Chiropractic Treatment Of Chronic Mechanical Low Back Pain In A Geriatric Population: A Practitioner-Scientist Protocol.
Subject: Geriatrics Research
Reference: Paul J. Osterbauer, D.C.*, Tom DeVita, D.C.**, Arlan W. Fuhr, D.C.*; *Activator Methods, Inc. **Private practice, Acton, MA. (Mailing address: 3714 East Indian School Road, Phoenix, AZ 85018.). Chiropractic Treatment Of Chronic Mechanical Low Back Pain In A Geriatric Population: A Practitioner-Scientist Protocol. In: The Proceedings of the FCER’s Third Annual International Conference on Spinal Manipulation. Washington. D.C., April 12-13. 1991. pp. 230-1
Introduction: Low back pain (LBP) is a common health problem among the elderly, affecting up to 90% of the over 65 population, and accounting for nearly $1 billion per year in Medicare payments alone. By far the greatest single cause of low back pain in the elderly is mechanical derangements occurring within the confines of the lumbar spine as a consequence of chronic degenerative joint disease which, in itself, is often painless and of little or no clinical significance.
Most of these cases (many of whom are presently being unsuccessfully treated in medical clinics and/or hospitals) would quite likely respond very well to routine office-based conservative chiropractic care. However, insofar as there is no conclusive data to support any particular method of chiropractic treatment for these cases, nor has there been any standardized procedures established by which such data might be collected for analysis, the issue is problematic inasmuch as most chiropractic physicians have had little training in clinical research methodology. Therefore, a “practitioner scientist” protocol was developed whereby selected office-based chiropractic physicians would collect the necessary data and provide treatment according to specified procedures under the direction of an experienced clinical researcher.
Basic inclusion/exclusion criteria were chosen for a standardized approach to the diagnosis of mechanical low back pain in the elderly and its treatment by conservative chiropractic technics. The inclusion criteria are:
- Age: 65 and over,
- Present episode of LBP greater than three months duration,
- Greater than 20 percent Modified Oswestry disability score (MODS),
- Primary pain localized to the lumbar spine (L1-S1),
- No prior chiropractic or medical treatment for present episode of LBP,
- No radicular or neurological symptoms,
- Any three of the following positive orthopedic tests:
- Kemp’s test (include only if it increased lumbar pain),
- Adam’s and supported Adam’s test (both equally cause pain in the lumbar spine),
- Goldthwait’s test (evokes lumbar pain or makes it worse, does not increase radiation of pain into the leg),
- Hyperextension test,
- Pain evoked on spinous process percussion which seated patient’s lumbar spine is flexed, Exclusion criteria are as follows:
- History of serious medical illness,
- Psychological disturbances,
- Recent trauma (major bruises; fractures; auto accidents; etc.),
- Leg or buttock pain of suspected neurological involvement,
- Anomalies such as spondylolisthesis,
- Uncertain diagnosis,
- referred pain of viscero-somatic origin,
- Change in diagnosis; new symptoms; deteriorating health while study is underway,
- More than two weeks of missed appointments.