# Chronic Low Back Pain in Older Adults: The Role of Co-Existing Hip Impairments

> **NIH NIH R01** · UNIVERSITY OF DELAWARE · 2020 · $1,083,813

## Abstract

PROJECT SUMMARY/ABSTRACT
Low back pain (LBP) is the most frequently reported musculoskeletal problem among older adults. Unique to this
age group, LBP is notably associated with a decline in mobility function. Clinicians have minimal evidence upon
which to base treatment decisions for older adults with LBP due to lack of research studies directly focusing on this
population. Thus, the long-term goal of this line of research is to develop and test a standardized rehabilitation
approach for older adults with chronic LBP that is specifically designed to optimize mobility function by addressing
pain and the unique impairments identified during the initial funding period of this grant. LBP experts have
concluded that patients with LBP do not belong to one homogeneous group, but rather should be classified into
subgroups that share similar clinical characteristics. Identification of clinical subgroups is the first step in the
development of a comprehensive therapeutic algorithm. During the initial funding period, we explored the
hypothesis that modifiable, co-existing hip impairments (pain, stiffness, weakness, motion restrictions) in older
adults with a primary complaint of chronic LBP would predict poor outcomes. Ultimately, in the context of a
prospective cohort study of 250 older adults with chronic LBP, we confirmed this hypothesis and identified a
subgroup based upon the combined presence of elevated hip pain and global weakness of the hip musculature;
further, this subgroup (>40% of the sample) was at risk for markedly worse LBP and functional outcomes over the
course of 12 months. Given our robust predictive findings, we developed a hip-focused rehabilitation intervention
(2x/week for 8 weeks) based on current best evidence to address the hip impairments in this subgroup. Our
preliminary data from the initial testing of this intervention suggest that this LBP subgroup may have a more
favorable LBP treatment response when the identified hip impairments are also addressed. Therefore, the natural
next step is to refine and explore the efficacy of this hip-focused intervention for the newly identified at-risk
subgroup through the conduct of a well-controlled Phase II trial. In this renewal application, we propose a multi-
site, single-blinded, randomized controlled, Phase II trial of 180 older adults with chronic LBP who are classified as
members of the at-risk hip-spine subgroup. We will investigate whether a hip-focused intervention warrants further
investigation as a treatment approach to improve LBP-related disability and physical function (gait speed) among
older adults with chronic LBP. Manual therapy will be used to address hip joint pain and progressive strengthening
will address hip weakness. We will also investigate improvements in hip joint pain, hip strength and functional self-
efficacy as underlying mechanisms contributing to treatment success. Successful completion of this Phase II trial
will provide the critical information needed t...

## Key facts

- **NIH application ID:** 9939375
- **Project number:** 5R01AG041202-08
- **Recipient organization:** UNIVERSITY OF DELAWARE
- **Principal Investigator:** Gregory E Hicks
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $1,083,813
- **Award type:** 5
- **Project period:** 2012-08-01 → 2022-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9939375

## Citation

> US National Institutes of Health, RePORTER application 9939375, Chronic Low Back Pain in Older Adults: The Role of Co-Existing Hip Impairments (5R01AG041202-08). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/9939375. Licensed CC0.

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