Chiropractic and Exercise for Seniors With Low Back Pain

Northwestern Health Sciences University

Status and phase

Completed

Phase 2

Conditions

Low Back Pain

Treatments

Procedure: Supervised rehabilitative exercise+home exercise

Behavioral: Home exercise

Procedure: Chiropractic Manual treatment + home exercise (procedure+behavior)

Study type

Interventional

Funder types

Other

Other U.S. Federal agency

Identifiers

NCT00269321

5R18HP01424

Details and patient eligibility

About

The purpose of this randomized clincal trial is to assess the relative effectiveness of three conservative treatment approaches for seniors with chronic low back pain: 1) chiropractic manual treatment plus home exercise, 2) supervised exercise plus home exercise and 3) home exercise alone.

Full description

Low back pain (LBP) is a significant health problem for both young and geriatric individuals. Of particular concern is that conditions associated with LBP, such as impaired strength and flexibility, can have very serious consequences for an older individual's independence and overall health.

The broad, long-term objective of this research is to identify effective therapies for low back pain (LBP) and to discover the best methods for enhancing health and functional capacity in the elderly population. This study is a multi-methods clinical trial consisting of a randomized clinical trial (RCT), a cost-effectiveness study alongside the RCT, and a qualitative study nested in the RCT.

This trial builds upon a previous study of chiropractic and exercise funded by HRSA, and focuses on elderly patients with sub-acute and chronic low back pain.

PRIMARY AIMS

To determine the relative clinical effectiveness the following treatments for LBP patients 65 years and older in both the short-term (after 12 weeks) and long-term (after 52 weeks), using low back pain as the main outcome measure
1. chiropractic manual treatment plus home exercise
2. supervised rehabilitative exercise plus home exercise
3. home exercise
  
  SECONDARY AIMS
To estimate the short- and long-term relative effectiveness of the three interventions using:
Patient-rated outcomes: low back disability, general health status, patient satisfaction, improvement, and medication use measured by self-report questionnaires
Objective functional performance outcomes: spinal motion, trunk strength and endurance, and functional ability measured by examiners masked to treatment group assignment
Cost measures: direct and indirect costs of treatment measured by questionnaires, phone interviews, and medical records.
To describe elderly LBP patients' perceptions of treatment and the issues they consider when determining their satisfaction with care using qualitative methods nested within the RCT.

Enrollment

240 patients

Sex

All

Ages

65+ years old

Volunteers

No Healthy Volunteers

Inclusion criteria

Sub-Acute and chronic low back pain (Defined as current episode more than 6 weeks duration.)
Quebec Task Force classifications 1, 2, 3 and 4. (This includes patients with back pain, stiffness or tenderness, with or without musculoskeletal signs and neurological signs.{1570})
65 years of age and older
Independent ambulation
Community dwelling (residency outside nursing home)
Score of 20 or more on Folstein Mini-Mental State Examination{13246}
Stable prescription medication plan (no changes in prescription medications that affect musculoskeletal pain in previous month)

Exclusion criteria

Referred low back pain from local joint lesions of the lower extremities or from visceral diseases
Significant infectious disease Determined by history or by referral to supplementary diagnostic tests
Ongoing treatment for low back pain by other health care providers
Mean baseline low back pain score of 20 percentage points or less
Contraindications to exercise Determined by history or by referral to supplementary diagnostic tests (i.e., uncontrolled arrhythmias, third degree heart block, recent ECG changes, unstable angina, acute myocardial infarction, acute congestive heart failure, cardiomyopathy, valvular heart disease, poorly controlled blood pressure, uncontrolled metabolic disease
Contraindications to spinal manipulation (i.e. Progressive neurological deficits blood clotting disorders; infectious and non-infectious inflammatory or destructive tissue changes of the spine; severe osteoporosis)