Prevalence of low back pain in older Brazilians: a systematic review with meta-analysis

Leopoldino, Amanda Aparecida Oliveira; Diz, Juliano Bergamaschine Mata; Martins, Vítor Tigre; Henschke, Nicholas; Pereira, Leani Souza Máximo; Dias, Rosângela Correa; Oliveira, Vinícius Cunha

doi:10.1016/j.rbre.2016.03.011

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Revista Brasileira de Reumatologia

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Review Article • Rev. Bras. Reumatol. 56 (3) • May-Jun 2016 • https://doi.org/10.1016/j.rbre.2016.03.011 copy

Prevalence of low back pain in older Brazilians: a systematic review with meta-analysis

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction

Prevalence of low back pain (LBP) is expected to increase worldwide with aging of the population but its prevalence in older people is not clear, mainly in developing countries.

Objective

To estimate the prevalence of LBP in older Brazilians.

Methods

Electronic searches on SciELO, LILACS, MEDLINE, EMBASE and CINAHL, as well as hand-searching identified studies investigating prevalence of LBP in older Brazilians aged 60 years or over. Two independent reviewers selected studies fulfilling the inclusion criteria, assessed risk of bias for each included study and extracted relevant data. Meta-analysis was conducted when enough homogeneity allowed and the GRADE system was used to summarize the overall quality of the evidence.

Results

Sixteen studies were included with a total of 28,448 participants. Data from point- and period-prevalence of LBP were obtained. Meta-analysis was conducted for 13 studies reporting point-prevalence. Pooled point-prevalence of LBP was 25.0% (95% CI 18.0–32.0). Other three studies investigated period-prevalence: one-week prevalence = 15.0% (95% CI 13.0–18.0); six-month prevalence = 43.0% (95% CI 42.0–44.0); and 12-month prevalence = 13.0% (95% CI 11.0–16.0). Sensitivity analyses were performed for point-prevalence and exclusion of studies with poorer methodological quality tended to increase the estimated prevalence of LBP.

Conclusion

Moderate-quality evidence showed that at any point in time one in four older Brazilians suffers from LBP. This was the first systematic review investigating nationwide data on the prevalence of LBP in older people and contributes important clinical and epidemiological evidence for policymakers.

Keywords
Systematic review; Prevalence; Low back pain; Older people; Brazil

Study	Design	Setting	Participants	Prevalence
Almeida et al.²²22 Almeida IC, Sa KN, Silva M, Baptista A, Matos MA, Lessa I. Chronic low back pain prevalence in the population of the city of Salvador. Rev Bras Ortop. 2008;43(3):96-102.	Population-based cross-sectional study	City (State) = Salvador (Bahia) Source of participants = random sample from community (urban); ≥60 years^a a Studies with the general population including older people aged 60 years or over (n ≥ 170 subjects).	n = 197 % of female = N/A Average age (SD) = N/A	Point-prevalence of chronic LBP = 18.3% (36 events) (Chronic LBP = ≥6 months)
Blay et al.²³23 Blay SL, Andreoli SB, Dewey ME, Gastal FL. Co-occurrence of chronic physical pain and psychiatric morbidity in a community sample of older people. Int J Geriatr Psychiatry. 2007;22(9):902-8.	Population-based cross-sectional study	City (State) = all State (Rio Grande do Sul) Source of participants = random sample from community (urban/rural); ≥60 years	n = 6961 % of female = 66.0 Average age (SD) = N/A	6-Month period prevalence of chronic LBP = 43.1% (3003 events) F = 47.5% (SE = 0.01) (2181 events), M = 34.7% (SE = 0.01) (822 events) (Chronic LBP = ≥3 months)
Dellaroza et al.²⁴24 Dellaroza MS, Pimenta CA, Duarte YA, Lebrao ML. Chronic pain among elderly residents in Sao Paulo, Brazil: prevalence, characteristics, and association with functional capacity and mobility (SABE Study). Cad Saude Publica. 2013;29(2):325-34.	Population-based cross-sectional study	City (State) = São Paulo (São Paulo) Source of participants = random sample from community (urban); ≥60 years	n = 1271 % of female = 59.6 Average age (SD) = 69.5(0.6) years	Point-prevalence of chronic LBP = 25.4% (323 events) (Chronic LBP = ≥6 months)
Dotta et al.¹²12 Dotta TA, Bonadio MB, Furlaneto ME, Silva JS, Leme LE. Prevalence of acute diseases in the elderly assisted in emergency department of orthopedics. Acta Ortop Bras. 2014;22(9):99-101.	Cross-sectional study	City (State) = São Paulo (São Paulo) Source of participants = convenience sample from a tertiary care setting; ≥60 years	n = 12,916 % of female = 68.4 Average age (SD) = N/A	Point-prevalence of acute LBP^b b Duration not defined. = 16.0% (2067 events)
Lima et al.²⁵25 Lima MG, Barros MB, Cesar CL, Goldbaum M, Carandina L, Ciconelli RM. Impact of chronic disease on quality of life among the elderly in the state of Sao Paulo, Brazil: a population-based study. Rev Panam Salud Publica. 2009;25(4):314-21.	Population-based cross-sectional study	City (State) = Botucatu, Campinas, Itapecerica da Serra, Embu, Taboão da Serra and São Paulo (São Paulo) Source of participants = random sample from community (urban); ≥60 years	n = 1958 % of female = 57.2 Average age (SD) = 69.9(0.3) years	Point-prevalence of chronic LBP^b b Duration not defined. = 30.1% (589 events)
Mascarenhas et al.²⁶26 Mascarenhas CH, Silva Neto DG, Sampaio LS, Reis LA, Oliveira TS, Torres GV, et al. Neurological and orthopedic diseases prevalence and pattern distribution in the elderly at Prado Valadares General Hospital. Rev Baiana Saude Publica. 2008;32(1):43-50.	Cross-sectional study	City (State) = Jequié (Bahia) Source of participants = convenience sample from a secondary care setting; ≥60 years	n = 353 % of female = N/A Average age (SD) = N/A	Point-prevalence of LBP of any duration^b b Duration not defined. = 5.7% (20 events)
Meneses et al.²⁷27 Meneses GS, Leorne RO, Gouveia SS, Gouveia GP. Correlation of changes and pain in elderly osteomyoarticular of Morrinhos – CE. Rev Bras Cien Envelh Hum. 2013;10(2):139-49.	Cross-sectional study	City (State) = Morrinhos (Ceará) Source of participants = random sample from community (urban/rural); ≥60 years	n = 275 % of female = 61.5 Average age (SD) = 70.0(8.0) years	Point-prevalence of LBP of any duration^b b Duration not defined. = 40.4% (111 events)
Meucci et al.²⁸28 Meucci RD, Fassa AG, Paniz VM, Silva MC, Wegman DH. Increase of chronic low back pain prevalence in a medium-sized city of southern Brazil. BMC Musculoskelet Disord. 2013;14:155.	Population-based cross-sectional study	City (State) = Pelotas (Rio Grande do Sul) Source of participants = random sample from community (urban); ≥60 years^a a Studies with the general population including older people aged 60 years or over (n ≥ 170 subjects).	n = 635 % of female = N/A Average age (SD) = N/A	12-month period prevalence of chronic LBP = 13.0% (95% CI 10.5 to 16.0) (83 events) (Chronic LBP = ≥7 weeks)
Panazzolo et al.²⁹29 Panazzolo D, Trelha CS, Dellaroza MS, Cabrera M, Souza R. Chronic pain in older people inhabitants of the Cabo Frio District of Londrina – PR. Rev Dor. 2007;8(3):1047-51.^,³⁰30 Dellaroza MS, Furuya RK, Cabrera M, Matsuo T, Trelha CS, Yamada KN, et al. Characterization of chronic pain and analgesic approaches among community-dwelling elderly people. Rev Assoc Med Bras. 2008;54:36-41.^,^c c Data available in two studies.	Cross-sectional study	City (State) = Londrina (Paraná) Source of participants = convenience sample from community (urban); ≥60 years	n = 245 % of female = 57.5 Average age (SD) = 68.8(6.9) years	Point-prevalence of LBP of any duration^b b Duration not defined. = 31.0% (76 events) Point-prevalence of chronic LBP = 27.7% (68 events) F = 28.4% (40 events), M = 26.9% (28 events) for chronic LBP (Chronic LBP = ≥6 months)
Pereira et al.³¹31 Pereira LV, Vasconcelos PP, Souza LA, Pereira GA, Nakatani AY, Bachion MM. Prevalence and intensity of chronic pain and self-perceived health among elderly people: a population-based study. Rev Latino Am Enfermagem. 2014;22(4):662-9.	Population-based cross-sectional study	City (State) = Goiânia (Goiás) Source of participants = random sample from community (urban); ≥60 years	n = 872 % of female = 62.3 Average age (SD) = 71.6(8.5) years	1-week period prevalence of chronic LBP = 15.5% (135 events) F = 18.0% (98 events), M = 11.2% (37 events) (Chronic LBP = ≥6 months)
Rosito³²32 Rosito MP [Master's thesis] Doenças osteomusculares e articulares em idosos atendidos em um centro de reabilitação de um hospital universitário: descrição da prevalência e do perfil demográfico e de saúde. Porto Alegre: Pontifícia Universidade Católica do Rio Grande do Sul; 2012, 111 pp.	Cross-sectional study	City (State) = Porto Alegre (Rio Grande do Sul) Source of participants = convenience sample from a secondary care setting; ≥60 years	n = 1203 % of female = 66.7 Average age (SD) = 70.1(7.9) years	Point-prevalence of LBP of any duration^b b Duration not defined. = 14.4% (173 events)
Sampaio et al.³³33 Sampaio LS, Reis LA, Lessa RS. Prevalence of the orthopedic disorders of taken care aged in public hopsital of the city Lajedo do Tabocal – BA. Rev Enferm atual. 2007;7(41):30-2.	Cross-sectional study	City (State) = Lajedo do Tabocal (Bahia) Source of participants = convenience sample from a secondary care setting; ≥60 years	n = 171 % of female = N/A Average age (SD) = N/A	Point-prevalence of LBP of any duration^b b Duration not defined. = 23.4% (40 events)
Santos et al.³⁴34 Santos KA, Koszuoski R, Costa JS, Pattussi MP. Factors associated with functional incapacity among the elderly in Guatambu, Santa Catarina State, Brazil. Cad Saude Publica. 2007;23(11):2781-8.	Population-based cross-sectional study	City (State) = Guatambu (Santa Catarina) Source of participants = all older people from community (urban/rural); ≥60 years	n = 352 % of female = 47.4 Average age (SD) = N/A	Point-prevalence of LBP of any duration^b b Duration not defined. = 49.0% (172 events)
Silva et al.³⁵35 Silva EF, Paniz VM, Laste G, Torres IL. The prevalence of morbidity and symptoms among the elderly: a comparative study between rural and urban areas. Cien Saude Colet. 2013;18(4):1029-40.	Cross-sectional study	City (State) = Cachoeira do Sul (Rio Grande do Sul) Source of participants = convenience sample from community (urban/rural); ≥60 years	n = 229 % of female = 56.3 Average age (SD) = 72.3(7.7) years	Point-prevalence of LBP of any duration^b b Duration not defined. = 52.4% (120 events)
Silva et al.³⁶36 Silva MC, Fassa AG, Valle NC. Chronic low back pain in a Southern Brazilian adult population: prevalence and associated factors. Cad Saude Publica. 2004;20(2):377-85.	Population-based cross-sectional study	City (State) = Pelotas (Rio Grande do Sul) Source of participants = random sample from community (urban); ≥60 years^a a Studies with the general population including older people aged 60 years or over (n ≥ 170 subjects).	n = 583 % of female = N/A Average age (SD) = N/A	Point-prevalence of chronic LBP = 5.1% (95% CI 3.6 to 7.2) (30 events) (Chronic LBP = ≥7 weeks)
Virtuoso Junior³⁷37 Virtuoso Junior JS [Master's thesis] Habitual physical activity and functional autonomy of elderly people in Florianópolis, Santa Catarina, Brazil. Florianópolis: Universidade Federal de Santa Catarina; 2004, 99 pp.	Cross-sectional study	City (State) = Florianópolis (Santa Catarina) Source of participants = convenience sample from community (urban); ≥60 years	n = 227 % of female = 83.3 Average age (SD) = 68.1(5.2) years	Point-prevalence of LBP of any duration^b b Duration not defined. = 64.8% (147 events)

Study	Item
	1	2	3	4	5	6	7	8	9	10	Overall score (0-10)
Almeida et al.²²22 Almeida IC, Sa KN, Silva M, Baptista A, Matos MA, Lessa I. Chronic low back pain prevalence in the population of the city of Salvador. Rev Bras Ortop. 2008;43(3):96-102.	Y	Y	Y	Y	Y	Y	U	N	N	N	6
Blay et al.²³23 Blay SL, Andreoli SB, Dewey ME, Gastal FL. Co-occurrence of chronic physical pain and psychiatric morbidity in a community sample of older people. Int J Geriatr Psychiatry. 2007;22(9):902-8.	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	10
Dellaroza et al.²⁴24 Dellaroza MS, Pimenta CA, Duarte YA, Lebrao ML. Chronic pain among elderly residents in Sao Paulo, Brazil: prevalence, characteristics, and association with functional capacity and mobility (SABE Study). Cad Saude Publica. 2013;29(2):325-34.	Y	Y	Y	Y	Y	Y	U	N	N	N	6
Dotta et al.¹²12 Dotta TA, Bonadio MB, Furlaneto ME, Silva JS, Leme LE. Prevalence of acute diseases in the elderly assisted in emergency department of orthopedics. Acta Ortop Bras. 2014;22(9):99-101.	Y	N	Y	N	Y	N	N	N	N	N	3
Lima et al.²⁵25 Lima MG, Barros MB, Cesar CL, Goldbaum M, Carandina L, Ciconelli RM. Impact of chronic disease on quality of life among the elderly in the state of Sao Paulo, Brazil: a population-based study. Rev Panam Salud Publica. 2009;25(4):314-21.	Y	Y	Y	Y	Y	U	Y	N	N	N	6
Mascarenhas et al.²⁶26 Mascarenhas CH, Silva Neto DG, Sampaio LS, Reis LA, Oliveira TS, Torres GV, et al. Neurological and orthopedic diseases prevalence and pattern distribution in the elderly at Prado Valadares General Hospital. Rev Baiana Saude Publica. 2008;32(1):43-50.	Y	N	Y	N	Y	N	N	N	N	N	3
Meneses et al.²⁷27 Meneses GS, Leorne RO, Gouveia SS, Gouveia GP. Correlation of changes and pain in elderly osteomyoarticular of Morrinhos – CE. Rev Bras Cien Envelh Hum. 2013;10(2):139-49.	Y	Y	Y	Y	Y	N	N	N	N	N	5
Meucci et al.²⁸28 Meucci RD, Fassa AG, Paniz VM, Silva MC, Wegman DH. Increase of chronic low back pain prevalence in a medium-sized city of southern Brazil. BMC Musculoskelet Disord. 2013;14:155.	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	10
Panazzolo et al.²⁹29 Panazzolo D, Trelha CS, Dellaroza MS, Cabrera M, Souza R. Chronic pain in older people inhabitants of the Cabo Frio District of Londrina – PR. Rev Dor. 2007;8(3):1047-51.^,³⁰30 Dellaroza MS, Furuya RK, Cabrera M, Matsuo T, Trelha CS, Yamada KN, et al. Characterization of chronic pain and analgesic approaches among community-dwelling elderly people. Rev Assoc Med Bras. 2008;54:36-41.	Y	N	Y	N	U	Y	U	N	Y	Y	5
Pereira et al.³¹31 Pereira LV, Vasconcelos PP, Souza LA, Pereira GA, Nakatani AY, Bachion MM. Prevalence and intensity of chronic pain and self-perceived health among elderly people: a population-based study. Rev Latino Am Enfermagem. 2014;22(4):662-9.	Y	Y	Y	Y	Y	Y	Y	N	Y	Y	9
Rosito³²32 Rosito MP [Master's thesis] Doenças osteomusculares e articulares em idosos atendidos em um centro de reabilitação de um hospital universitário: descrição da prevalência e do perfil demográfico e de saúde. Porto Alegre: Pontifícia Universidade Católica do Rio Grande do Sul; 2012, 111 pp.	Y	N	Y	N	Y	U	U	N	N	N	3
Sampaio et al.³³33 Sampaio LS, Reis LA, Lessa RS. Prevalence of the orthopedic disorders of taken care aged in public hopsital of the city Lajedo do Tabocal – BA. Rev Enferm atual. 2007;7(41):30-2.	Y	N	Y	U	Y	U	U	N	U	U	3
Santos et al.³⁴34 Santos KA, Koszuoski R, Costa JS, Pattussi MP. Factors associated with functional incapacity among the elderly in Guatambu, Santa Catarina State, Brazil. Cad Saude Publica. 2007;23(11):2781-8.	Y	Y	Y	Y	Y	N	U	N	N	N	5
Silva et al.³⁵35 Silva EF, Paniz VM, Laste G, Torres IL. The prevalence of morbidity and symptoms among the elderly: a comparative study between rural and urban areas. Cien Saude Colet. 2013;18(4):1029-40.	Y	N	Y	Y	Y	N	Y	N	N	N	5
Silva et al.³⁶36 Silva MC, Fassa AG, Valle NC. Chronic low back pain in a Southern Brazilian adult population: prevalence and associated factors. Cad Saude Publica. 2004;20(2):377-85.	Y	Y	Y	Y	Y	Y	Y	N	Y	Y	9
Virtuoso Junior³⁷37 Virtuoso Junior JS [Master's thesis] Habitual physical activity and functional autonomy of elderly people in Florianópolis, Santa Catarina, Brazil. Florianópolis: Universidade Federal de Santa Catarina; 2004, 99 pp.	Y	Y	Y	Y	Y	N	Y	N	N	N	6

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[1] *Corresponding author. E-mail:aoliveiraleopoldino@gmail.com (A.A.O. Leopoldino).