive hip-focused (n=91) or spine-focused physical therapy (n=93) interventions. The mean age was 70·7 (SD 6·2) years. 121 (66%) of 184 participants were women, 63 (34%) were men, and 149 (81%) were White. At 8 weeks, the mean between-group difference on the QBPDS was 4·0 (95% CI 0·5 to 7·5), favouring hip-focused physical therapy. Both groups had similar, clinically meaningful gait speed improvements (10MWT) at 8 weeks (mean difference 0·004 m/s [95% CI -0·044 to 0·052]). No serious adverse events were related to study participation. INTERPRETATION:Tailored hip-focused physical therapy demonstrated greater improvements in low back pain-related disability at 8 weeks. However, both hip-focused physical therapy and spine-focused physical therapy produced clinically meaningful improvements in disability and function for this high-risk population at 6 months. These findings warrant further investigation before clinical implementation. FUNDING:US National Institute on Aging of the National Institutes of Health.

Abstract Back pain is highly prevalent in older adults and a risk factor for poor/declining physical performance. Back pain intensity and pain catastrophizing are two factors known to be associated with physical performance in younger adults; though a paucity of similar research exists in older adults. Thirty-nine older adults with back pain completed a battery of four standardized physical performance tests: 30-second chair rise, repetitive seated trunk rotation, repetitive standing functional reaching, and six-minute walk. Test scores were z-transformed and summated for a standardized physical performance score. We measured resting pain intensity and dispositional pain catastrophizing before the battery and movement-evoked pain intensity and situational pain catastrophizing during/after the battery. After accounting for age and biological sex, resting and movement-evoked pain intensity explained 14% and 39% unique variance in physical performance. In multivariable models, movement-evoked pain was the stronger factor. Similar modeling showed dispositional and situational pain catastrophizing explained 14% and 28% unique variance in physical performance. In multivariable models, situational pain catastrophizing was the stronger factor. Finally, path modeling showed situational pain catastrophizing mediated the total effect of movement-evoked pain on physical performance (21%). Findings suggest: 1) Factors with movement (i.e., movement-evoked pain, situational pain catastrophizing) are more strongly associated with physical performance than factors measured independent of movement (i.e., resting pain, dispositional pain catastrophizing); and 2) The impact of pain on physical performance is mediated by psychological distress. Importantly, neither movement-evoked pain nor situational pain catastrophizing are part of current standard of care for older adults with back pain.

Trunk muscles may be an overlooked region of deficits following lower-limb amputation (LLA). This study sought to determine the extent that trunk muscle deficits are associated with physical function following amputation. Sedentary adults with a unilateral transtibial- (n = 25) or transfemoral-level (n = 14) amputation were recruited for this cross-sectional research study. Participants underwent a clinical examination that included ultrasound imaging of the lumbar multifidi muscles, the modified Biering-Sorensen Endurance Test (mBSET), and performance-based measures, that is, the Timed Up and Go (TUG), Berg Balance Scale (BBS), and 10-m Walk Test (10mWT). Associations between trunk muscle metrics and performance were explored with regression modeling, while considering covariates known to impact performance postamputation (p ≤ 0.100). Average ultrasound-obtained, lumbar multifidi activity was 14% and 16% for transfemoral- and transtibial-level amputations, respectively, while extensor endurance was 37.34 and 12.61 s, respectively. For TUG, nonamputated-side multifidi activity and an interaction term (level x non-amputated-side multifidi activity) explained 9.4% and 6.2% of the total variance, respectively. For 10mWT, beyond covariates, non-amputated-side multifidi activity and the interaction term explained 6.1% and 5.8% of the total variance, respectively. For TUG, extensor endurance and an interaction term (level x mBSET) explained 11.9% and 8.3% of the total variance beyond covariates; for BBS and 10mWT, extensor endurance explained 11.2% and 17.2% of the total variance, respectively. Findings highlight deficits in lumbar multifidi activity and extensor muscle endurance among sedentary adults with a LLA; reduced muscle activity and endurance may be important factors to target during rehabilitation to enhance mobility-related outcomes.

Objectives: Low back pain (LBP) is highly prevalent and disabling for older adults. Movement-evoked pain is an emerging measure that may help to predict disability; but is not currently a part of geriatric LBP clinical care. This study tested the safety and feasibility of a new Movement-Evoked Provocation Test for Low Back Pain in Older Adults (MEPLO). We also compared associations between movement-evoked pain via 2 different scoring methods and disability-associated outcomes. Materials and Methods: Thirty-nine older adults with persistent LBP provided baseline recalled and resting pain ratings, self-reported physical function, and usual gait speed. Participants then completed MEPLO, involving 4 tasks essential for functional independence: chair rises, trunk rotation, reaching, and walking. Movement-evoked pain was then quantified using the traditional change score (delta) method of pain premovement to postmovement; and also, a new aggregate method that combines pain ratings after the 4 tasks. Results: No safety or feasibility issues were identified. Compared with the delta score, the aggregate score was more strongly associated with self-reported physical function (beta: −0.495 vs. −0.090) and usual gait speed (beta: −0.450 vs. −0.053). Similarly, the aggregate score was more strongly associated with self-reported physical function than recalled and resting pain (beta: −0.470, −0.283, and 0.136, respectively). Discussion: This study shows the safety and feasibility of testing movement-evoked pain in older adults with persistent LBP, and its potential superiority to traditional pain measures. Future studies must validate these findings and test the extent to which MEPLO is implementable to change with geriatric LBP standard of care.

OBJECTIVES:Low back pain (LBP) is highly prevalent and disabling for older adults. Movement-evoked pain is an emerging measure that may help to predict disability; but is not currently a part of geriatric LBP clinical care. This study tested the safety and feasibility of a new Movement-Evoked Provocation Test for Low Back Pain in Older Adults (MEPLO). We also compared associations between movement-evoked pain via 2 different scoring methods and disability-associated outcomes.MATERIALS AND METHODS:Thirty-nine older adults with persistent LBP provided baseline recalled and resting pain ratings, self-reported physical function, and usual gait speed. Participants then completed MEPLO, involving 4 tasks essential for functional independence: chair rises, trunk rotation, reaching, and walking. Movement-evoked pain was then quantified using the traditional change score (delta) method of pain premovement to postmovement; and also, a new aggregate method that combines pain ratings after the 4 tasks.RESULTS:No safety or feasibility issues were identified. Compared with the delta score, the aggregate score was more strongly associated with self-reported physical function (beta: -0.495 vs. -0.090) and usual gait speed (beta: -0.450 vs. -0.053). Similarly, the aggregate score was more strongly associated with self-reported physical function than recalled and resting pain (beta: -0.470, -0.283, and 0.136, respectively).DISCUSSION:This study shows the safety and feasibility of testing movement-evoked pain in older adults with persistent LBP, and its potential superiority to traditional pain measures. Future studies must validate these findings and test the extent to which MEPLO is implementable to change with geriatric LBP standard of care.

Objective Among adults with persistent post-amputation pain, increased amputated-region pain sensitivity may reflect peripheral sensitization or indicate underlying central sensitization. To determine whether underlying central sensitization may contribute to increased pain sensitivity in this population, this study compared clinical signs and symptoms associated with central sensitization between adults with post-amputation pain who demonstrate or lack increased amputated-region sensitivity (as compared to reference data). Design Cross-sectional. Subjects Ninety-nine adults (60 with a unilateral, transtibial amputation and post-amputation pain, 39 pain-free controls with intact limbs). Methods Participants underwent pain-pressure threshold testing of amputated-region and secondary (non-amputated region) sites and completed outcome measures assessing central sensitization symptoms (Patient-Reported Outcomes Measurement Information System (R) pain intensity and interference domains, Central Sensitization Inventory). Among the full sample, the presence and frequency of specific central sensitization symptoms were evaluated. Participants with post-amputation pain were then grouped based on whether normalized, amputated-region pain-pressure thresholds fell below (i.e., sensitive) or above (i.e., non-sensitive) the 25th percentile of sex-specific reference data. Between-group differences in normalized secondary-site sensitivity were evaluated using a multivariate analysis of variance; central sensitization symptom scores were compared using a Kruskal-Wallis test. Results Noteworthy symptoms associated with central sensitization (e.g., fatigue, sleep disturbance, cognitive difficulty) were reported by 33%-62% of participants. Secondary-site pain sensitivity was greater among individuals with increased amputated-region sensitivity (n = 24) compared to peers without increased amputated-region sensitivity ([n = 36], mean difference > 1.33 standard deviation [SD], p < 0.001). Central sensitization symptom scores, however, were similar between groups (p > 0.187). Conclusions Participants with increased amputated-region sensitivity demonstrate generalized, secondary-site pain hypersensitivity, potentially indicating underlying central sensitization. Central sensitization symptom scores, however, were similar between groups, suggesting differences in physiological pain sensitivity may not manifest in subjective post-amputation pain descriptions.

Research agendas play an important role in directing scholarly inquiry in a field. The Research Agenda for Physical Therapy From the American Physical Therapy Association (APTA) outlines research priorities that are vital to advancing physical therapist practice and the profession. The development of the research agenda included multiple iterative steps and feedback from stakeholders. A research agenda subgroup (n = 6) of the APTA Scientific and Practice Affairs Committee (SPAC), with APTA staff support, gathered information on existing research agendas, developed draft priority descriptions, and gathered feedback via surveys. The subgroup first conducted an environmental scan of the research agendas in the physical therapy and rehabilitation fields. To gather information about research priorities, APTA's Technology and Organizational Performance department distributed a survey to 3 samples. APTA staff organized the feedback, and SPAC edited and synthesized a draft agenda. This draft was sent out in survey form to the original samples and to members of the APTA Academy of Research. Concurrently, a repeat environmental scan was conducted. A final draft of the research agenda was sent for final review to a smaller cohort (n = 95) that included content experts in each of the main categories of the agenda as identified by the APTA Academy of Research. The SPAC research agenda subgroup reviewed and incorporated the information into the final draft. The final research agenda includes priorities in topical areas (population health, mechanistic research, clinical research, education/professional development research, health services research, and workforce development) identified as key in the evolution of our profession.Impact The Research Agenda for Physical Therapy From APTA identifies research priorities within the profession vital to advancing the practice and profession of physical therapy. The research agenda has 6 key areas of focus: population health research, mechanistic research, clinical research, education and professional development research, health services research, and workforce research. Researchers, funding agencies, and public policy makers can use the research agenda to concentrate research efforts around these areas.

It is currently unknown which pain-related factors contribute to long-term disability and poorer perceived health among older adults with chronic low back pain (LBP). This investi-gation sought to examine the unique influence of movement-evoked pain (MeP) and widespread pain (WP) on longitudinal health outcomes (ie, gait speed, perceived disability, and self-efficacy) in 250 older adults with chronic LBP. MeP was elicited with 3 standardized functional tests, while presence of WP was derived from the McGill Pain Map. Robust regression with HC3 stan-dard errors was used to examine associations between these baseline pain variables and health outcomes at 12-month follow-up. Covariates for these models included age, sex, body mass index, resting and recall LBP intensity, LBP duration, depression, pain catastrophizing, and base-line outcome (eg, baseline gait speed). Greater MeP was independently associated with worse 12-month LBP-related disability (b = .384, t = 2.013, P = .046) and poorer self-efficacy (b =-.562, t =-2.074, P = .039); but not gait speed (P > .05). In contrast, WP and resting and recall LBP intensity were not associated with any prospective health outcome after adjustment (all P > .05). Compared to WP and resting and recall LBP intensity, MeP is most strongly related to longi-tudinal health outcomes in older adults with chronic LBP.Perspective: This article establishes novel independent associations between MeP and worse per-ceived disability and self-efficacy at 12-months in older adults with chronic LBP. MeP likely has biop-sychosocial underpinnings and consequences and may therefore be an important determinant of health outcomes in LBP and other geriatric chronic pain populations.& COPY; 2023 by United States Association for the Study of Pain, Inc.

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

Objective: Despite high prevalence estimates, chronic low back pain (CLBP) remains poorly understood among older adults. Movement-evoked pain (MeP) is an understudied factor in this population that may importantly contribute to disability. This study investigated whether a novel MeP paradigm contributed to self-reported and performance-based function in older adults with CLBP. Materials and Methods: This secondary analysis includes baseline data from 230 older adults with CLBP in the context of a prospective cohort study. The Repeated Chair Rise Test, Six Minute Walk Test, and Stair Climbing Test were used to elicit pain posttest LBP ratings were aggregated to yield the MeP variable. Self-reported and performance-based function were measured by the Late Life Function and Disability Index (LLFDI) scaled function score and Timed Up-and-Go Test (TUG), respectively. Robust regression with HC3 standard errors was used to model adjusted associations between MeP and both functional outcomes; age, sex, body mass index, and pain characteristics (ie, intensity, quality, and duration) were utilized as covariates. Results: MeP was present in 81.3% of participants, with an average rating of 5.09 (SD=5.4). Greater aggregated posttest MeP was associated with decreased LLFDI scores ( b =−0.30, t =−2.81, P =0.005) and poorer TUG performance ( b =0.081, t =2.35, P =0.020), independent of covariates. LBP intensity, quality and duration were not associated with the LLFDI or TUG, (all P >0.05). Discussion: Aggregated posttest MeP independently contributed to worse self-reported and performance-based function among older adults with CLBP. To understand long-term consequences of MeP, future studies should examine longitudinal associations between MeP and function in this population.

BACKGROUND:Following lower-limb amputation, phantom limb pain (i.e., pain perceived as coming from the amputated portion of the limb) is common. Phantom limb pain may be associated with impaired body image and perception, which may be targets for rehabilitative intervention. OBJECTIVE:To compare measures of body image and perception between adults with and without phantom limb pain post amputation and evaluate associations between measures of body image and perception and phantom limb pain. DESIGN:Survey. SETTING:Online, remote assessment. PARTICIPANTS:Seventy-two adults ≥1 year post unilateral lower-limb loss (n = 42 with phantom limb pain, n = 30 without phantom limb pain or pain in the remaining portion of the limb). INTERVENTIONS:Not applicable. MAIN OUTCOME MEASURES:Self-reported outcome measures assessing body image (i.e., Amputee Body Image Scale-Revised), perceptual disturbances associated with the phantom limb (i.e., a modified Bath Complex Regional Pain Syndrome Body Perception Disturbance Scale), and prosthesis satisfaction (i.e., Trinity Amputation and Prosthesis Experience Scale) were administered; participants with phantom limb pain reported pain interference via the Brief Pain Inventory-Short Form. Between-group comparisons of self-reported outcome measure scores were conducted using Mann Whitney U or chi-square tests, as appropriate (a = .05). RESULTS:Compared to peers without phantom limb pain, adults with phantom limb pain reported more negative body image; increased phantom limb ownership, attention, and awareness; and reduced prosthesis satisfaction and embodiment (U = 175.50-364.00, p < .001 to .034). Disturbances in phantom limb perception (i.e., size, weight, pressure, temperature) were similar between groups (p = .086 to >.999). More negative body image was associated with increased phantom limb pain interference (τb = .25, p = .026). CONCLUSIONS:Adults with phantom limb pain demonstrate more negative body image and hypervigilance of the phantom limb as compared to peers with nonpainful phantom sensations. Mind-body treatments that target impaired body image and perception may be critical interventions for adults with phantom limb pain.