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Chronic Low Back Pain in Older Adults: Prevalence, Reliability, and Validity of Physical Examination Findings
Author(s) -
Weiner Debra K.,
Sakamoto Sara,
Perera Subashan,
Breuer Paula
Publication year - 2006
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2005.00534.x
Subject(s) - medicine , physical therapy , fibromyalgia , lumbar , physical examination , low back pain , scoliosis , chronic pain , referred pain , back pain , sacroiliac joint , physical medicine and rehabilitation , surgery , alternative medicine , pathology
Objectives: To develop a structured physical examination protocol that identifies common biomechanical and soft‐tissue abnormalities for older adults with chronic low back pain (CLBP) that can be used as a triage tool for healthcare providers and to test the interobserver reliability and discriminant validity of this protocol. Design: Cross‐sectional survey and examination. Setting: Older adult pain clinic. Participants: One hundred eleven community‐dwelling adults aged 60 and older with CLBP and 20 who were pain‐free. Measurements: Clinical history for demographics, pain duration, previous lumbar surgery or advanced imaging, neurogenic claudication, and imaging clinically serious symptoms Physical examination for scoliosis, functional leg length discrepancy, pain with lumbar movement, myofascial pain (paralumbar, piriformis, tensor fasciae latae (TFL)), regional bone pain (sacroiliac joint (SIJ), hip, vertebral body), and fibromyalgia. Results: Scoliosis was prevalent in those with (77.5%) and without pain (60.0%), but prevalence of SIJ pain (84% vs 5%), fibromyalgia tender points (19% vs 0%), myofascial pain (96% vs 10%), and hip pain (48% vs 0%) was significantly different between groups ( P < .001). Interrater reliability was excellent for SIJ pain (0.81), number of fibromyalgia tender points (0.84), and TFL pain (0.81); good for scoliosis (0.43), kyphosis (0.66), lumbar movement pain (0.75), piriformis pain (0.71), and hip disease by internal rotation (0.56); and marginal for leg length (0.00) and paravertebral pain (0.39). Conclusion: Biomechanical and soft tissue pathologies are common in older adults with CLBP, and many can be assessed reliably using a brief physical examination. Their recognition may save unnecessary healthcare expenditure and patient suffering.