The evidence base for managing older persons with low back pain
Stephan Schild von Spannenberg1, Gareth T Jones2, Gary J Macfarlane2
1Department of Public Health, University of Bremen, Bremen, Germany.
British Journal of Pain
|October 31, 2015
Summary
Older adults often face suboptimal pain management. This review found many low back pain trials exclude older individuals, with few justifying age limits or analyzing age-specific effectiveness for manual therapy and exercise.
Area of Science:
- Geriatric Medicine
- Pain Management
- Clinical Trial Analysis
Background:
- Older adults may receive suboptimal pain care, with evidence suggesting differences in low back pain (LBP) management based on age.
- Low back pain is a prevalent condition requiring effective management strategies across all age groups.
Purpose of the Study:
- To review the evidence base for managing LBP in older individuals.
- To determine if randomized controlled trials provide data on the effectiveness of manual therapy and physical activity/exercise for LBP in older patients.
- To examine age restrictions and age-specific analyses in LBP trials.
Main Methods:
- Systematic review of randomized controlled trials contributing to UK National Institute for Health and Clinical Excellence (NICE) guidelines for LBP.
- Analysis of trial eligibility criteria for upper age limits and their justifications.
- Assessment of whether age-specific effectiveness analyses were conducted for manual therapy and physical activity/exercise.
Main Results:
- A significant proportion of trials for both manual therapy (24%) and physical activity/exercise (44%) had upper age limits of 60 years or less.
- Justifications for upper age limits were rarely provided (17% for manual therapy, 9% for physical activity/exercise).
- Age-specific analyses were uncommon, reported in only 14% of manual therapy trials and 1% of physical activity/exercise trials.
Conclusions:
- Upper age limits are frequently imposed in LBP trials for manual therapy and physical activity/exercise, often without clear justification.
- There is a lack of research reporting on the differential effectiveness of these common non-pharmacological treatments for low back pain in older populations.
