Back Pain in Older Adults

The World Health Organisation has identified low back pain as the major disabling condition in older persons. Low back pain limits their physical ability and decreases social well-being. Of those older adults who experience back pain, 1 in 5 report difficulties in caring for themselves at home or participating in family and social activities.1-4

In Australia, the prevalence of low back pain in older adults is 24 - 27%,5 therefore, in our ageing population a substantial number of older Australians regularly experience low back pain. Low back pain in older adults is more severe than in younger adults.6 For example, people aged >80 years are three times more likely to have high intensity low back pain than those aged 50-59 years.(7)

In a recent study, 74% of chiropractors reported regularly see older adults7 and 12% of chiropractic patients are older Australians.8 Therefore in terms of improving patient-centred care, research that is focused on establishing evidence on whether chiropractic is safe for older Australians and in understanding the risk factors of disability in this population is extremely important.

BACE:C-A

The Back Complaints in the Elderly: Chiropractic – Australia (BACE:C-A) study is an internationally collaborative, prospective, longitudinal study being led by post-doctoral research fellow, Dr Katie de Luca from Macquarie University. The team join a European BACE:C research group, led by Dr Sidney Rubenstein who developed the chiropractic protocol from the international consortium on BAck Complaints in Elders in a primary care setting.9

The study will follow adults over the age of 55 who see a chiropractor for a NEW episode of back pain for 12 months. It will collect vital information on the safety and satisfaction of chiropractic care for the treatment of low back pain in older people and determine predictors of disability in this population. Ultimately, information collected through BACE:C-A will assist chiropractic representation when engaging with healthcare policymakers and will place chiropractors as important stakeholders in the primary care of spinal health for older adults. The study was awarded a competitive research grant by the Australian Chiropractors Association in January 2019.

We need you!!

Having recently been granted ethics approval from Macquarie University, the BACE:C-A research team are now ready to engage with the profession and recruit chiropractors interested in participating in BACE:C—A. Chiropractors and their staff will be trained to recruit older chiropractic patients with low back pain to the study. As this study is purely observational, participating chiropractors will not be asked to provide an intervention to their patients. After completing the baseline survey, participants will complete a further six studies over 12 months, regardless of whether they have chiropractic treatment or not.

Interested chiropractors are invited to contact the BACE:C-A team to express their interest in participating. The study is particularly interested in hearing from chiropractors who feel they have a high number of older patients, particularly older people who are new patients.

What do patients have to do?

We are looking to recruit 1,000 older adults (aged 55 years and over) who present with a NEW episode of low back pain. Eligible older patients will be provided with an information sheet and consent form by clinic administration staff (where possible) and then asked to complete an online survey. Study participants will then be contacted via phone by the BACE:C-A team to confirm the details of the study. Participants will be sent six surveys over the course of 12 months, answering questions related to healthcare use and their pain experience.

“As a researcher, the clinics of chiropractors are the greatest opportunity that we have to collect data on chiropractic patients. This is the first study of its kind in Australia, and I hope that chiropractors will engage with researchers as opportunities for practice-based research arise. These are very exciting times, and I am looking forward to working with Australian chiropractors to collect valuable patient data.”

How to be a part of BACE:C-A

If you wish to be a part of the BACE:C-A study, please email Katie or Lucy (Research Assistant) at bace.c@mq.edu.au or for more information visit our website at mq.edu.au/about/bacechiropractic

REFERENCES:

1. Hartvigsen J, Frederiksen H and Christensen K. Back and neck pain in seniors-prevalence and impact. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 2006; 15: 802-806.

2. Leveille SG, Guralnik JM, Hochberg M, et al. Low back pain and disability in older women: independent association with difficulty but not inability to perform daily activities. The journals of gerontology Series A, Biological sciences and medical sciences 1999; 54: M487-493. 1999/11/24.

3. Weiner DK, Haggerty CL, Kritchevsky SB, et al. How does low back pain impact physical function in independent, well-functioning older adults? Evidence from the Health ABC Cohort and implications for the future. Pain medicine (Malden, Mass) 2003; 4: 311-320. 2004/01/31.

4. de Luca K, Parkinson L, Haldeman S, et al. The relationship between spinal pain and comorbidity: a cross-sectional analysis of 579 communitydwelling, older, Australian women. Journal of manipulative and physiological therapeutics 2017; 40: 459-466.

5. Walker BF, Muller R and Grant WD. Low back pain in Australian adults: prevalence and associated disability. Journal of manipulative and physiological therapeutics 2004; 27: 238-244. 2004/05/19. DOI: 10.1016/j.jmpt.2004.02.002.

6. Stewart Williams J, Ng N and Peltzer K. Risk Factors and Disability Associated with Low Back Pain in Older Adults in Low- and Middle Income Countries. Results from the WHO Study on Global AGEing and Adult Health (SAGE). . PloS One 2015; 10. DOI: 10.1371/journal.pone.0127880.

7. Moore C, de Luca K, Wong A, et al. Characteristics of chiropractors who manage people aged 65 and older: A nationally representative sample of 1903 chiropractors. Australasian Journal of Ageing 2018; In Press.

8. Charity MJ, Britt HC, Walker BF, et al. Who consults chiropractors in Victoria, Australia?: Reasons for attending, general health and lifestyle habits of chiropractic patients. Chiropractic & manual therapies 2016; 24: 28.

9. Scheele J, Luijsterburg PA, Ferreira ML, et al. Back Complaints in the Elders (BACE); design of cohort studies in primary care: an international consortium. BMC musculoskeletal disorders 2011; 12: 193. DOI: 10.1186/1471-2474-12-193.