title: Deconstructing Chronic Low Back Pain in the Older Adult-Step-by-Step Evidence and Expert-Based Recommendations for Evaluation and Treatment: Part XII: Leg Length Discrepancy.
abstract: To present the last in a 12-part series designed to deconstruct chronic low back pain (CLBP) in older adults. This article focuses on leg length discrepancy (LLD) and presents an algorithm outlining approaches to diagnosis and management of LLD in older adults, along with a representative clinical case. METHODS : Using a modified Delphi approach, the LLD evaluation and treatment algorithm was developed by a multidisciplinary expert panel representing expertise in physical therapy, geriatric medicine, and physical medicine and rehabilitation. The materials were subsequently refined through an iterative process of input from a primary care provider panel comprised of VA and non-VA providers. The clinical case was taken from one of the authors. RESULTS : We present an algorithm and illustrative clinical case to help guide the care of older adults with LLD, which can be an important contributor to CLBP. Firstline assessment includes referral to physical therapy or orthopedics, depending on the context of the LLD. A variety of nonsurgical interventions may ensue depending on the etiology of the LLD, including shoe inserts, customized shoes, manual therapy, or a combination. CONCLUSIONS : To promote a patient-centered approach, providers should consider evaluating for leg length discrepancy when treating older adults with CLBP to help diminish pain and disability.
authors.affiliation: Extended Care and Rehab, VA Central Iowa Health Care Systems, De Moines, Iowa.|Rehabilitation and Prosthetics Services, Veterans Health Administration, Washington DC.
authors.forename: Mark
authors.initials: M
authors.lastname: Havran
authors.affiliation: Washington DC VA Medical Center, Washington DC.|Rehabilitation and Prosthetics Services, Veterans Health Administration, Washington DC.
authors.forename: Joel D
authors.initials: JD
authors.lastname: Scholten
authors.affiliation: Centers for Rehab Services, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Paula
authors.initials: P
authors.lastname: Breuer
authors.affiliation: Extended Care and Rehab, VA Central Iowa Health Care Systems, De Moines, Iowa.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Lundberg
authors.affiliation: VA Medical Center, Canandaigua, New York.|Division of Geriatrics, School of Medicine and Dentistry, University of Rochester, Rochester, New York.
authors.forename: Gary
authors.initials: G
authors.lastname: Kochersberger
authors.affiliation: Geriatric Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Departments of.
authors.forename: Dave
authors.initials: D
authors.lastname: Newman
authors.affiliation: Geriatric Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Departments of debra.weiner@va.gov.|Geriatric Medicine.|Psychiatry.|Anesthesiology.|Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: Debra K
authors.initials: DK
authors.lastname: Weiner
mesh_terms: D000369:Aged, 80 and over; D000465:Algorithms; D059350:Chronic Pain; D003697:Delphi Technique; D019317:Evidence-Based Medicine; D006801:Humans; D007870:Leg Length Inequality / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D017116:Low Back Pain / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D008297:Male; D059408:Pain Management / Q000379:methods*
keywords: Chronic Low Back Pain; Chronic Pain; Elderly; Leg Length Discrepancy; Leg Length Inequality; Older Adults