Physical therapy management of older adults with chronic low back pain

Chronic low back pain (CLBP) is common in older adults. Findings from younger patients may not be generalizable to older adults with this condition. Objective: To investigate the evidence from RCTs for the effectiveness of physiotherapeutic interventions on pain and function in older adults with non-specific CLBP. Study group: Studies including older adults (>65years) with non-specific CLBP of >3 month's duration were included. Methods: The Cochrane Back Research Groups' guidelines were used as a methodological template for this systematic review. A literature search of EMBASE, CENTRAL, Medline, AMED, CINAHL and PEDro was performed up to November 2010. Two reviewers assessed the quality of included articles and the evidence for interventions was qualified using the GRADE system. Results: Three moderate quality RCTs were included. They investigated the following: mindfulness meditation, Percutaneous Electrical Nerve Stimulation [PENS], Exercise, and PENS and Exercise combined. Outcome measures for pain and function were reported for the short and medium-term only. There was limited evidence that compared to control/placebo interventions mindfulness meditation, exercise, and PENS combined with exercise have no effect on pain or function in older adults with non-specific CLBP. There was conflicting evidence that PENS compared to placebo is effective for pain and function. Conclusions: This systematic review identified only three studies that have investigated the effect of physiotherapeutic interventions on older adults with CLBP. There was insufficient research upon which to make firm clinical recommendations. Further research is needed on this severely under investigated and growing clinical population, to guide clinical practice.