Do the WHO-ICF personal factors “age” and “sex” impact limited activity and restricted participation category profiles differently between younger and older women and men in multimodal chronic back pain rehabilitation?

Abstract

Purpose

To investigate if the International Classification of Functioning and Health (ICF) context factors “age” and “sex” would impact the disablement and respective improvement with rehabilitation defined with the ICF core set for chronic low back pain (cLBP). Furthermore, associations between limitations/restrictions and measures of body function or quality of life were of interest.

Materials and methods

One thousand five hundred and twelve employed cLBP patients who completed 6 months of outpatient rehabilitation and for whom complete assessments were available before and after rehabilitation. Rehabilitation comprised of progressive resistance training, psychological counseling, and educational sessions. Main outcome measures were the ICF-activity/participation core categories automatically predicted from random forests and utilizing information from the Roland Morris Disability Questionnaire and Pain Disability Index.

Results

Generalized linear-mixed models revealed that upon completion of rehabilitation the presence of a limitation within the ICF activity “walking” significantly decreased with significant between-group differences. The category “doing housework” demonstrated gender-specific differences, and both gender- and age-specific differences were observed for work-related participation categories. There were no meaningful associations between ICF limitation/restriction categories and body function measures (point-biserial/Spearman’s correlations).

Conclusions

The personal factors “age” and “sex” impact some ICF limitation/restriction categories in cLBP; appropriately addressing these personal features could further improve phase III rehabilitation outcome.

Implications for rehabilitation

• Consistent with calls to explore the age and sex/gender influence on health and disease, little is known how these factors affect the disablement of individuals with chronic back pain.

• The factors “age” and “sex” drive differences in some categories within the ICF activity/restriction categories.

• If age- and gender-specific features in activities and participation are not appropriately addressed through interventions, rehabilitation outcome may remain suboptimal in cLBP.

Keywords:

• International Classification of Functioning
• Disability and Health
• health status
• outcome assessment
• low back pain
• age groups
• gender issue

Acknowledgements

The authors gratefully thank Haley Milko for providing English language corrections.

Disclosure statement

The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript. We have not received reimbursements, grants, fees, funding, financing of the manuscript, equipment provided or salary from an organization that may in any way gain or lose financially from the publication of this manuscript, either now or in the future. We do not hold any stocks or shares in an organization that may in any way gain or lose financially from the publication of this manuscript, either now or in the future. We do not hold nor are we currently applying for any patents relating to the content of the manuscript. We have not received reimbursements, fees, funding, or salary from an organization that holds or has applied for patents relating to the content of the manuscript. We have no other financial competing interests. We have no non-financial competing interest (political, personal, religious, ideological, academic, intellectual, commercial, or any other) to declare in relation to the manuscript.

This research was not presented previously in any form.

All authors participated sufficiently in the conception and design of this work and contributed substantially. All authors have read the submitted manuscript and vouched for its accuracy. The First and Corresponding author of this manuscript confirms that he had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis as well as the decision to submit for publication.