Chronic low back pain in older adults: prevalence, reliability, and validity of physical examination findings.
OBJECTIVE
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.


METHODS
Cross-sectional survey and examination.


METHODS
Older adult pain clinic.


METHODS
One hundred eleven community-dwelling adults aged 60 and older with CLBP and 20 who were pain-free.


METHODS
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).


CONCLUSIONS
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.
Weiner
Debra K
DK
Department of Medicine, Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. dweiner@pitt.edu
Sakamoto
Sara
S
Perera
Subashan
S
Breuer
Paula
P
D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D008297:Male; D009140:Musculoskeletal Diseases / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D010147:Pain Measurement; D010808:Physical Examination; D015995:Prevalence; D015203:Reproducibility of Results