title: Chronic low back pain in older adults: prevalence, reliability, and validity of physical examination findings.
abstract: 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.
authors.affiliation: Department of Medicine, Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. dweiner@pitt.edu
authors.forename: Debra K
authors.initials: DK
authors.lastname: Weiner
authors.forename: Sara
authors.initials: S
authors.lastname: Sakamoto
authors.forename: Subashan
authors.initials: S
authors.lastname: Perera
authors.forename: Paula
authors.initials: P
authors.lastname: Breuer
mesh_terms: 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