Multisystem Resiliency as a Predictor of Physical and Psychological Functioning in Older Adults With Chronic Low Back Pain

Abstract

Evidence supports the benefits of resilience among older adults with chronic pain. While numerous factors confer resilience, research has largely examined these measures in isolation, despite evidence of their synergistic effects. Conceptualizing resilience from a multisystem perspective may provide a deeper understanding of adaptive functioning in pain. Sixty adults (ages 60+ years) with chronic low back pain completed measures of physical function, pain intensity, disability, and a performance-based task assessing back-related physical functioning and movement-evoked pain (MEP). Depressive symptoms, quality of life, and general resilience were also evaluated. To examine multisystem resiliency, principal components analysis (PCA) was conducted to create composite domains for psychological (positive affect, hope, positive well-being, optimism), health (waist-hip ratio, body mass index, medical comorbidities), and social (emotional, instrumental, informational support) functioning measures, followed by cluster analysis to identify participant subgroups based upon composites. Results yielded four clusters: Cluster 1 (high levels of functioning across psychological, health, and social support domains); Cluster 2 (optimal health and low psychosocial functioning); Cluster 3 (high psychological function, moderate-to-high social support, and poorer health); and Cluster 4 (low levels of functioning across the three domains). Controlling for sociodemographic characteristics, individuals with a more resilient phenotype (Cluster 1) exhibited lower levels of disability, higher quality of life and psychological functioning, and greater functional performance when compared to those with a lower degree of personal resources (Cluster 4). No significant cluster differences emerged in self-reported pain intensity or MEP. These findings signify the presence of resiliency profiles based upon psychological, social, and health-related functioning. Further examination of the additive effects of multiple adaptive behaviors and resources may improve our understanding of resilience in the context of pain, informing novel interventions for older adults.

Keywords: aging; health; low back pain; multisystem; psychological; resilience; social support.

FIGURE 1

Cluster group differences across multisystem resilience domains comprised of psychological, health, and social functioning.

FIGURE 2

Pain and physical functioning outcomes across multisystem resilience profiles. Relative to Cluster 4 (Low Resilience group), individuals with a greater degree of protective resources had higher functional performance and self-reported physical function, as well as lower disability. There were no group differences in movement-evoked pain or pain intensity. Higher scores on PROMIS function, better physical functioning; BPS, Back Performance Scale; ME, Movement-Evoked; PROMIS, Patient-Reported Outcomes Measurement Information System; RMDQ, Roland-Morris Disability Questionnaire.

FIGURE 3

Psychological functioning across multisystem resilience profiles. Compared to Cluster 4 (Low Resilience group), individuals with more resilient phenotypes exhibited lower depressive symptoms, and higher general resilience and quality of life. PROMIS, Patient-Reported Outcomes Measurement Information System; BRS, Brief Resilience Scale; WHOQOL, World Health Organization Quality of Life questionnaire.