Spinal manipulative therapy in older adults with chronic low back pain: an individual participant data meta-analysis.

PURPOSE: Many systematic reviews have reported on the effectiveness of spinal manipulative therapy (SMT) for low back pain (LBP) in adults. Much less is known about the older population regarding the effects of SMT. OBJECTIVE: To assess the effects of SMT on pain and function in older adults with chronic LBP in an individual participant data (IPD) meta-analysis. SETTING: Electronic databases from 2000 until June 2020, and reference lists of eligible trials and related reviews. DESIGN AND SUBJECTS: Randomized controlled trials (RCTs) which examined the effects of SMT in adults with chronic LBP compared to interventions recommended in international LBP guidelines. METHODS: Authors of trials eligible for our IPD meta-analysis were contacted to share data. Two review authors conducted a risk of bias assessment. Primary results were examined in a one-stage mixed model, and a two-stage analysis was conducted in order to confirm findings. MAIN OUTCOMES AND MEASURES: Pain and functional status examined at 4, 13, 26, and 52 weeks. RESULTS: 10 studies were retrieved, including 786 individuals, of which 261 were between 65 and 91 years of age. There is moderate-quality evidence that SMT results in similar outcomes at 4 weeks (pain: mean difference [MD] - 2.56, 95% confidence interval [CI] - 5.78 to 0.66; functional status: standardized mean difference [SMD] - 0.18, 95% CI - 0.41 to 0.05). Second-stage and sensitivity analysis confirmed these findings. CONCLUSION: SMT provides similar outcomes to recommended interventions for pain and functional status in the older adult with chronic LBP. SMT should be considered a treatment for this patient population.

Roland-Morris Disability Questionnaire, Oswestry Disability Index, and Quebec Back Pain Disability Scale: Which Has Superior Measurement Properties in Older Adults With Low Back Pain?

OBJECTIVE: To examine the validity, reliability, and responsiveness of 3 commonly used questionnaires for assessing physical function (ie, Oswestry Disability Index [ODI], Quebec Back Pain Disability Scale [QBPDS], and Roland-Morris Disability Questionnaire [RMDQ]) in older patients undergoing chiropractic care for low back pain (LBP). DESIGN: Head-to-head clinimetric comparison. METHODS: Patients completed the ODI, QBPDS, and RMDQ at baseline and after 2 weeks of treatment. Reliability was evaluated for internal consistency (Cronbach α), test-retest reliability (interclass correlation coefficient [ICC]), and measurement error (standard error of measurement and smallest detectable change [SDC]). Structural validity was evaluated through unidimensional confirmatory factor analysis, and construct validity was investigated by a priori hypotheses with other measures. Responsiveness was evaluated by testing a priori hypotheses using data at baseline and at 2-week follow-up. RESULTS: Two hundred fourteen patients (53% males and 47% females) with a mean age of 66.2 years (standard deviation = 7.8 years) were included, of which 193 patients completed the 2-week follow-up for our responsiveness analysis. The RMDQ, ODI, and QBPDS showed sufficient internal consistency (Cronbach α of .89, .86, and .94, respectively) and test-retest reliability (ICC[2,1] of 0.85, 0.89, and 0.84, respectively). The SDC for the RMDQ was 6.9, for the ODI was 19.1, and for the QBPDS was 23.6, which are values larger than the minimal important change. None of the measures met all criteria for sufficient structural validity, but the RMDQ and ODI exhibited a partial unidimensional fit. The questionnaires had sufficient construct validity and responsiveness. CONCLUSION: The ODI, QBPDS, and RMDQ have similar measurement properties in older adults with LBP. J Orthop Sports Phys Ther 2022;52(7):457-469. Epub: 18 May 2022. doi:10.2519/jospt.2022.10802.

Psychological interventions for reducing fear avoidance beliefs among people with chronic back pain.

OBJECTIVE: Chronic back pain (CBP) is responsible for considerable suffering across the world and is frequently associated with decreased functional capacity, quality of life, and substantial health care costs. Fear avoidance beliefs (FAB) comprise cognitions and fears about the potential for physical activities to produce pain and harm and are common among people with CBP. Collectively, research shows that FAB are frequently associated with low levels of physical activity, poorer work outcomes, and disability. Therefore, the purpose of this systematic review is to systematically locate and synthesize the current evidence regarding the effectiveness of psychological interventions on fear avoidance beliefs and fear avoidance behavior in patients with CBP. DESIGN: A systematic literature search was conducted based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and included the databases Web of Science, PubMed, Cochrane, CINAHL, Medline, and PsycINFO. RESULTS: A total of 5,052 records were identified resulting in 2,448 documents after duplicates were removed. We screened 147 studies full text. Twenty-two studies were included in the qualitative synthesis. FAB were assessed by the Fear Avoidance Beliefs Questionnaire, the Tampa Scale of Kinesiophobia and the Avoidance Exercise Questionnaire. Interventions included cognitive behavior therapy (CBT), psychoeducation (PE), and other psychological approaches like motivational interviewing. Twelve of 22 studies demonstrated significant improvements in FAB for people with CBP who underwent a PE or CBT intervention or a different psychological approach. CONCLUSION: CBT and PE interventions are mainly used to address FAB among people with CBP. However, there is still inconsistent evidence as to which psychological interventions are most effective to treat FAB among people with CBP. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

BAck complaints in the elders - chiropractic (BACE-C): protocol of an international cohort study of older adults with low back pain seeking chiropractic care.

BACKGROUND: Low back pain is a common condition among older adults that significantly influences physical function and participation. Compared to their younger counterparts, there is limited information available about the clinical course of low back pain in older people, in particularly those presenting for chiropractic care. Improving our understanding of this patient population and the course of their low back pain may provide input for studies researching safer and more effective care than is currently provided. OBJECTIVES: The primary objectives are to examine the clinical course over one year of pain intensity, healthcare costs and pain, functional status and recovery rates of low back pain in people 55 years and older who visit a chiropractor for a new episode of low back pain. METHODS: An international prospective, multi-center cohort study with one-year follow-up. Chiropractic practices are to be recruited in the Netherlands, Sweden, United Kingdom and Australia. Treatment will be left to the discretion of the chiropractor. Inclusion/Exclusion criteria: Patients aged 55 and older who consult a chiropractor for a new episode of low back pain, meaning low back pain for the first time or those patients who have not been to a chiropractor in the previous six months. This is independent of whether they have seen another type of health care provider for the current episode. Patients who are unable to complete the web-based questionnaires because of language restrictions or those with computer literacy restrictions will be excluded as well as those with cognitive disorders. In addition, those with a suspected tumor, fracture, infection or any other potential red flag or condition considered to be a contraindication for chiropractic care will be excluded. Data will be collected using online questionnaires at baseline, and at 2 and 6 weeks and at 3, 6, 9 and 12 months. DISCUSSION: This study, to our knowledge, is the first large-scale, prospective, multicenter, international cohort study to be conducted in a chiropractic setting to focus on older adults with low back pain consulting a chiropractor. By understanding the clinical course, satisfaction and safety of chiropractic treatment of this common debilitating condition in the aged population, this study will provide input for informing future clinical trials. TRIAL REGISTRATION: Nederlandse Trial Registrar NL7507.