Paulo R C do Nascimento1, Leonardo O P Costa2, Amanda C Araujo3, Stéphane Poitras4, Martin Bilodeau5. 1. School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, ON, Canada; Bruyère Research Institute, Ottawa, ON, Canada. Electronic address: paulotherapy@gmail.com. 2. Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil; Musculoskeletal Division, The George Institute for Global Health, Sydney, Australia. 3. Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil. 4. School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, ON, Canada. 5. School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, ON, Canada; Bruyère Research Institute, Ottawa, ON, Canada; School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, ON, Canada.
Abstract
OBJECTIVES: Systematically review the literature about all available interventions to manage non-specific low back pain (NSLBP) in older adults (≥60 years). DESIGN: We searched the Medline, EMBASE, CINAHL, LILACS, PEDro, and Cochrane CENTRAL databases reference lists for randomized controlled trials (RCTs) testing interventions for NSLBP. Two independent reviewers extracted data, assessed the risk of bias and completeness of the description of interventions. RESULTS: Eighteen (RCTs) fulfilled the eligibility criteria. Evidence about interventions to manage NSLBP in older adults is weak. Very low to moderate quality evidence showed that complementary health approach (i.e., manual therapy, acupuncture, mindfulness, yoga), percutaneous electrical nerve stimulation (PENS), education, exercise or pharmacological agents were not effective to produce a clinically significant reduction in pain and disability at short-term and intermediate-term compared to sham, usual care or minimal intervention. Interventions were moderately well-described according to the template for intervention description and replication (TIDieR) and the risk of bias was moderate 6.4 points on the 10-point PEDro Scale (SD=1.44). CONCLUSION: Evidence about interventions for NSLP in older adults is limited and new studies are highly likely to change these results. This result may impact healthcare providers due to the lack of effective evidence based interventions, patients, and policy makers that will expend financial resources with interventions that provide in the best scenario a not significant improvement of the clinical symptoms. Researchers need to consider the importance of designing clinical trials targeting older adults and examine possible outcome modifiers present in this population allowing the recommendation of more efficacious evidence-based interventions. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO (CRD42016036686).
OBJECTIVES: Systematically review the literature about all available interventions to manage non-specific low back pain (NSLBP) in older adults (≥60 years). DESIGN: We searched the Medline, EMBASE, CINAHL, LILACS, PEDro, and Cochrane CENTRAL databases reference lists for randomized controlled trials (RCTs) testing interventions for NSLBP. Two independent reviewers extracted data, assessed the risk of bias and completeness of the description of interventions. RESULTS: Eighteen (RCTs) fulfilled the eligibility criteria. Evidence about interventions to manage NSLBP in older adults is weak. Very low to moderate quality evidence showed that complementary health approach (i.e., manual therapy, acupuncture, mindfulness, yoga), percutaneous electrical nerve stimulation (PENS), education, exercise or pharmacological agents were not effective to produce a clinically significant reduction in pain and disability at short-term and intermediate-term compared to sham, usual care or minimal intervention. Interventions were moderately well-described according to the template for intervention description and replication (TIDieR) and the risk of bias was moderate 6.4 points on the 10-point PEDro Scale (SD=1.44). CONCLUSION: Evidence about interventions for NSLP in older adults is limited and new studies are highly likely to change these results. This result may impact healthcare providers due to the lack of effective evidence based interventions, patients, and policy makers that will expend financial resources with interventions that provide in the best scenario a not significant improvement of the clinical symptoms. Researchers need to consider the importance of designing clinical trials targeting older adults and examine possible outcome modifiers present in this population allowing the recommendation of more efficacious evidence-based interventions. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO (CRD42016036686).
Authors: Karen J Sherman; Robert D Wellman; Rene J Hawkes; Elizabeth A Phelan; Tamsin Lee; Judith A Turner Journal: J Altern Complement Med Date: 2020-02-03 Impact factor: 2.579
Authors: Kathleen K Mangione; Michael A Posner; Rebecca L Craik; Edward F Wolff; Richard H Fortinsky; Brock A Beamer; Ellen F Binder; Denise L Orwig; Jay Magaziner; Barbara Resnick Journal: Phys Ther Date: 2021-08-01