Ninety percent of persons over the age of 65 have some type of degenerative spine condition. While degenerative spine conditions are becoming increasingly common in the United States, the treatment outcomes are inconsistent presumably because the degree or severity of degenerative disease by clinical diagnostic testing does not correlate well with the person's level of self-reported pain and physical functioning. Lumbar degenerative spine conditions increase with age, wear and tear, and can result in considerable pain and physical functioning deficits. Poor treatment outcomes in persons with lumbar degenerative spine conditions can lead to chronic pain and long term disability and affect health related quality of life. Health promotion theories posit that patient perceptions are critical to engagement in health seeking behaviors and ultimately affect quality of life. This study uses an adapted theoretical model that utilizes concepts from the Wilson and Cleary's health related quality of life model and Pender's health promotion model. This study sought to determine how the demographic, biologic, and social antecedent factors affect health perceptions such as perceived physical functioning and perceived pain interference, and how health perceptions in turn, affect health seeking behaviors such as medication use and participation in prescribed exercise regimens. A retrospective record review of 130 patients from an urban community spine clinic was combined with a database of health perceptions at entry into treatment and 12 weeks of treatment. Females experienced lower perceived physical functioning than males (p = .014) at start of treatment. Persons with Medicaid insurance had higher levels of perceived pain interference (CI 5.53, 28.31) than any other insurance type at start of treatment. At 12 weeks of treatment persons with Medicaid insurance experienced lower levels of perceived physical functioning (CI -9.23, -28.81), higher levels of perceived pain interference (p = .001), and a higher number of comorbidities (p = .003) than persons with other insurance types. Higher levels of pain interference predicted the use of medications (p = .028) but lower perceived physical functioning predicted higher numbers of medications used (p = .001). Lower numbers of medications were used by persons with Medicaid insurance (p = .000). In this study, 3 factors were associated with poorer perceived physical functioning and/or higher levels of perceived pain interference-female sex/gender, Medicaid insurance and higher levels of comorbidity. In nursing practice, evaluation of the patient's environment and unique barriers can decrease the patient's frustration and increase physical functioning for patients with lumbar degenerative spine conditions. In persons with Medicaid insurance, careful assessment of patient access issues is necessary since persons with Medicaid insurance are at risk for being referred later in the process of their condition. Further research regarding the specific needs and barriers experienced by persons with Medicaid insurance is needed to develop and test interventions that improve care outcomes in lumbar degenerative spine conditions. Less aggressive treatment for painful musculoskeletal conditions has been well documented in persons with Medicaid insurance. This study provides evidence that persons with lumbar degenerative spine conditions and Medicaid insurance may have decreased levels of perceived physical functioning and increased levels of pain interference. Assuring that health care policy includes mechanisms that provide adequate access and services to persons with Medicaid insurance may decrease the likelihood of long term disability in lumbar degenerative spine conditions.
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