Managing Low Back Pain in Older Adults: A Multi-Country Observational Study

This thesis investigates the clinical course and management of low back pain (LBP) in older adults receiving chiropractic care, aiming to provide a comprehensive understanding of treatment outcomes and healthcare utilization in this demographic. Through a prospective, multi-center, observational cohort study, the research addresses several critical clinical questions. Chapters 3 - 5 present the results of various analyses using this data, while additional insights are drawn from a related study on healthcare costs. Chapter 1: Introduction In Chapter 1, a brief overview of the studies included in this thesis is provided, along with the primary clinical questions addressed. The focus is on understanding the course of LBP in older adults and the effectiveness of chiropractic care. Chapter 2: Spinal Manipulative Therapy in Older Adults: An Individual Participant Data Analysis Chapter 2 discusses the efficacy of spinal manipulative therapy for older patients with chronic low back pain. It introduces various researchers and practitioners involved in the study, illustrating the need for tailored therapeutic approaches. The chapter underscores the potential benefits of chiropractic care while acknowledging the necessity of further research to optimize treatment outcomes. Chapter 3: Comparison of Disability Indexes Chapter 3 examines the validity, reliability, and responsiveness of three commonly used disability questionnaires (Roland-Morris Disability Questionnaire, Oswestry Disability Index, and Quebec Back Pain Disability Scale) in older adults undergoing chiropractic care for LBP. Findings indicate that all three indexes have sufficient reliability and validity, though each has unique strengths and limitations. Chapter 4: Pain Trajectories in Older Adults In Chapter 4, latent class analysis is used to identify distinct pain trajectories in older adults with LBP. Three main trajectories are identified: improvement from severe pain, improvement from moderate pain, and stable moderate pain. The study highlights the variability in pain experiences among older adults and discusses the implications for tailored interventions. Chapter 5: Back Complaints in the Elders – Chiropractic (BACE-C): design of a cohort study in chiropractic care Chapter 5 outlines the design and methodology of the Back Complaints in Elders Chiropractic (BACE-C) study. This chapter details the inclusion criteria, data collection methods, and the significance of studying LBP in older adults across multiple countries, specifically the Netherlands, Sweden, and the UK. Chapter 6: The Clinical Course of LBP Chapter 6 evaluates the one-year clinical course of LBP in older adults receiving chiropractic care. Key findings include a gradual reduction in pain levels and consistent functional improvements throughout the year. The chapter also discusses healthcare utilization patterns, noting high use of medical specialist visits and diagnostic imaging, particularly in Sweden. Chapter 7: General Discussion The final chapter presents the principal findings of the thesis, discussing their implications for clinical practice and future research. The strengths and limitations of the study are reviewed, and recommendations for optimizing chiropractic care for older adults with LBP are provided. Overall, this thesis contributes valuable real-world evidence on the clinical course, treatment outcomes, and healthcare utilization associated with chiropractic care for older adults with LBP. It underscores the importance of personalized, multidisciplinary care strategies to enhance the quality of life for this growing population.