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

Background: Although there are many special exercise-based therapy approaches for the working population suffering chronic low back pain, similar programmes for older individuals are rare. Objectives: To summarise all evaluated physical therapy approaches, and assess the effects on older people with chronic low back pain. Data sources: Medline, CINAHL, Cochrane, Embase, PEDro, PsychINFO and Psyndex. Study selection/eligibility: Age. ≥. 65 years, subacute or chronic non-specific low back pain of ≥6. weeks' duration, and a physical therapy approach. Study appraisal and synthesis methods: Study 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. Results: In 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. Limitations: The results must be interpreted with caution due to poor methodological quality. Conclusion and implications of key findings: Few 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. © 2015 Chartered Society of Physiotherapy.