We have recently embarked on a new programme of work to investigate the management of back pain in older people; the BOOST programme (Better Outcomes for Older people with Spinal Trouble).
At the heart of this research programme is a randomised controlled trial of a physiotherapy programme for people over 65 years old with neurogenic claudication. This is a condition that arises from degenerative changes within the spine resulting in pressure on nerves and blood vessels. Commonly, people report pain and other symptoms such as tingling and weakness in their legs as well as back pain. It is particularly disabling as it affects a person's ability to stand and walk which is a real threat to maintaining independence which we know is a priority of older people.
In February we bought together key stakeholders to discuss the physiotherapy intervention to be tested.
Physiotherapists, occupational therapists, a health psychologist, a cognitive behavioural therapist, a sociologist, patient representatives and researchers with experience of working with older adults spent a day together at Wadham College, Oxford. RRIO has held similar days for previous studies and they have been invaluable in ensuring that the intervention to be tested is acceptable to both clinicians and patients.
The aim of the day was to gather the views of all attendees on the proposed intervention and the majority of the day was spent in group discussion about the intervention. Everybody was given the opportunity to comment and give their views. Attendees also voted on possible components of the intervention to help prioritise the intervention content.
Generally the intervention components were as we expected – a group programme focusing on fitness, strength and balance with education and discussion promoting physical activity and exercise, understanding the condition and pain management skills. However, discussions from the day highlighted the challenge of delivering a physiotherapy intervention within the current restraints of the health service. This means that compromises will need to be made to ensure we design an intervention that is deliverable in the NHS if we want departments to sign up for the trial. This has to be balanced against the necessity to design an intervention that is likely to work. Ensuring that patients attend for enough sessions so that we are confident they have received an adequate dose of exercise to improve strength and fitness is vital.
In some ways, the day has raised more questions than answers. Now, the challenge is for us is to take away what key stakeholders have told us and use this information to come up with a rehabilitation programme that is evidence driven but also deliverable in the NHS. The BOOST team have some thinking to do.
Read more about the BOOST programme here