Is multidisciplinary rehabilitation for low back pain effective in patients above 65 years? An observational cohort study with 12-month follow-up.

Abstract

BACKGROUND\nIn contrast to the broad evidence for the effectiveness of multidisciplinary biopsychosocial rehabilitation (MBR) in chronic low back pain (CLBP) patients of working age, little is known about the benefit in patients aged ≥ 65 years.\n\n\nAIM\nTo quantify the short-term and 12-month effects of a 3-week CLBP specific MBR program in patients ≥ 65 years of age; to compare the effects in patients ≥ 65 years of age to the effects in younger patients.\n\n\nDESIGN\nObservational prospective cohort study.\n\n\nSETTING\nOutpatient clinic at a tertiary physical medicine and rehabilitation centre.\n\n\nPOPULATION\nConsecutive patients with CLBP who participated in a CLBP a specific MBR program.\n\n\nMETHODS\nThe 3-week MBR program included 44 hours of treatment. The primary outcomes pain and disability were measured by the North American Spine Society Questionnaire (NASS). Secondary outcome measures were the Short-Form 36 (SF-36) and the numerical rating scale for pain. Effects were quantified using effect sizes (ES).\n\n\nRESULTS\nFrom 203 included patients, 104 patients older than 65 years (mean: 70.7; SD: 4.0) were compared to 99 patients younger than 65 years (mean: 56.4; SD: 6.7). The older patients had more comorbidities (two or more comorbidities: 49.5% versus 23.5%; p < 0.001). Both groups showed significant improvements in pain and disability at discharge (both groups: p<0.001) and at the 12 months follow-up (old: p < 0.001; young: 0.039) with slightly higher effects for the older patients compared to the younger patients (discharge: ES = 0.67 versus ES = 0.53; 12 months: ES = 0.42 versus ES = 0.29). Both groups also improved in the SF-36 Physical Component Summary with slightly lower effects for the older patients (discharge: ES =0.31, p<0.001 versus ES=0.43, p<0.001; 12 months: ES=0.27, p=0.025 versus ES=0.39, p=0.001). The group differences of the change scores were not significant in any of the outcome measures.\n\n\nCONCLUSIONS\nMBR shows similar improvements in pain and disability in patients aged ≥ 65 compared to younger patients for at least 12 months.\n\n\nCLINICAL REHABILITATION IMPACT\nThe findings support the concept of MBR in the growing population of CLBP patients older than 65 years of age.