Lower back pain (LBP) is the leading cause of disability worldwide and is extremely common.  Over 70% of people will suffer with LBP in their lifetime, and the chance of having the most serious forms of LBP is greatest in later life. LBP is associated with mobility decline and falls in older people, and in turn, loss of independence and frailty.

Conversely, this is the time in life when GPs and patients are least likely to target LBP for treatment. The reasons are complicated. In later life people are much more likely to have other health conditions which they think are a greater priority for treatment. Some older people just grin and bear the pain, accepting it as part of ageing. GPs and older people may not recognise the importance of LBP to the development of frailty and decline in later life.

Although there is a large body of research in LBP, this has focused almost exclusively on younger people. Hence there is little guidance appropriate to older people. We suspect older people respond and react differently to the common treatments for LBP.

Our aim

Our aim is twofold. The first is to help primary health care teams, patients and their carers recognise when LBP is a useful treatment target in older people, and to explore and hopefully counter prejudices held by older people and clinicians.

Our second aim is to evaluate whether physiotherapy can benefit people with common spinal condition unique to old age called neurogenic claudication (NC). NC results from narrowing of the spinal canal due to degeneration putting pressures on nerves and blood vessels (spinal stenosis) causing pain and other symptoms in the back and legs. It particularly affects a person’s ability to stand and walk.

Our objectives:

  • To refine a physiotherapy intervention for neurogenic claudication (NC).
  • To complete a feasibility study for a prognostic study and clinical trial of the NC intervention in the UK NHS.
  • To develop a tool that will help clinicians and older people recognise when and what types of LBP are important targets for treatment for older people. The outcomes will be mobility, disability, frailty and falls.
  • If feasible, to undertake a definitive randomised controlled trial demonstrating that access and participation in a physiotherapy intervention for NC can improve important outcomes including pain, disability, mobility, frailty and falls.
  • Explore whether MRI scans and other factors can help determine who will and will not respond to this treatment.
  • To integrate the findings of the trial and the prognostic tool into a package of treatments that can be used in primary care and other settings. This will include exploring GPs attitudes and beliefs to inform implementation and future research.

We need physiotherapy departments to be involved in recruiting participants and providing physiotherapy treatments as part of this research.

If you are interested in this research and would like to know more, please contact the team on boost@ndorms.ox.ac.uk

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