Is Quality of Life in Older Adults With Non-Specific Low Back Pain Influenced by Pain or Disability? Longitudinal Data From the Back Complaints in the Elders Brazil Cohort

BACKGROUND: Low back pain (LBP) represents the leading cause of years lived with disability (YLD) globally. Among older adults, non-specific LBP constitutes a predominant determinant of functional decline, diminished quality of life (QoL) and considerable socioeconomic burden. This study aimed to assess the impact of pain intensity and disability on healthy-related quality of life (HRQoL) in older adults with non-specific LBP over 12 months. METHODS: 602 participants from the BACE-Brazil cohort with acute non-specific LBP were followed for 12 months, 156 were excluded from the analysis due to missing data on the Short Form-36 Questionnaire (SF-36), leaving a final sample of 446 participants. Pain intensity was assessed using the Numerical Rating Scale (NRS), disability with the Roland Morris Disability Questionnaire (RMDQ) and HRQoL with the Short Form-36 (SF-36). Linear regression models examined the relationships between pain, disability and HRQoL, adjusting for sociodemographic and clinical covariates. RESULTS: In the longitudinal analysis of 446 older adults (mean age 67 ± 7 years, 84.9% women), greater pain intensity was significantly associated with reductions in the physical component of HRQoL, but not with the emotional component. In contrast, worsening disability was associated with declines in both physical and emotional components of HRQoL. CONCLUSION: In older adults with acute non-specific LBP, disability exerts a stronger and broader impact on HRQoL than pain intensity. Interventions targeting functional independence may therefore be more effective in preserving HRQoL than strategies focused solely on pain reduction. SIGNIFICANCE STATEMENT: This is the first longitudinal study in a developing country showing that disability, rather than pain intensity, exerts the greatest long-term impact on both physical and emotional quality of life in older adults with acute non- specific low back pain. These findings highlight the need for interventions that prioritise functional preservation and disability reduction, rather than solely focusing on pain relief, to improve outcomes and guide clinical decision-making for this growing and vulnerable population.