Activating therapy modalities in older individuals with chronic non-specific low back pain: a systematic review

BackgroundAlthough there are many special exercise-based therapy approaches for the working population suffering chronic low back pain, similar programmes for older individuals are rare.ObjectivesTo summarise all evaluated physical therapy approaches, and assess the effects on older people with chronic low back pain.Data sourcesMedline, CINAHL, Cochrane, Embase, PEDro, PsychINFO and Psyndex.Study selection/eligibilityAge ≥ 65 years, subacute or chronic non-specific low back pain of ≥6 weeks’ duration, and a physical therapy approach.Study appraisal and synthesis methodsStudy selection, data extraction, and assessment of methodological quality and clinical relevance were performed independently by two reviewers. As there were only a few controlled trials and wide heterogeneity in observation periods and outcome measures, pooling of data was not feasible. Therefore, the results are presented descriptively.ResultsIn total, nine studies were included; six related to mixed physiotherapy modalities, one related to strength training, and two related to endurance training. Low-quality evidence suggests that physical therapy modalities are associated with a small-to-moderate reduction in pain and a small improvement in function.LimitationsThe results must be interpreted with caution due to poor methodological quality.Conclusion and implications of key findingsFew studies have been performed in this highly relevant and growing age group. It is not possible to recommend one particular modality or programme; as such, prescriptions should reflect patients’ preferences and local conditions. Further research of higher methodological quality is needed urgently.