Acessibilidade / Reportar erro

Prevalence of low back pain in the elderly population: a systematic review

Abstract

The aim of this study was to estimate the prevalence of low-back pain (LBP) and to identify the level of functional disability in elderly individuals in different populations. From January 1985 to October 2018, a search was performed using the following databases: Embase, LILACS, SciELO, Scopus, Medline, and the Web of Science. The descriptors were low-back pain, back pain, lower-back pain, prevalence, and elderly in Portuguese and English. Two independent reviewers conducted a search for studies and evaluated their methodological quality. The search strategy returned 2186 titles, and 35 were included in this review. The studies evaluated 135,059 elderly individuals aged between 60 and 102 years, and the prevalence of LBP ranged from 21% to 75%. The levels of functional disability, as well as functional difficulties, activities of daily living, and physical capacity, were identified in 60% of the studies. This review indicated a high prevalence of LBP in elderly individuals and functional disability that affects factors important for independence. However, the studies used different methodologies, suggesting that more studies be conducted with scientific accuracy, methodological quality, and low risk of bias to contribute to the proposal of preventive actions for elderly populations.

Prevalence; Low Back Pain; Spine; Elderly; Systematic Review


INTRODUCTION

Low-back pain (LBP) is one of the most common health problems in primary care (11. Rapoport J, Jacobs P, Bell NR, Klarenbach S. Refining the measurement of the economic burden of chronic diseases in Canada. Chronic Dis Can. 2004;25(1):13-21.). LBP can be defined as any pain between the last ribs and the lower gluteal folds, with or without pain in the lower limbs (22. Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, et al. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006;15 Suppl 2:S192-300. https://doi.org/10.1007/s00586-006-1072-1.
https://doi.org/10.1007/s00586-006-1072-...
). In addition, the duration of pain is one criterion for LBP classification. Acute LBP has a sudden onset and lasts less than six weeks, subacute LBP lasts from six to 12 weeks, and chronic LBP presents for a period greater or equal to 12 weeks (33. Martins MR, Foss MH, Santos Junior R, Zancheta M, Pires IC, Cunha AMR, et al. A eficácia da conduta do grupo de postura em pacientes com lombalgia crônica. Rev Dor. 2010;11(2):116-21.).

It is estimated that 70% to 85% of the population will experience an episode of LBP at some point. Ninety percent of these individuals will have more than one episode (44. 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. https://doi.org/10.1590/S0102-311X2004000200005.
https://doi.org/10.1590/S0102-311X200400...

5. Institucionais IT. Programa Nacional de Promoção da Atividade Física “Agita Brasil”: Atividade física e sua contribuição para a qualidade de vida. Rev Saude Publica. 2002;36(2):254-6. https://doi.org/10.1590/S0034-89102002000200022.
https://doi.org/10.1590/S0034-8910200200...
-66. Andersson GB. Epidemiological features of chronic low-back pain. Lancet. 1999;354(9178):581-5. https://doi.org/10.1016/S0140-6736(99)01312-4.
https://doi.org/10.1016/S0140-6736(99)01...
). The United States spent more than $100 billion on LBP-related healthcare in 2005 (77. Katz JN. Lumbar disc disorders and low-back pain: socioeconomic factors and consequences. J Bone Joint Surg Am. 2006;88 Suppl 2:21-4.), and these costs are expected to increase as the prevalence of back pain also increases (88. Freburger JK, Holmes GM, Agans RP, Jackman AM, Darter JD, Wallace AS, et al. The rising prevalence of chronic low back pain. Arch Intern Med. 2009;169(3):251-8. https://doi.org/10.1001/archinternmed.2008.543.
https://doi.org/10.1001/archinternmed.20...
).

Historically, research on LBP has primarily focused on young people and adults, while little attention has been given to the elderly population (99. Woolf AD, Pfleger B. Burden of major musculoskeletal conditions. Bull World Health Organ. 2003;81(9):646-56.). There is evidence that LBP may be responsible for a large percentage of functional limitations (1010. Edmond SL, Felson DT. Function and back symptoms in older adults. J Am Geriatr Soc. 2003;51(12):1702-9. https://doi.org/10.1046/j.1532-5415.2003.51553.x.
https://doi.org/10.1046/j.1532-5415.2003...
), result in difficulty performing daily life activities (1111. Cooper JK, Kohlmann T. Factors associated with health status of older Americans. Age Ageing. 2001;30(6):495-501. https://doi.org/10.1093/ageing/30.6.495.
https://doi.org/10.1093/ageing/30.6.495...
), and be a risk factor for incapacity and invalidity. LBP is one of the symptoms most frequently reported by older people (1212. Teixeira MJ, Teixeira WGJ, Santos FPS, Andrade DCA, Bezerra SL, Figueiró JB, et al. Epidemiologia clínica da dor músculo-esquelética. Rev Med. 2001;80(ed. esp. pt.1):1-21.). Notwithstanding the fact that it has been identified as a major health problem, its prevalence is not well known in the elderly population (1313. Bressler HB, Keyes WJ, Rochon PA, Badley E. The prevalence of low back pain in the elderly. A systematic review of the literature. Spine. 1999;24(17):1813-9. https://doi.org/10.1097/00007632-199909010-00011.
https://doi.org/10.1097/00007632-1999090...
,1414. Gallagher RM. Low back pain, health status, and quality of life in older adults: challenge and opportunity. Pain Med. 2003;4(4):305-7. https://doi.org/10.1111/j.1526-4637.2003.03049.x.
https://doi.org/10.1111/j.1526-4637.2003...
).

This systematic review aims to identify, analyze and synthesize, in a systematic way, the prevalence of LBP in the elderly population.

METHODS

The protocol of this review is registered at PROSPERO (CRD42019118004), and the methods followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations (1515. Moher D, Liberati A, Tetzlaff J, Altman DG; Prisma Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264-9, W64. https://doi.org/10.7326/0003-4819-151-4-200908180-00135.
https://doi.org/10.7326/0003-4819-151-4-...
).

Search Strategy and Literature Sources

Searches were performed in the following databases: Scientific Electronic Library Online (SciELO), Latin American and Caribbean Health Sciences (LILACS), US National Library of Medicine (Medline), Scopus Info Site (Scopus), the Web of Science, and Embase (Excerpta Medica).

The Health Sciences Descriptors (DeCS) and Medical Subject Headings (MeSH) used for the English search were low-back pain, back pain, lower back pain, prevalence, and elderly; for the search in Portuguese, they were low-back pain, prevalence, and elderly. For MeSH and DeCS, the operators “OR” and “AND” were used to form research topics that could be combined. The search strategy is shown in the supplementary material.

Inclusion criteria

The inclusion criteria were as follows: studies that primarily or secondarily investigated LBP prevalence among elderly individuals aged 60 years or over according to the World Health Organization (1616. World Health Organization. Active Ageing: A Policy Framework. A Contribution of the World Health Organization to the Second United Nations World Assembly on Ageing. Available from: https://extranet.who.int/agefriendlyworld/wp-content/uploads/2014/06/WHO-Active-Ageing-Framework.pdf. [Accessed Oct, 2019].
https://extranet.who.int/agefriendlyworl...
); studies that included both sexes and individuals living in the community or institutionalized (in clinics, hospitals or public or private care institutions), regardless of duration of LBP symptoms (i.e., acute, subacute, or chronic LBP); and articles that are available in English or Portuguese.

Data extraction

Studies published in Portuguese and English with a cross-sectional design from 1985 to October 2018 were searched. Two independent reviewers (IMBS and TFS) selected studies based on the title and summary. The ones that met the eligibility criteria were analyzed and evaluated. After fully reading the selected studies, no conflicts were found between the two independent reviewers.

The descriptive data extracted and analyzed from the studies were as follows: first author/year of publication, participant’s characteristics (sex, age, population), country, instrument of collection, sample size, definition of LBP, absolute frequency of LBP, prevalence, investigated duration of LBP and functional disability level.

Risk of bias assessment

To assess the risk of bias and the methodological quality, the instrument developed by Hoy et al. was used (1717. Hoy D, Brooks P, Woolf A, Blyth F, March L, Bain C, et al. Assessing risk of bias in prevalence studies: modification of an existing tool and evidence of interrater agreement. J Clin Epidemiol. 2012;65(9):934-9. https://doi.org/10.1016/j.jclinepi.2011.11.014.
https://doi.org/10.1016/j.jclinepi.2011....
). Considering that selected studies could present potential sources of bias that could influence the results (Table 2), the tool was used to assess the risk of bias of the eligible studies. This instrument allows for the verification of the risk of bias related to external and internal validity, allowing for the classification of the risk of bias as low, moderate, or high. This instrument was chosen mainly because it is easy to use, shows high interexaminer agreement, and was developed specifically to measure the risk of bias in prevalence studies of patients with LBP.

This instrument (1717. Hoy D, Brooks P, Woolf A, Blyth F, March L, Bain C, et al. Assessing risk of bias in prevalence studies: modification of an existing tool and evidence of interrater agreement. J Clin Epidemiol. 2012;65(9):934-9. https://doi.org/10.1016/j.jclinepi.2011.11.014.
https://doi.org/10.1016/j.jclinepi.2011....
) uses the following criteria: (1) representativeness of the study sample in relation to the national population to assess the generalizability of the results; (2) a sampling system that represents the target population; (3) a method for selecting the sample; (4) probability of nonresponse bias; (5) method of obtaining a response of interest; (6) definition of LBP used to select the sample; (7) reliability and validity of the tools used; (8) standardization of the collection process; (9) period of prevalence of appropriate interest; and (10) presence of error in calculation and/or reporting values of the numerator and denominator of the parameter of interest. The first four topics are related to the external validity of the study. Consequently, the other items report the risk of bias in categories relating to internal validity. At the end of the analysis, studies with at least nine criteria were classified as having a low risk of bias; studies that had between seven and eight of the criteria had a medium risk of bias; and those with less than seven of the criteria had a high risk of bias.

RESULTS

Summary of included studies

We identified 2186 titles; of these, 38 were duplicates. During the search by title and abstract, 2148 studies were selected, and 1936 were excluded after reading the summaries. One hundred six studies were selected for full-text reading, and only 35 met the eligibility criteria and were included in the systematic review (Figure 1). Because of great heterogeneity, a meta-analysis was not possible.

Figure 1
Flowchart of the included studies.

Characteristics of the studies

The prevalence of LBP among the elderly individuals ranged from 21 to 75%. These studies included a total of 135,059 elderly individuals, with sample sizes ranging from 54 to 55,690 elderly individuals, and LBP was present in 34,516 of the participants (Tables 1, 2 and 3).

Table 1
Characteristics of the studies found in the systematic review with acute low back pain prevalence.
Table 2
Characteristics of the studies found in the systematic review with chronic low back pain prevalence.
Table 3
Characteristics of the studies found in the systematic review with prevalence period not informed.

An approach regarding complaints of LBP at different moments was found in this systematic review. Eight studies (1818. Hartvigsen J, Christensen K, Frederiksen H. Back pain remains a common symptom in old age. a population-based study of 4486 Danish twins aged 70-102. https://doi.org/Eur Spine J. 2003;12(5):528-34. 10.1007/s00586-003-0542-y.
https://doi.org/Eur Spine J. 2003;12(5):...

19. Blay SL, Andreoli SB, Gastal FL. Chronic painful physical conditions, disturbed sleep and psychiatric morbidity: results from an elderly survey. Ann Clin Psychiatry. 2007;19(3):169-74. https://doi.org/10.1080/10401230701468099.
https://doi.org/10.1080/1040123070146809...

20. Meyer T, Cooper J, Raspe H. Disabling low back pain and depressive symptoms in the community-dwelling elderly: a prospective study. Spine. 2007;32(21):2380-6. https://doi.org/10.1097/BRS.0b013e3181557955.
https://doi.org/10.1097/BRS.0b013e318155...

21. Lima MG, Barros MB, César CL, Goldbaum M, Carandina L, Ciconelli RM. Impact of chronic disease on quality of life among the elderly in the state of São Paulo, Brazil: a population-based study. Rev Panam Salud Publ. 2009;25(4):314-21. https://doi.org/10.1590/S1020-49892009000400005.
https://doi.org/10.1590/S1020-4989200900...

22. Rana AM, Wahlin A, Streatfield PK, Kabir ZN. Association of bone and joint diseases with health-related quality of life among older people: a population-based cross-sectional study in rural Bangladesh. Ageing Soc. 2009;29(05):727-43. https://doi.org/10.1017/S0144686X09008411.
https://doi.org/10.1017/S0144686X0900841...

23. Gálvez-Barrón C, Narvaiza L, Dapena MD, Macho O, Rodríguez-Molinero A. Prevalence and treatment of pain in non-institutionalized very old population: transversal study at national level. Aging Clin Exp Res. 2016;28(2):347-53. https://doi.org/10.1007/s40520-015-0387-3.
https://doi.org/10.1007/s40520-015-0387-...

24. Tomita Y, Arima K, Kanagae M, Okabe T, Mizukami S, Nishimura T, et al. Association of Physical Performance and Pain With Fear of Falling Among Community-Dwelling Japanese Women Aged 65 Years and Older. Medicine. 2015;94(35):e1449. https://doi.org/10.1097/MD.0000000000001449.
https://doi.org/10.1097/MD.0000000000001...
-2525. Cedraschi C, Luthy C, Allaz AF, Herrmann FR, Ludwig C. Low back pain and health-related quality of life in community-dwelling older adults. Eur Spine J. 2016;25(9):2822-32. https://doi.org/10.1007/s00586-016-4483-7.
https://doi.org/10.1007/s00586-016-4483-...
) addressed acute LBP prevalence, and 21 studies (2626. Lavsky-Shulan M, Wallace RB, Kohout FJ, Lemke JH, Morris MC, Smith IM. Prevalence and functional correlates of low back pain in the elderly: the Iowa 65+ Rural Health Study. J Am Geriatr Soc. 1985;33(1):23-8. https://doi.org/10.1111/j.1532-5415.1985.tb02855.x.
https://doi.org/10.1111/j.1532-5415.1985...

27. Weiner DK, Haggerty CL, Kritchevsky SB, Harris T, Simonsick EM, Nevitt M, et al. How does low back pain impact physical function in independent, well-functioning older adults? Evidence from the Health ABC Cohort and implications for the future. Pain Med. 2003;4(4):311-20. https://doi.org/10.1111/j.1526-4637.2003.03042.x.
https://doi.org/10.1111/j.1526-4637.2003...

28. Cecchi F, Debolini P, Lova RM, Macchi C, Bandinelli S, Bartali B, et al. Epidemiology of back pain in a representative cohort of Italian persons 65 years of age and older: the InCHIANTI study. Spine. 2006;31(10):1149-55. https://doi.org/10.1097/01.brs.0000216606.24142.e1.
https://doi.org/10.1097/01.brs.000021660...

29. Dellaroza MS, Pimenta CA, Duarte YA, Lebrão ML. [Chronic pain among elderly residents in São Paulo, Brazil: prevalence, characteristics, and association with functional capacity and mobility (SABE Study)]. Cad Saude Publica. 2013;29(2):325-34. https://doi.org/10.1590/S0102-311X2013000200019.
https://doi.org/10.1590/S0102-311X201300...

30. Hicks GE, Gaines JM, Shardell M, Simonsick EM. Associations of back and leg pain with health status and functional capacity of older adults: findings from the retirement community back pain study. Arthritis Rheum. 2008;59(9):1306-13. https://doi.org/10.1002/art.24006.
https://doi.org/10.1002/art.24006...

31. Kovacs F, Noguera J, Abraira V, Royuela A, Cano A, Gil del Real MT, et al. The influence of psychological factors on low back pain-related disability in community dwelling older persons. Pain Med. 2008;9(7):871-80. https://doi.org/10.1111/j.1526-4637.2008.00518.x.
https://doi.org/10.1111/j.1526-4637.2008...

32. dos Reis LA, Mascarenhas CH, Marinho Filho LE, Borges PS. Lombalgia na terceira idade: distribuição e prevalência na Clínica Escola de Fisioterapia da Universidade Estadual do Sudoeste da Bahia. Rev Bras Geriatr Gerontol. 2008;11(1):93-103. https://doi.org/10.1590/1809-9823.2008.11019.
https://doi.org/10.1590/1809-9823.2008.1...

33. Woo J, Leung J, Lau E. Prevalence and correlates of musculoskeletal pain in Chinese elderly and the impact on 4-year physical function and quality of life. Public Health. 2009;123(8):549-56. https://doi.org/10.1016/j.puhe.2009.07.006.
https://doi.org/10.1016/j.puhe.2009.07.0...

34. Holton KF, Denard PJ, Yoo JU, Kado DM, Barrett-Connor E, Marshall LM, et al., editors. Diffuse idiopathic skeletal hyperostosis and its relation to back pain among older men: the MrOS Study. Semin Arthritis Rheum. 2011;41(2):131-8. https://doi.org/10.1016/j.semarthrit.2011.01.001.
https://doi.org/10.1016/j.semarthrit.201...

35. Abegunde KA, Owoaje ET. Health problems and associated risk factors in selected urban and rural elderly population groups of South-West Nigeria. Ann Afr Med. 2013;12(2):90-7. https://doi.org/10.4103/1596-3519.112398.
https://doi.org/10.4103/1596-3519.112398...

36. Exarchou S, Redlund-Johnell I, Karlsson M, Mellström D, Ohlsson C, Turesson C, et al. The prevalence of moderate to severe radiographic sacroiliitis and the correlation with health status in elderly Swedish men--the MrOS study. BMC Musculoskelet Disord. 2013;14:352. https://doi.org/10.1186/1471-2474-14-352.
https://doi.org/10.1186/1471-2474-14-352...

37. Figueiredo VF, Pereira LS, Ferreira PH, Pereira AM, Amorim JS. Incapacidade funcional, sintomas depressivos e dor lombar em idosos. Fisioter Mov. 2013;26(3):549-57. https://doi.org/10.1590/S0103-51502013000300008.
https://doi.org/10.1590/S0103-5150201300...

38. Ghanei I, Rosengren BE, Hasserius R, Nilsson JÅ, Mellström D, Ohlsson C, et al. The prevalence and severity of low back pain and associated symptoms in 3,009 old men. Eur Spine J. 2014;23(4):814-20. https://doi.org/10.1007/s00586-013-3139-0.
https://doi.org/10.1007/s00586-013-3139-...

39. Palma R, de Conti MH, Quintino NM, Gatti MA, Simeão SF, de Vitta A. Functional capacity and its associated factors in the elderly with low back pain. Acta Ortop Bras. 2014;22(6):295-9. https://doi.org/10.1590/1413-78522014220600890.
https://doi.org/10.1590/1413-78522014220...

40. Pereira LV, de Vasconcelos PP, Souza LA, Pereira Gde A, Nakatani AY, Bachion MM. Prevalence and intensity of chronic pain and self-perceived health among elderly people: a population-based study. Rev Lat Am Enfermagem. 2014;22(4):662-9. https://doi.org/10.1590/0104-1169.3591.2465.
https://doi.org/10.1590/0104-1169.3591.2...

41. Santos FC, Moraes NS, Pastore A, Cendoroglo MS. Chronic pain in long-lived elderly: prevalence, characteristics, measurements and correlation with serum vitamin D level. Revista Dor. 2015;16(3):171-5. https://doi.org/10.5935/1806-0013.20150034.
https://doi.org/10.5935/1806-0013.201500...

42. Scherer M, Hansen H, Gensichen J, Mergenthal K, Riedel-Heller S, Weyerer S, et al. Association between multimorbidity patterns and chronic pain in elderly primary care patients: a cross-sectional observational study. BMC Fam Pract. 2016;17:68. https://doi.org/10.1186/s12875-016-0468-1.
https://doi.org/10.1186/s12875-016-0468-...

43. Kherad M, Rosengren BE, Hasserius R, Nilsson JA, Redlund-Johnell I, Ohlsson C, et al. Age Ageing. 2017;8;46(1):64-71. https://doi.org/10.1093/ageing/afw152.
https://doi.org/10.1093/ageing/afw152...

44. Marshall LM, Litwack-Harrison S, Makris UE, Kado DM, Cawthon PM, Deyo RA, et al. A Prospective Study of Back Pain and Risk of Falls Among Older Community-dwelling Men. J Gerontol A Biol Sci Med Sci. 2017;72(9):1264-9. https://doi.org/10.1097/AJP.0000000000000564.
https://doi.org/10.1097/AJP.000000000000...

45. Quintino NM, De Conti MHS, Palma R, Gatti MAN, Simeão SFAP, Vitta A. Prevalence and factors associated with low back pain in elderly registered in the Family Health Strategy. Fisioter Mov. 2017;30(2):367-77. https://doi.org/10.1590/1980-5918.030.002.ao17.
https://doi.org/10.1590/1980-5918.030.00...
-4646. Machado LAC, Viana JU, da Silva SLA, Couto FGP, Mendes LP, Ferreira PH, et al. Correlates of a Recent History of Disabling Low Back Pain in Community-dwellin Older Persons: The Pain in the Elderly (PAINEL) study. Clin J Pain. 2018;34(6):515-24. https://doi.org/10.1097/AJP.0000000000000564.
https://doi.org/10.1097/AJP.000000000000...
) addressed chronic LBP prevalence; however, six studies (4747. Liu-Ambrose T, Eng JJ, Khan KM, Mallinson A, Carter ND, McKay HA. The influence of back pain on balance and functional mobility in 65- to 75-year-old women with osteoporosis. Osteoporos Int. 2002;13(11):868-73. https://doi.org/10.1007/s001980200119.
https://doi.org/10.1007/s001980200119...

48. Kobuke Y, Abe Y, Ye Z, Honda S, Tomita M, Osaki M, et al. Association of Age, Obesity, Joint Pain, and Chewing Ability with Chair Stand Difficulty among Community-dwelling Elderly People in Nagasaki, Japan. Acta Med Nagasaki. 2009;53:65-8. https://doi.org/10.11343/amn.53.65.
https://doi.org/10.11343/amn.53.65...

49. Peng LN, Lin MH, Lai HY, Hwang SJ, Chen LK, Lan CF. Pain and health-care utilization among older men in a veterans care home. Arch Gerontol Geriatr. 2009;49 Suppl 2:S13-6. https://doi.org/10.1016/S0167-4943(09)70006-8.
https://doi.org/10.1016/S0167-4943(09)70...

50. Baek SR, Lim JY, Lim JY, Park JH, Lee JJ, Lee SB, et al. Prevalence of musculoskeletal pain in an elderly Korean population: results from the Korean Longitudinal Study on Health and Aging (KLoSHA). Arch Gerontol Geriatr. 2010;51(3):e46-51. https://doi.org/10.1016/j.archger.2009.11.011.
https://doi.org/10.1016/j.archger.2009.1...

51. Barros MB, Francisco PM, Lima MG, César CL. Social inequalities in health among the elderly. Cad Saude Publica. 2011;27 Suppl 2:S198-208. https://doi.org/10.1590/S0102-311X2011001400008.
https://doi.org/10.1590/S0102-311X201100...
-5252. Kim H, Yoshida H, Hu X, Saito K, Yoshida Y, Kim M, et al. Association between self-reported urinary incontinence and musculoskeletal conditions in community-dwelling elderly women: a cross-sectional study. Neurourol Urodyn. 2015;34(4):322-6. https://doi.org/10.1002/nau.22567.
https://doi.org/10.1002/nau.22567...
) did not specify the prevalence period investigated.

Of the 35 original studies, 26 included both sexes. The age range was from 60 to ≥86 years, and the places where the studies took place included North America (USA and Canada), South America (Brazil), Europe (Spain, Sweden, Italy, Denmark and Switzerland), Asia (Japan, South Korea, Bangladesh, Taiwan, and China), and Africa (Nigeria).

Regarding data collection instruments, a customized questionnaire was employed in 20 studies (1818. Hartvigsen J, Christensen K, Frederiksen H. Back pain remains a common symptom in old age. a population-based study of 4486 Danish twins aged 70-102. https://doi.org/Eur Spine J. 2003;12(5):528-34. 10.1007/s00586-003-0542-y.
https://doi.org/Eur Spine J. 2003;12(5):...

19. Blay SL, Andreoli SB, Gastal FL. Chronic painful physical conditions, disturbed sleep and psychiatric morbidity: results from an elderly survey. Ann Clin Psychiatry. 2007;19(3):169-74. https://doi.org/10.1080/10401230701468099.
https://doi.org/10.1080/1040123070146809...

20. Meyer T, Cooper J, Raspe H. Disabling low back pain and depressive symptoms in the community-dwelling elderly: a prospective study. Spine. 2007;32(21):2380-6. https://doi.org/10.1097/BRS.0b013e3181557955.
https://doi.org/10.1097/BRS.0b013e318155...

21. Lima MG, Barros MB, César CL, Goldbaum M, Carandina L, Ciconelli RM. Impact of chronic disease on quality of life among the elderly in the state of São Paulo, Brazil: a population-based study. Rev Panam Salud Publ. 2009;25(4):314-21. https://doi.org/10.1590/S1020-49892009000400005.
https://doi.org/10.1590/S1020-4989200900...
-2222. Rana AM, Wahlin A, Streatfield PK, Kabir ZN. Association of bone and joint diseases with health-related quality of life among older people: a population-based cross-sectional study in rural Bangladesh. Ageing Soc. 2009;29(05):727-43. https://doi.org/10.1017/S0144686X09008411.
https://doi.org/10.1017/S0144686X0900841...
,2424. Tomita Y, Arima K, Kanagae M, Okabe T, Mizukami S, Nishimura T, et al. Association of Physical Performance and Pain With Fear of Falling Among Community-Dwelling Japanese Women Aged 65 Years and Older. Medicine. 2015;94(35):e1449. https://doi.org/10.1097/MD.0000000000001449.
https://doi.org/10.1097/MD.0000000000001...
,2626. Lavsky-Shulan M, Wallace RB, Kohout FJ, Lemke JH, Morris MC, Smith IM. Prevalence and functional correlates of low back pain in the elderly: the Iowa 65+ Rural Health Study. J Am Geriatr Soc. 1985;33(1):23-8. https://doi.org/10.1111/j.1532-5415.1985.tb02855.x.
https://doi.org/10.1111/j.1532-5415.1985...

27. Weiner DK, Haggerty CL, Kritchevsky SB, Harris T, Simonsick EM, Nevitt M, et al. How does low back pain impact physical function in independent, well-functioning older adults? Evidence from the Health ABC Cohort and implications for the future. Pain Med. 2003;4(4):311-20. https://doi.org/10.1111/j.1526-4637.2003.03042.x.
https://doi.org/10.1111/j.1526-4637.2003...
-2828. Cecchi F, Debolini P, Lova RM, Macchi C, Bandinelli S, Bartali B, et al. Epidemiology of back pain in a representative cohort of Italian persons 65 years of age and older: the InCHIANTI study. Spine. 2006;31(10):1149-55. https://doi.org/10.1097/01.brs.0000216606.24142.e1.
https://doi.org/10.1097/01.brs.000021660...
,3232. dos Reis LA, Mascarenhas CH, Marinho Filho LE, Borges PS. Lombalgia na terceira idade: distribuição e prevalência na Clínica Escola de Fisioterapia da Universidade Estadual do Sudoeste da Bahia. Rev Bras Geriatr Gerontol. 2008;11(1):93-103. https://doi.org/10.1590/1809-9823.2008.11019.
https://doi.org/10.1590/1809-9823.2008.1...
,3535. Abegunde KA, Owoaje ET. Health problems and associated risk factors in selected urban and rural elderly population groups of South-West Nigeria. Ann Afr Med. 2013;12(2):90-7. https://doi.org/10.4103/1596-3519.112398.
https://doi.org/10.4103/1596-3519.112398...
,4343. Kherad M, Rosengren BE, Hasserius R, Nilsson JA, Redlund-Johnell I, Ohlsson C, et al. Age Ageing. 2017;8;46(1):64-71. https://doi.org/10.1093/ageing/afw152.
https://doi.org/10.1093/ageing/afw152...

44. Marshall LM, Litwack-Harrison S, Makris UE, Kado DM, Cawthon PM, Deyo RA, et al. A Prospective Study of Back Pain and Risk of Falls Among Older Community-dwelling Men. J Gerontol A Biol Sci Med Sci. 2017;72(9):1264-9. https://doi.org/10.1097/AJP.0000000000000564.
https://doi.org/10.1097/AJP.000000000000...
-4545. Quintino NM, De Conti MHS, Palma R, Gatti MAN, Simeão SFAP, Vitta A. Prevalence and factors associated with low back pain in elderly registered in the Family Health Strategy. Fisioter Mov. 2017;30(2):367-77. https://doi.org/10.1590/1980-5918.030.002.ao17.
https://doi.org/10.1590/1980-5918.030.00...
), and a Roland-Morris questionnaire was employed in four studies (3131. Kovacs F, Noguera J, Abraira V, Royuela A, Cano A, Gil del Real MT, et al. The influence of psychological factors on low back pain-related disability in community dwelling older persons. Pain Med. 2008;9(7):871-80. https://doi.org/10.1111/j.1526-4637.2008.00518.x.
https://doi.org/10.1111/j.1526-4637.2008...
,3636. Exarchou S, Redlund-Johnell I, Karlsson M, Mellström D, Ohlsson C, Turesson C, et al. The prevalence of moderate to severe radiographic sacroiliitis and the correlation with health status in elderly Swedish men--the MrOS study. BMC Musculoskelet Disord. 2013;14:352. https://doi.org/10.1186/1471-2474-14-352.
https://doi.org/10.1186/1471-2474-14-352...

37. Figueiredo VF, Pereira LS, Ferreira PH, Pereira AM, Amorim JS. Incapacidade funcional, sintomas depressivos e dor lombar em idosos. Fisioter Mov. 2013;26(3):549-57. https://doi.org/10.1590/S0103-51502013000300008.
https://doi.org/10.1590/S0103-5150201300...
-3838. Ghanei I, Rosengren BE, Hasserius R, Nilsson JÅ, Mellström D, Ohlsson C, et al. The prevalence and severity of low back pain and associated symptoms in 3,009 old men. Eur Spine J. 2014;23(4):814-20. https://doi.org/10.1007/s00586-013-3139-0.
https://doi.org/10.1007/s00586-013-3139-...
). The Oswestry questionnaire (4747. Liu-Ambrose T, Eng JJ, Khan KM, Mallinson A, Carter ND, McKay HA. The influence of back pain on balance and functional mobility in 65- to 75-year-old women with osteoporosis. Osteoporos Int. 2002;13(11):868-73. https://doi.org/10.1007/s001980200119.
https://doi.org/10.1007/s001980200119...
,5050. Baek SR, Lim JY, Lim JY, Park JH, Lee JJ, Lee SB, et al. Prevalence of musculoskeletal pain in an elderly Korean population: results from the Korean Longitudinal Study on Health and Aging (KLoSHA). Arch Gerontol Geriatr. 2010;51(3):e46-51. https://doi.org/10.1016/j.archger.2009.11.011.
https://doi.org/10.1016/j.archger.2009.1...
), the Visual Analog Scale (3131. Kovacs F, Noguera J, Abraira V, Royuela A, Cano A, Gil del Real MT, et al. The influence of psychological factors on low back pain-related disability in community dwelling older persons. Pain Med. 2008;9(7):871-80. https://doi.org/10.1111/j.1526-4637.2008.00518.x.
https://doi.org/10.1111/j.1526-4637.2008...
,3838. Ghanei I, Rosengren BE, Hasserius R, Nilsson JÅ, Mellström D, Ohlsson C, et al. The prevalence and severity of low back pain and associated symptoms in 3,009 old men. Eur Spine J. 2014;23(4):814-20. https://doi.org/10.1007/s00586-013-3139-0.
https://doi.org/10.1007/s00586-013-3139-...
), the Face Pain Scale (2323. Gálvez-Barrón C, Narvaiza L, Dapena MD, Macho O, Rodríguez-Molinero A. Prevalence and treatment of pain in non-institutionalized very old population: transversal study at national level. Aging Clin Exp Res. 2016;28(2):347-53. https://doi.org/10.1007/s40520-015-0387-3.
https://doi.org/10.1007/s40520-015-0387-...
,4141. Santos FC, Moraes NS, Pastore A, Cendoroglo MS. Chronic pain in long-lived elderly: prevalence, characteristics, measurements and correlation with serum vitamin D level. Revista Dor. 2015;16(3):171-5. https://doi.org/10.5935/1806-0013.20150034.
https://doi.org/10.5935/1806-0013.201500...
), the Numeric Scale (4040. Pereira LV, de Vasconcelos PP, Souza LA, Pereira Gde A, Nakatani AY, Bachion MM. Prevalence and intensity of chronic pain and self-perceived health among elderly people: a population-based study. Rev Lat Am Enfermagem. 2014;22(4):662-9. https://doi.org/10.1590/0104-1169.3591.2465.
https://doi.org/10.1590/0104-1169.3591.2...
,4141. Santos FC, Moraes NS, Pastore A, Cendoroglo MS. Chronic pain in long-lived elderly: prevalence, characteristics, measurements and correlation with serum vitamin D level. Revista Dor. 2015;16(3):171-5. https://doi.org/10.5935/1806-0013.20150034.
https://doi.org/10.5935/1806-0013.201500...
), the Physical Activity Scale of the Elderly (3333. Woo J, Leung J, Lau E. Prevalence and correlates of musculoskeletal pain in Chinese elderly and the impact on 4-year physical function and quality of life. Public Health. 2009;123(8):549-56. https://doi.org/10.1016/j.puhe.2009.07.006.
https://doi.org/10.1016/j.puhe.2009.07.0...
,3636. Exarchou S, Redlund-Johnell I, Karlsson M, Mellström D, Ohlsson C, Turesson C, et al. The prevalence of moderate to severe radiographic sacroiliitis and the correlation with health status in elderly Swedish men--the MrOS study. BMC Musculoskelet Disord. 2013;14:352. https://doi.org/10.1186/1471-2474-14-352.
https://doi.org/10.1186/1471-2474-14-352...
), and the Nordic questionnaire (3939. Palma R, de Conti MH, Quintino NM, Gatti MA, Simeão SF, de Vitta A. Functional capacity and its associated factors in the elderly with low back pain. Acta Ortop Bras. 2014;22(6):295-9. https://doi.org/10.1590/1413-78522014220600890.
https://doi.org/10.1590/1413-78522014220...
,4545. Quintino NM, De Conti MHS, Palma R, Gatti MAN, Simeão SFAP, Vitta A. Prevalence and factors associated with low back pain in elderly registered in the Family Health Strategy. Fisioter Mov. 2017;30(2):367-77. https://doi.org/10.1590/1980-5918.030.002.ao17.
https://doi.org/10.1590/1980-5918.030.00...
) were employed in two studies each. The following instruments were used in only one study each: the Lawton questionnaire (2929. Dellaroza MS, Pimenta CA, Duarte YA, Lebrão ML. [Chronic pain among elderly residents in São Paulo, Brazil: prevalence, characteristics, and association with functional capacity and mobility (SABE Study)]. Cad Saude Publica. 2013;29(2):325-34. https://doi.org/10.1590/S0102-311X2013000200019.
https://doi.org/10.1590/S0102-311X201300...
), the McGill questionnaire (3636. Exarchou S, Redlund-Johnell I, Karlsson M, Mellström D, Ohlsson C, Turesson C, et al. The prevalence of moderate to severe radiographic sacroiliitis and the correlation with health status in elderly Swedish men--the MrOS study. BMC Musculoskelet Disord. 2013;14:352. https://doi.org/10.1186/1471-2474-14-352.
https://doi.org/10.1186/1471-2474-14-352...
), the Quebec Pain Disability Scale (3535. Abegunde KA, Owoaje ET. Health problems and associated risk factors in selected urban and rural elderly population groups of South-West Nigeria. Ann Afr Med. 2013;12(2):90-7. https://doi.org/10.4103/1596-3519.112398.
https://doi.org/10.4103/1596-3519.112398...
), the Graded Chronic Pain Scale (4242. Scherer M, Hansen H, Gensichen J, Mergenthal K, Riedel-Heller S, Weyerer S, et al. Association between multimorbidity patterns and chronic pain in elderly primary care patients: a cross-sectional observational study. BMC Fam Pract. 2016;17:68. https://doi.org/10.1186/s12875-016-0468-1.
https://doi.org/10.1186/s12875-016-0468-...
), the North American Spine Society Questionnaires for Back and Neck Pain (3434. Holton KF, Denard PJ, Yoo JU, Kado DM, Barrett-Connor E, Marshall LM, et al., editors. Diffuse idiopathic skeletal hyperostosis and its relation to back pain among older men: the MrOS Study. Semin Arthritis Rheum. 2011;41(2):131-8. https://doi.org/10.1016/j.semarthrit.2011.01.001.
https://doi.org/10.1016/j.semarthrit.201...
), the Katz index (2323. Gálvez-Barrón C, Narvaiza L, Dapena MD, Macho O, Rodríguez-Molinero A. Prevalence and treatment of pain in non-institutionalized very old population: transversal study at national level. Aging Clin Exp Res. 2016;28(2):347-53. https://doi.org/10.1007/s40520-015-0387-3.
https://doi.org/10.1007/s40520-015-0387-...
) and medical records from a physiotherapy clinic school at the State University of Southwestern Bahia, Brazil (3232. dos Reis LA, Mascarenhas CH, Marinho Filho LE, Borges PS. Lombalgia na terceira idade: distribuição e prevalência na Clínica Escola de Fisioterapia da Universidade Estadual do Sudoeste da Bahia. Rev Bras Geriatr Gerontol. 2008;11(1):93-103. https://doi.org/10.1590/1809-9823.2008.11019.
https://doi.org/10.1590/1809-9823.2008.1...
).

Functional disability due to LBP was investigated in 60% of the studies, and LBP was shown to hinder functionality (1818. Hartvigsen J, Christensen K, Frederiksen H. Back pain remains a common symptom in old age. a population-based study of 4486 Danish twins aged 70-102. https://doi.org/Eur Spine J. 2003;12(5):528-34. 10.1007/s00586-003-0542-y.
https://doi.org/Eur Spine J. 2003;12(5):...
,2020. Meyer T, Cooper J, Raspe H. Disabling low back pain and depressive symptoms in the community-dwelling elderly: a prospective study. Spine. 2007;32(21):2380-6. https://doi.org/10.1097/BRS.0b013e3181557955.
https://doi.org/10.1097/BRS.0b013e318155...
,2121. Lima MG, Barros MB, César CL, Goldbaum M, Carandina L, Ciconelli RM. Impact of chronic disease on quality of life among the elderly in the state of São Paulo, Brazil: a population-based study. Rev Panam Salud Publ. 2009;25(4):314-21. https://doi.org/10.1590/S1020-49892009000400005.
https://doi.org/10.1590/S1020-4989200900...
,2323. Gálvez-Barrón C, Narvaiza L, Dapena MD, Macho O, Rodríguez-Molinero A. Prevalence and treatment of pain in non-institutionalized very old population: transversal study at national level. Aging Clin Exp Res. 2016;28(2):347-53. https://doi.org/10.1007/s40520-015-0387-3.
https://doi.org/10.1007/s40520-015-0387-...
,2727. Weiner DK, Haggerty CL, Kritchevsky SB, Harris T, Simonsick EM, Nevitt M, et al. How does low back pain impact physical function in independent, well-functioning older adults? Evidence from the Health ABC Cohort and implications for the future. Pain Med. 2003;4(4):311-20. https://doi.org/10.1111/j.1526-4637.2003.03042.x.
https://doi.org/10.1111/j.1526-4637.2003...
,2828. Cecchi F, Debolini P, Lova RM, Macchi C, Bandinelli S, Bartali B, et al. Epidemiology of back pain in a representative cohort of Italian persons 65 years of age and older: the InCHIANTI study. Spine. 2006;31(10):1149-55. https://doi.org/10.1097/01.brs.0000216606.24142.e1.
https://doi.org/10.1097/01.brs.000021660...
,3030. Hicks GE, Gaines JM, Shardell M, Simonsick EM. Associations of back and leg pain with health status and functional capacity of older adults: findings from the retirement community back pain study. Arthritis Rheum. 2008;59(9):1306-13. https://doi.org/10.1002/art.24006.
https://doi.org/10.1002/art.24006...
,3737. Figueiredo VF, Pereira LS, Ferreira PH, Pereira AM, Amorim JS. Incapacidade funcional, sintomas depressivos e dor lombar em idosos. Fisioter Mov. 2013;26(3):549-57. https://doi.org/10.1590/S0103-51502013000300008.
https://doi.org/10.1590/S0103-5150201300...
,3939. Palma R, de Conti MH, Quintino NM, Gatti MA, Simeão SF, de Vitta A. Functional capacity and its associated factors in the elderly with low back pain. Acta Ortop Bras. 2014;22(6):295-9. https://doi.org/10.1590/1413-78522014220600890.
https://doi.org/10.1590/1413-78522014220...
) and result in major dependence for daily living activities (2424. Tomita Y, Arima K, Kanagae M, Okabe T, Mizukami S, Nishimura T, et al. Association of Physical Performance and Pain With Fear of Falling Among Community-Dwelling Japanese Women Aged 65 Years and Older. Medicine. 2015;94(35):e1449. https://doi.org/10.1097/MD.0000000000001449.
https://doi.org/10.1097/MD.0000000000001...
,2929. Dellaroza MS, Pimenta CA, Duarte YA, Lebrão ML. [Chronic pain among elderly residents in São Paulo, Brazil: prevalence, characteristics, and association with functional capacity and mobility (SABE Study)]. Cad Saude Publica. 2013;29(2):325-34. https://doi.org/10.1590/S0102-311X2013000200019.
https://doi.org/10.1590/S0102-311X201300...
,4848. Kobuke Y, Abe Y, Ye Z, Honda S, Tomita M, Osaki M, et al. Association of Age, Obesity, Joint Pain, and Chewing Ability with Chair Stand Difficulty among Community-dwelling Elderly People in Nagasaki, Japan. Acta Med Nagasaki. 2009;53:65-8. https://doi.org/10.11343/amn.53.65.
https://doi.org/10.11343/amn.53.65...
,3838. Ghanei I, Rosengren BE, Hasserius R, Nilsson JÅ, Mellström D, Ohlsson C, et al. The prevalence and severity of low back pain and associated symptoms in 3,009 old men. Eur Spine J. 2014;23(4):814-20. https://doi.org/10.1007/s00586-013-3139-0.
https://doi.org/10.1007/s00586-013-3139-...
,5252. Kim H, Yoshida H, Hu X, Saito K, Yoshida Y, Kim M, et al. Association between self-reported urinary incontinence and musculoskeletal conditions in community-dwelling elderly women: a cross-sectional study. Neurourol Urodyn. 2015;34(4):322-6. https://doi.org/10.1002/nau.22567.
https://doi.org/10.1002/nau.22567...
) and physical capacity (3030. Hicks GE, Gaines JM, Shardell M, Simonsick EM. Associations of back and leg pain with health status and functional capacity of older adults: findings from the retirement community back pain study. Arthritis Rheum. 2008;59(9):1306-13. https://doi.org/10.1002/art.24006.
https://doi.org/10.1002/art.24006...
,3333. Woo J, Leung J, Lau E. Prevalence and correlates of musculoskeletal pain in Chinese elderly and the impact on 4-year physical function and quality of life. Public Health. 2009;123(8):549-56. https://doi.org/10.1016/j.puhe.2009.07.006.
https://doi.org/10.1016/j.puhe.2009.07.0...
,3636. Exarchou S, Redlund-Johnell I, Karlsson M, Mellström D, Ohlsson C, Turesson C, et al. The prevalence of moderate to severe radiographic sacroiliitis and the correlation with health status in elderly Swedish men--the MrOS study. BMC Musculoskelet Disord. 2013;14:352. https://doi.org/10.1186/1471-2474-14-352.
https://doi.org/10.1186/1471-2474-14-352...
,2424. Tomita Y, Arima K, Kanagae M, Okabe T, Mizukami S, Nishimura T, et al. Association of Physical Performance and Pain With Fear of Falling Among Community-Dwelling Japanese Women Aged 65 Years and Older. Medicine. 2015;94(35):e1449. https://doi.org/10.1097/MD.0000000000001449.
https://doi.org/10.1097/MD.0000000000001...
,4646. Machado LAC, Viana JU, da Silva SLA, Couto FGP, Mendes LP, Ferreira PH, et al. Correlates of a Recent History of Disabling Low Back Pain in Community-dwellin Older Persons: The Pain in the Elderly (PAINEL) study. Clin J Pain. 2018;34(6):515-24. https://doi.org/10.1097/AJP.0000000000000564.
https://doi.org/10.1097/AJP.000000000000...
).

The methodological quality assessment (Table 4) ranged from four to ten points. Four studies (1919. Blay SL, Andreoli SB, Gastal FL. Chronic painful physical conditions, disturbed sleep and psychiatric morbidity: results from an elderly survey. Ann Clin Psychiatry. 2007;19(3):169-74. https://doi.org/10.1080/10401230701468099.
https://doi.org/10.1080/1040123070146809...
,2525. Cedraschi C, Luthy C, Allaz AF, Herrmann FR, Ludwig C. Low back pain and health-related quality of life in community-dwelling older adults. Eur Spine J. 2016;25(9):2822-32. https://doi.org/10.1007/s00586-016-4483-7.
https://doi.org/10.1007/s00586-016-4483-...
,2828. Cecchi F, Debolini P, Lova RM, Macchi C, Bandinelli S, Bartali B, et al. Epidemiology of back pain in a representative cohort of Italian persons 65 years of age and older: the InCHIANTI study. Spine. 2006;31(10):1149-55. https://doi.org/10.1097/01.brs.0000216606.24142.e1.
https://doi.org/10.1097/01.brs.000021660...
,4242. Scherer M, Hansen H, Gensichen J, Mergenthal K, Riedel-Heller S, Weyerer S, et al. Association between multimorbidity patterns and chronic pain in elderly primary care patients: a cross-sectional observational study. BMC Fam Pract. 2016;17:68. https://doi.org/10.1186/s12875-016-0468-1.
https://doi.org/10.1186/s12875-016-0468-...
) presented methodological quality without risk of bias, and eleven studies (2020. Meyer T, Cooper J, Raspe H. Disabling low back pain and depressive symptoms in the community-dwelling elderly: a prospective study. Spine. 2007;32(21):2380-6. https://doi.org/10.1097/BRS.0b013e3181557955.
https://doi.org/10.1097/BRS.0b013e318155...
,2323. Gálvez-Barrón C, Narvaiza L, Dapena MD, Macho O, Rodríguez-Molinero A. Prevalence and treatment of pain in non-institutionalized very old population: transversal study at national level. Aging Clin Exp Res. 2016;28(2):347-53. https://doi.org/10.1007/s40520-015-0387-3.
https://doi.org/10.1007/s40520-015-0387-...
,2727. Weiner DK, Haggerty CL, Kritchevsky SB, Harris T, Simonsick EM, Nevitt M, et al. How does low back pain impact physical function in independent, well-functioning older adults? Evidence from the Health ABC Cohort and implications for the future. Pain Med. 2003;4(4):311-20. https://doi.org/10.1111/j.1526-4637.2003.03042.x.
https://doi.org/10.1111/j.1526-4637.2003...
,2929. Dellaroza MS, Pimenta CA, Duarte YA, Lebrão ML. [Chronic pain among elderly residents in São Paulo, Brazil: prevalence, characteristics, and association with functional capacity and mobility (SABE Study)]. Cad Saude Publica. 2013;29(2):325-34. https://doi.org/10.1590/S0102-311X2013000200019.
https://doi.org/10.1590/S0102-311X201300...
,3434. Holton KF, Denard PJ, Yoo JU, Kado DM, Barrett-Connor E, Marshall LM, et al., editors. Diffuse idiopathic skeletal hyperostosis and its relation to back pain among older men: the MrOS Study. Semin Arthritis Rheum. 2011;41(2):131-8. https://doi.org/10.1016/j.semarthrit.2011.01.001.
https://doi.org/10.1016/j.semarthrit.201...
,3838. Ghanei I, Rosengren BE, Hasserius R, Nilsson JÅ, Mellström D, Ohlsson C, et al. The prevalence and severity of low back pain and associated symptoms in 3,009 old men. Eur Spine J. 2014;23(4):814-20. https://doi.org/10.1007/s00586-013-3139-0.
https://doi.org/10.1007/s00586-013-3139-...

39. Palma R, de Conti MH, Quintino NM, Gatti MA, Simeão SF, de Vitta A. Functional capacity and its associated factors in the elderly with low back pain. Acta Ortop Bras. 2014;22(6):295-9. https://doi.org/10.1590/1413-78522014220600890.
https://doi.org/10.1590/1413-78522014220...
-4040. Pereira LV, de Vasconcelos PP, Souza LA, Pereira Gde A, Nakatani AY, Bachion MM. Prevalence and intensity of chronic pain and self-perceived health among elderly people: a population-based study. Rev Lat Am Enfermagem. 2014;22(4):662-9. https://doi.org/10.1590/0104-1169.3591.2465.
https://doi.org/10.1590/0104-1169.3591.2...
,4343. Kherad M, Rosengren BE, Hasserius R, Nilsson JA, Redlund-Johnell I, Ohlsson C, et al. Age Ageing. 2017;8;46(1):64-71. https://doi.org/10.1093/ageing/afw152.
https://doi.org/10.1093/ageing/afw152...
,) were classified as a low risk of bias. Seventeen (1818. Hartvigsen J, Christensen K, Frederiksen H. Back pain remains a common symptom in old age. a population-based study of 4486 Danish twins aged 70-102. https://doi.org/Eur Spine J. 2003;12(5):528-34. 10.1007/s00586-003-0542-y.
https://doi.org/Eur Spine J. 2003;12(5):...
,2121. Lima MG, Barros MB, César CL, Goldbaum M, Carandina L, Ciconelli RM. Impact of chronic disease on quality of life among the elderly in the state of São Paulo, Brazil: a population-based study. Rev Panam Salud Publ. 2009;25(4):314-21. https://doi.org/10.1590/S1020-49892009000400005.
https://doi.org/10.1590/S1020-4989200900...
,2222. Rana AM, Wahlin A, Streatfield PK, Kabir ZN. Association of bone and joint diseases with health-related quality of life among older people: a population-based cross-sectional study in rural Bangladesh. Ageing Soc. 2009;29(05):727-43. https://doi.org/10.1017/S0144686X09008411.
https://doi.org/10.1017/S0144686X0900841...
,2424. Tomita Y, Arima K, Kanagae M, Okabe T, Mizukami S, Nishimura T, et al. Association of Physical Performance and Pain With Fear of Falling Among Community-Dwelling Japanese Women Aged 65 Years and Older. Medicine. 2015;94(35):e1449. https://doi.org/10.1097/MD.0000000000001449.
https://doi.org/10.1097/MD.0000000000001...
,2626. Lavsky-Shulan M, Wallace RB, Kohout FJ, Lemke JH, Morris MC, Smith IM. Prevalence and functional correlates of low back pain in the elderly: the Iowa 65+ Rural Health Study. J Am Geriatr Soc. 1985;33(1):23-8. https://doi.org/10.1111/j.1532-5415.1985.tb02855.x.
https://doi.org/10.1111/j.1532-5415.1985...
,3030. Hicks GE, Gaines JM, Shardell M, Simonsick EM. Associations of back and leg pain with health status and functional capacity of older adults: findings from the retirement community back pain study. Arthritis Rheum. 2008;59(9):1306-13. https://doi.org/10.1002/art.24006.
https://doi.org/10.1002/art.24006...
,3131. Kovacs F, Noguera J, Abraira V, Royuela A, Cano A, Gil del Real MT, et al. The influence of psychological factors on low back pain-related disability in community dwelling older persons. Pain Med. 2008;9(7):871-80. https://doi.org/10.1111/j.1526-4637.2008.00518.x.
https://doi.org/10.1111/j.1526-4637.2008...
,3333. Woo J, Leung J, Lau E. Prevalence and correlates of musculoskeletal pain in Chinese elderly and the impact on 4-year physical function and quality of life. Public Health. 2009;123(8):549-56. https://doi.org/10.1016/j.puhe.2009.07.006.
https://doi.org/10.1016/j.puhe.2009.07.0...
,3535. Abegunde KA, Owoaje ET. Health problems and associated risk factors in selected urban and rural elderly population groups of South-West Nigeria. Ann Afr Med. 2013;12(2):90-7. https://doi.org/10.4103/1596-3519.112398.
https://doi.org/10.4103/1596-3519.112398...

36. Exarchou S, Redlund-Johnell I, Karlsson M, Mellström D, Ohlsson C, Turesson C, et al. The prevalence of moderate to severe radiographic sacroiliitis and the correlation with health status in elderly Swedish men--the MrOS study. BMC Musculoskelet Disord. 2013;14:352. https://doi.org/10.1186/1471-2474-14-352.
https://doi.org/10.1186/1471-2474-14-352...
-3737. Figueiredo VF, Pereira LS, Ferreira PH, Pereira AM, Amorim JS. Incapacidade funcional, sintomas depressivos e dor lombar em idosos. Fisioter Mov. 2013;26(3):549-57. https://doi.org/10.1590/S0103-51502013000300008.
https://doi.org/10.1590/S0103-5150201300...
,4141. Santos FC, Moraes NS, Pastore A, Cendoroglo MS. Chronic pain in long-lived elderly: prevalence, characteristics, measurements and correlation with serum vitamin D level. Revista Dor. 2015;16(3):171-5. https://doi.org/10.5935/1806-0013.20150034.
https://doi.org/10.5935/1806-0013.201500...
,4545. Quintino NM, De Conti MHS, Palma R, Gatti MAN, Simeão SFAP, Vitta A. Prevalence and factors associated with low back pain in elderly registered in the Family Health Strategy. Fisioter Mov. 2017;30(2):367-77. https://doi.org/10.1590/1980-5918.030.002.ao17.
https://doi.org/10.1590/1980-5918.030.00...

46. Machado LAC, Viana JU, da Silva SLA, Couto FGP, Mendes LP, Ferreira PH, et al. Correlates of a Recent History of Disabling Low Back Pain in Community-dwellin Older Persons: The Pain in the Elderly (PAINEL) study. Clin J Pain. 2018;34(6):515-24. https://doi.org/10.1097/AJP.0000000000000564.
https://doi.org/10.1097/AJP.000000000000...
-4747. Liu-Ambrose T, Eng JJ, Khan KM, Mallinson A, Carter ND, McKay HA. The influence of back pain on balance and functional mobility in 65- to 75-year-old women with osteoporosis. Osteoporos Int. 2002;13(11):868-73. https://doi.org/10.1007/s001980200119.
https://doi.org/10.1007/s001980200119...
,5151. Barros MB, Francisco PM, Lima MG, César CL. Social inequalities in health among the elderly. Cad Saude Publica. 2011;27 Suppl 2:S198-208. https://doi.org/10.1590/S0102-311X2011001400008.
https://doi.org/10.1590/S0102-311X201100...
,5252. Kim H, Yoshida H, Hu X, Saito K, Yoshida Y, Kim M, et al. Association between self-reported urinary incontinence and musculoskeletal conditions in community-dwelling elderly women: a cross-sectional study. Neurourol Urodyn. 2015;34(4):322-6. https://doi.org/10.1002/nau.22567.
https://doi.org/10.1002/nau.22567...
) were classified as having a medium risk of bias, and three studies (3232. dos Reis LA, Mascarenhas CH, Marinho Filho LE, Borges PS. Lombalgia na terceira idade: distribuição e prevalência na Clínica Escola de Fisioterapia da Universidade Estadual do Sudoeste da Bahia. Rev Bras Geriatr Gerontol. 2008;11(1):93-103. https://doi.org/10.1590/1809-9823.2008.11019.
https://doi.org/10.1590/1809-9823.2008.1...
,4848. Kobuke Y, Abe Y, Ye Z, Honda S, Tomita M, Osaki M, et al. Association of Age, Obesity, Joint Pain, and Chewing Ability with Chair Stand Difficulty among Community-dwelling Elderly People in Nagasaki, Japan. Acta Med Nagasaki. 2009;53:65-8. https://doi.org/10.11343/amn.53.65.
https://doi.org/10.11343/amn.53.65...
,4949. Peng LN, Lin MH, Lai HY, Hwang SJ, Chen LK, Lan CF. Pain and health-care utilization among older men in a veterans care home. Arch Gerontol Geriatr. 2009;49 Suppl 2:S13-6. https://doi.org/10.1016/S0167-4943(09)70006-8.
https://doi.org/10.1016/S0167-4943(09)70...
) presented a high risk of bias, with scores lower than seven.

Table 4
Evaluation of the methodological quality of included studies in the systematic review.

DISCUSSION

Among all chronic pain problems and spinal pain conditions, LBP is the most common public health, economic, and social problem. Moreover, LBP affects the population indiscriminately worldwide (5353. Manchikanti L, Singh V, Datta S, Cohen SP, Hirsch JA; American Society of Interventional Pain Physicians. Comprehensive review of epidemiology, scope, and impact of spinal pain. Pain Physician. 2009;12(4):E35-70.). Nevertheless, the prevalence of LBP varies according to the definitions used and the population studied (99. Woolf AD, Pfleger B. Burden of major musculoskeletal conditions. Bull World Health Organ. 2003;81(9):646-56.).

This systematic review summarizes the international literature data on the prevalence of LBP in the elderly population. The results indicate a high prevalence of LBP among elderly individuals, ranging from 21.7 to 75%. Furthermore, the prevalence of LBP is high in developed countries such as Canada (1818. Hartvigsen J, Christensen K, Frederiksen H. Back pain remains a common symptom in old age. a population-based study of 4486 Danish twins aged 70-102. https://doi.org/Eur Spine J. 2003;12(5):528-34. 10.1007/s00586-003-0542-y.
https://doi.org/Eur Spine J. 2003;12(5):...
) (75%), the United States (4444. Marshall LM, Litwack-Harrison S, Makris UE, Kado DM, Cawthon PM, Deyo RA, et al. A Prospective Study of Back Pain and Risk of Falls Among Older Community-dwelling Men. J Gerontol A Biol Sci Med Sci. 2017;72(9):1264-9. https://doi.org/10.1097/AJP.0000000000000564.
https://doi.org/10.1097/AJP.000000000000...
) (67%), Sweden (4343. Kherad M, Rosengren BE, Hasserius R, Nilsson JA, Redlund-Johnell I, Ohlsson C, et al. Age Ageing. 2017;8;46(1):64-71. https://doi.org/10.1093/ageing/afw152.
https://doi.org/10.1093/ageing/afw152...
) (49%), China (3333. Woo J, Leung J, Lau E. Prevalence and correlates of musculoskeletal pain in Chinese elderly and the impact on 4-year physical function and quality of life. Public Health. 2009;123(8):549-56. https://doi.org/10.1016/j.puhe.2009.07.006.
https://doi.org/10.1016/j.puhe.2009.07.0...
) (39.2%) and Japan (4848. Kobuke Y, Abe Y, Ye Z, Honda S, Tomita M, Osaki M, et al. Association of Age, Obesity, Joint Pain, and Chewing Ability with Chair Stand Difficulty among Community-dwelling Elderly People in Nagasaki, Japan. Acta Med Nagasaki. 2009;53:65-8. https://doi.org/10.11343/amn.53.65.
https://doi.org/10.11343/amn.53.65...
) (32%). LBP occurs in 43% of both men and women, differing from the mean global prevalence, which was 31% (2222. Rana AM, Wahlin A, Streatfield PK, Kabir ZN. Association of bone and joint diseases with health-related quality of life among older people: a population-based cross-sectional study in rural Bangladesh. Ageing Soc. 2009;29(05):727-43. https://doi.org/10.1017/S0144686X09008411.
https://doi.org/10.1017/S0144686X0900841...
). This finding was also true in developing countries such as Brazil, where the prevalence was 33.6% to 68.3%. In other Brazilian studies (3737. Figueiredo VF, Pereira LS, Ferreira PH, Pereira AM, Amorim JS. Incapacidade funcional, sintomas depressivos e dor lombar em idosos. Fisioter Mov. 2013;26(3):549-57. https://doi.org/10.1590/S0103-51502013000300008.
https://doi.org/10.1590/S0103-5150201300...
,3939. Palma R, de Conti MH, Quintino NM, Gatti MA, Simeão SF, de Vitta A. Functional capacity and its associated factors in the elderly with low back pain. Acta Ortop Bras. 2014;22(6):295-9. https://doi.org/10.1590/1413-78522014220600890.
https://doi.org/10.1590/1413-78522014220...
), the small samples studied may have contributed to a high prevalence, and the samples may not have been representative of the study population.

Only one systematic review performed in 1999, including only developed countries in the Northern Hemisphere, evaluated the prevalence of LBP among elderly individuals. This study also showed a prevalence ranging from 12.8% to 51% (age above 65 years), based on the prevalence of punctual pain, pain in the last six months and pain in the last year (1313. Bressler HB, Keyes WJ, Rochon PA, Badley E. The prevalence of low back pain in the elderly. A systematic review of the literature. Spine. 1999;24(17):1813-9. https://doi.org/10.1097/00007632-199909010-00011.
https://doi.org/10.1097/00007632-1999090...
). Another systematic review of the prevalence of spinal pain among elderly individuals, including studies conducted in developed countries, presented a 20% prevalence (≥60 years) (5454. Macfarlane G, Jones G, McBeth J. Epidemiology of pain. Wall and Melzack’s textbook of pain. 2005.). However, the study did not separately analyze elderly individuals with LBP.

It was found that 46.6% of the studies included in the review defined a six-month period of LBP in the last year as chronic LBP; this definition was in accordance with one of the diagnostic criteria for research on chronic noncancer pain recommended by the taxonomy of the “International Association for Study of Pain” (5555. [No authors listed]. Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. Prepared by the International Association for the Study of Pain, Subcommittee on Taxonomy. Pain Suppl. 1986;3:S1-226.).

The most recent assessment of the global prevalence of punctual LBP comprising all age groups estimated that pain is an emerging problem in the elderly population that requires monitoring (5656. Dionne CE, Dunn KM, Croft PR. Does back pain prevalence really decrease with increasing age? A systematic review. Age Ageing. 2006;35(3):229-34. https://doi.org/10.1093/ageing/afj055.
https://doi.org/10.1093/ageing/afj055...
), especially in developing countries. Furthermore, another study reported that LBP is more frequent and is characterized by longer episodes in elderly individuals than in young adults (5757. Schillewaert N, Langerak F, Duharnel T. Non probability sampling for WWW surveys: a comparison of methods. J Market Res Soc. 1998;40(4):1-13. https://doi.org/10.1177/147078539804000403.
https://doi.org/10.1177/1470785398040004...
).

The proportion of elderly individuals (60 years or more) in almost all developed and developing countries worldwide is increasing faster than any other age group (5858. Cassidy JD, Cote P, Carroll LJ, Kristman V. Incidence and course of low back pain episodes in the general population. Spine. 2005;30(24):2817-23. https://doi.org/10.1097/01.brs.0000190448.69091.53.
https://doi.org/10.1097/01.brs.000019044...
). In a world report on aging and health by the World Health Organization (WHO), it was stated that the world population aged over 60 years will increase from the current 841 million to two billion by 2050, turning chronic diseases and the welfare of older people into new challenges for global public health (5858. Cassidy JD, Cote P, Carroll LJ, Kristman V. Incidence and course of low back pain episodes in the general population. Spine. 2005;30(24):2817-23. https://doi.org/10.1097/01.brs.0000190448.69091.53.
https://doi.org/10.1097/01.brs.000019044...
,5959. Hoy D, March L, Brooks P, Blyth F, Woolf A, Bain C, et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014;73(6):968-74. https://doi.org/10.1136/annrheumdis-2013-204428.
https://doi.org/10.1136/annrheumdis-2013...
).

Fejer et al. (6060. Fejer R, Ruhe A. What is the prevalence of musculoskeletal problems in the elderly population in developed countries? A systematic critical literature review. Chiropr Man Therap. 2012;20(1):31. https://doi.org/10.1186/2045-709X-20-31.
https://doi.org/10.1186/2045-709X-20-31...
) reported that the prevalence of LBP increases until 80 years of age and then decreases slightly, except among women, who report a greater frequency of LBP than men. There are several possible explanations for the decline in pain with advancing age (from 80 years on). Not only is there an increase in life expectancy, there is also an increase in the incidence of chronic noncommunicable diseases, which leads to increased morbidity and disability (6161. Celich KL, Galon C. Dor crônica em idosos e sua influência nas atividades da vida diária e convivência social. Rev Bras Geriatr Gerontol. 2009;12(3):345-59. https://doi.org/10.1590/1809-9823.2009.00004.
https://doi.org/10.1590/1809-9823.2009.0...
). Pain is experience by elderly individuals due to their fragility, threatening their safety, autonomy, and independence. Pain often prevents them from performing daily life activities, as well as limits their social interactions, which are situations that considerably diminish their quality of life (6262. Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global burden of disease and risk factors. New York: Oxford University Press New York. 2006. https://doi.org/10.1596/978-0-8213-6262-4.
https://doi.org/10.1596/978-0-8213-6262-...
).

Consequently, pain among elderly individuals should be considered as a continuation of pain from previous years (6363. Leveille SG, Zhang Y, McMullen W, Kelly-Hayes M, Felson DT. Sex differences in musculoskeletal pain in older adults. Pain. 2005;116(3):332-8. https://doi.org/10.1016/j.pain.2005.05.002.
https://doi.org/10.1016/j.pain.2005.05.0...
), while accepting that pain among the elderly population occurs as a part of aging (6464. Sjogren P, Ekholm O, Peuckmann V, Gronbaek M. Epidemiology of chronic pain in Denmark: an update. Eur J Pain. 2009;13(3):287-92. https://doi.org/10.1016/j.ejpain.2008.04.007.
https://doi.org/10.1016/j.ejpain.2008.04...
). In other words, pain becomes a natural part of life; therefore, it becomes less disturbing or it is simply ignored. Finally, a decline in the prevalence of pain in the elderly population may be explained by a phenomenon of “survival of the fittest” (6565. Lima e Costa MF. A saúde dos adultos na Região Metropolitana de Belo Horizonte: um estudo epidemiológico de base populacional. A saúde dos adultos na Região Metropolitana de Belo Horizonte: um estudo epidemiológico de base populacional. UFMG; FIOCRUZ; 2004. 120p.).

Another aspect that can be highlighted in this review is the greater prevalence among females observed in various studies (2222. Rana AM, Wahlin A, Streatfield PK, Kabir ZN. Association of bone and joint diseases with health-related quality of life among older people: a population-based cross-sectional study in rural Bangladesh. Ageing Soc. 2009;29(05):727-43. https://doi.org/10.1017/S0144686X09008411.
https://doi.org/10.1017/S0144686X0900841...
,2323. Gálvez-Barrón C, Narvaiza L, Dapena MD, Macho O, Rodríguez-Molinero A. Prevalence and treatment of pain in non-institutionalized very old population: transversal study at national level. Aging Clin Exp Res. 2016;28(2):347-53. https://doi.org/10.1007/s40520-015-0387-3.
https://doi.org/10.1007/s40520-015-0387-...
,3333. Woo J, Leung J, Lau E. Prevalence and correlates of musculoskeletal pain in Chinese elderly and the impact on 4-year physical function and quality of life. Public Health. 2009;123(8):549-56. https://doi.org/10.1016/j.puhe.2009.07.006.
https://doi.org/10.1016/j.puhe.2009.07.0...
,3939. Palma R, de Conti MH, Quintino NM, Gatti MA, Simeão SF, de Vitta A. Functional capacity and its associated factors in the elderly with low back pain. Acta Ortop Bras. 2014;22(6):295-9. https://doi.org/10.1590/1413-78522014220600890.
https://doi.org/10.1590/1413-78522014220...
,4242. Scherer M, Hansen H, Gensichen J, Mergenthal K, Riedel-Heller S, Weyerer S, et al. Association between multimorbidity patterns and chronic pain in elderly primary care patients: a cross-sectional observational study. BMC Fam Pract. 2016;17:68. https://doi.org/10.1186/s12875-016-0468-1.
https://doi.org/10.1186/s12875-016-0468-...
,4747. Liu-Ambrose T, Eng JJ, Khan KM, Mallinson A, Carter ND, McKay HA. The influence of back pain on balance and functional mobility in 65- to 75-year-old women with osteoporosis. Osteoporos Int. 2002;13(11):868-73. https://doi.org/10.1007/s001980200119.
https://doi.org/10.1007/s001980200119...
,4848. Kobuke Y, Abe Y, Ye Z, Honda S, Tomita M, Osaki M, et al. Association of Age, Obesity, Joint Pain, and Chewing Ability with Chair Stand Difficulty among Community-dwelling Elderly People in Nagasaki, Japan. Acta Med Nagasaki. 2009;53:65-8. https://doi.org/10.11343/amn.53.65.
https://doi.org/10.11343/amn.53.65...
); the prevalence ranged from 35% to 82%. These findings confirm that women outlive men, despite suffering longer exposure to risk factors; women live with more comorbidities and experience the chronicity of clinical conditions - a phenomenon called “feminization” of old age (6666. Turk DC, Okifuji A. Psychological factors in chronic pain: evolution and revolution. J Consult Clin Psychol. 2002;70(3):678-90. https://doi.org/10.1037/0022-006X.70.3.678.
https://doi.org/10.1037/0022-006X.70.3.6...
). A recent systematic review showed that the prevalence of LBP seemed higher among middle-aged adults and women (5656. Dionne CE, Dunn KM, Croft PR. Does back pain prevalence really decrease with increasing age? A systematic review. Age Ageing. 2006;35(3):229-34. https://doi.org/10.1093/ageing/afj055.
https://doi.org/10.1093/ageing/afj055...
). A biopsychosocial model of chronic pain attributes sexual differences in pain to interactions between biological, psychological, and sociocultural factors (6767. Fillingim RB. Sex, gender and pain: The biopsychosocial model in action XX vs. XY. The International Journal of Sex Differences in the Study of Health, Disease and Aging. 2003;1:98-101.,6868. Rollman GB, Lautenbacher S. Sex differences in musculoskeletal pain. Clin J Pain. 2001;17(1):20-4. https://doi.org/10.1097/00002508-200103000-00004.
https://doi.org/10.1097/00002508-2001030...
). A greater sensitivity to pain among women may also partially explain higher reports of pain by women than by men (6969. Makris UE, Fraenkel L, Han L, Leo-Summers L, Gill TM. Epidemiology of restricting back pain in community-living older persons. J Am Geriatr Soc. 2011;59(4):610-4. https://doi.org/10.1111/j.1532-5415.2011.03329.x.
https://doi.org/10.1111/j.1532-5415.2011...
).

Although most LBP is self-limiting, begins to improve after a few days and resolves within a month (7070. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2224-60. https://doi.org/10.1016/S0140-6736(12)61766-8.
https://doi.org/10.1016/S0140-6736(12)61...
), some patients are susceptible to chronic LBP that leads to significant disability. Age is a well-known risk factor for chronic LBP (7171. Klineberg E, Mazanec D, Orr D, Demicco R, Bell G, McLain R. Masquerade: medical causes of back pain. Cleve Clin J Med. 2007;74(12):905-13. https://doi.org/10.3949/ccjm.74.12.905.
https://doi.org/10.3949/ccjm.74.12.905...
), and other factors may perpetuate LBP in older adults. The understanding of these factors can help identify high-risk patients and improve their LBP management. Since older adults usually face both age-related physical and psychosocial issues, comprehensive assessments and treatments are needed to effectively manage LBP in the elderly population.

Methodological limitations, when related to external validity relevant to criterion (11. Rapoport J, Jacobs P, Bell NR, Klarenbach S. Refining the measurement of the economic burden of chronic diseases in Canada. Chronic Dis Can. 2004;25(1):13-21.) (representatives of the study sample in relation to the national population to allow for the generalizability of results), were not found in 22 studies (1818. Hartvigsen J, Christensen K, Frederiksen H. Back pain remains a common symptom in old age. a population-based study of 4486 Danish twins aged 70-102. https://doi.org/Eur Spine J. 2003;12(5):528-34. 10.1007/s00586-003-0542-y.
https://doi.org/Eur Spine J. 2003;12(5):...
,2222. Rana AM, Wahlin A, Streatfield PK, Kabir ZN. Association of bone and joint diseases with health-related quality of life among older people: a population-based cross-sectional study in rural Bangladesh. Ageing Soc. 2009;29(05):727-43. https://doi.org/10.1017/S0144686X09008411.
https://doi.org/10.1017/S0144686X0900841...
,2424. Tomita Y, Arima K, Kanagae M, Okabe T, Mizukami S, Nishimura T, et al. Association of Physical Performance and Pain With Fear of Falling Among Community-Dwelling Japanese Women Aged 65 Years and Older. Medicine. 2015;94(35):e1449. https://doi.org/10.1097/MD.0000000000001449.
https://doi.org/10.1097/MD.0000000000001...
,2727. Weiner DK, Haggerty CL, Kritchevsky SB, Harris T, Simonsick EM, Nevitt M, et al. How does low back pain impact physical function in independent, well-functioning older adults? Evidence from the Health ABC Cohort and implications for the future. Pain Med. 2003;4(4):311-20. https://doi.org/10.1111/j.1526-4637.2003.03042.x.
https://doi.org/10.1111/j.1526-4637.2003...
,2929. Dellaroza MS, Pimenta CA, Duarte YA, Lebrão ML. [Chronic pain among elderly residents in São Paulo, Brazil: prevalence, characteristics, and association with functional capacity and mobility (SABE Study)]. Cad Saude Publica. 2013;29(2):325-34. https://doi.org/10.1590/S0102-311X2013000200019.
https://doi.org/10.1590/S0102-311X201300...
,3131. Kovacs F, Noguera J, Abraira V, Royuela A, Cano A, Gil del Real MT, et al. The influence of psychological factors on low back pain-related disability in community dwelling older persons. Pain Med. 2008;9(7):871-80. https://doi.org/10.1111/j.1526-4637.2008.00518.x.
https://doi.org/10.1111/j.1526-4637.2008...

32. dos Reis LA, Mascarenhas CH, Marinho Filho LE, Borges PS. Lombalgia na terceira idade: distribuição e prevalência na Clínica Escola de Fisioterapia da Universidade Estadual do Sudoeste da Bahia. Rev Bras Geriatr Gerontol. 2008;11(1):93-103. https://doi.org/10.1590/1809-9823.2008.11019.
https://doi.org/10.1590/1809-9823.2008.1...

33. Woo J, Leung J, Lau E. Prevalence and correlates of musculoskeletal pain in Chinese elderly and the impact on 4-year physical function and quality of life. Public Health. 2009;123(8):549-56. https://doi.org/10.1016/j.puhe.2009.07.006.
https://doi.org/10.1016/j.puhe.2009.07.0...
-3434. Holton KF, Denard PJ, Yoo JU, Kado DM, Barrett-Connor E, Marshall LM, et al., editors. Diffuse idiopathic skeletal hyperostosis and its relation to back pain among older men: the MrOS Study. Semin Arthritis Rheum. 2011;41(2):131-8. https://doi.org/10.1016/j.semarthrit.2011.01.001.
https://doi.org/10.1016/j.semarthrit.201...
,3636. Exarchou S, Redlund-Johnell I, Karlsson M, Mellström D, Ohlsson C, Turesson C, et al. The prevalence of moderate to severe radiographic sacroiliitis and the correlation with health status in elderly Swedish men--the MrOS study. BMC Musculoskelet Disord. 2013;14:352. https://doi.org/10.1186/1471-2474-14-352.
https://doi.org/10.1186/1471-2474-14-352...
,3737. Figueiredo VF, Pereira LS, Ferreira PH, Pereira AM, Amorim JS. Incapacidade funcional, sintomas depressivos e dor lombar em idosos. Fisioter Mov. 2013;26(3):549-57. https://doi.org/10.1590/S0103-51502013000300008.
https://doi.org/10.1590/S0103-5150201300...
,4040. Pereira LV, de Vasconcelos PP, Souza LA, Pereira Gde A, Nakatani AY, Bachion MM. Prevalence and intensity of chronic pain and self-perceived health among elderly people: a population-based study. Rev Lat Am Enfermagem. 2014;22(4):662-9. https://doi.org/10.1590/0104-1169.3591.2465.
https://doi.org/10.1590/0104-1169.3591.2...
,4141. Santos FC, Moraes NS, Pastore A, Cendoroglo MS. Chronic pain in long-lived elderly: prevalence, characteristics, measurements and correlation with serum vitamin D level. Revista Dor. 2015;16(3):171-5. https://doi.org/10.5935/1806-0013.20150034.
https://doi.org/10.5935/1806-0013.201500...
,4343. Kherad M, Rosengren BE, Hasserius R, Nilsson JA, Redlund-Johnell I, Ohlsson C, et al. Age Ageing. 2017;8;46(1):64-71. https://doi.org/10.1093/ageing/afw152.
https://doi.org/10.1093/ageing/afw152...

44. Marshall LM, Litwack-Harrison S, Makris UE, Kado DM, Cawthon PM, Deyo RA, et al. A Prospective Study of Back Pain and Risk of Falls Among Older Community-dwelling Men. J Gerontol A Biol Sci Med Sci. 2017;72(9):1264-9. https://doi.org/10.1097/AJP.0000000000000564.
https://doi.org/10.1097/AJP.000000000000...

45. Quintino NM, De Conti MHS, Palma R, Gatti MAN, Simeão SFAP, Vitta A. Prevalence and factors associated with low back pain in elderly registered in the Family Health Strategy. Fisioter Mov. 2017;30(2):367-77. https://doi.org/10.1590/1980-5918.030.002.ao17.
https://doi.org/10.1590/1980-5918.030.00...

46. Machado LAC, Viana JU, da Silva SLA, Couto FGP, Mendes LP, Ferreira PH, et al. Correlates of a Recent History of Disabling Low Back Pain in Community-dwellin Older Persons: The Pain in the Elderly (PAINEL) study. Clin J Pain. 2018;34(6):515-24. https://doi.org/10.1097/AJP.0000000000000564.
https://doi.org/10.1097/AJP.000000000000...

47. Liu-Ambrose T, Eng JJ, Khan KM, Mallinson A, Carter ND, McKay HA. The influence of back pain on balance and functional mobility in 65- to 75-year-old women with osteoporosis. Osteoporos Int. 2002;13(11):868-73. https://doi.org/10.1007/s001980200119.
https://doi.org/10.1007/s001980200119...
-4848. Kobuke Y, Abe Y, Ye Z, Honda S, Tomita M, Osaki M, et al. Association of Age, Obesity, Joint Pain, and Chewing Ability with Chair Stand Difficulty among Community-dwelling Elderly People in Nagasaki, Japan. Acta Med Nagasaki. 2009;53:65-8. https://doi.org/10.11343/amn.53.65.
https://doi.org/10.11343/amn.53.65...
). The researchers involved in these studies conducted data collection in regions or municipalities without nationally representing the target population, which would not occur if there were core studies or multicentric groups to produce representative samples. Random selection was used in 18 studies (1919. Blay SL, Andreoli SB, Gastal FL. Chronic painful physical conditions, disturbed sleep and psychiatric morbidity: results from an elderly survey. Ann Clin Psychiatry. 2007;19(3):169-74. https://doi.org/10.1080/10401230701468099.
https://doi.org/10.1080/1040123070146809...

20. Meyer T, Cooper J, Raspe H. Disabling low back pain and depressive symptoms in the community-dwelling elderly: a prospective study. Spine. 2007;32(21):2380-6. https://doi.org/10.1097/BRS.0b013e3181557955.
https://doi.org/10.1097/BRS.0b013e318155...
-2121. Lima MG, Barros MB, César CL, Goldbaum M, Carandina L, Ciconelli RM. Impact of chronic disease on quality of life among the elderly in the state of São Paulo, Brazil: a population-based study. Rev Panam Salud Publ. 2009;25(4):314-21. https://doi.org/10.1590/S1020-49892009000400005.
https://doi.org/10.1590/S1020-4989200900...
,2222. Rana AM, Wahlin A, Streatfield PK, Kabir ZN. Association of bone and joint diseases with health-related quality of life among older people: a population-based cross-sectional study in rural Bangladesh. Ageing Soc. 2009;29(05):727-43. https://doi.org/10.1017/S0144686X09008411.
https://doi.org/10.1017/S0144686X0900841...
,2424. Tomita Y, Arima K, Kanagae M, Okabe T, Mizukami S, Nishimura T, et al. Association of Physical Performance and Pain With Fear of Falling Among Community-Dwelling Japanese Women Aged 65 Years and Older. Medicine. 2015;94(35):e1449. https://doi.org/10.1097/MD.0000000000001449.
https://doi.org/10.1097/MD.0000000000001...
,2727. Weiner DK, Haggerty CL, Kritchevsky SB, Harris T, Simonsick EM, Nevitt M, et al. How does low back pain impact physical function in independent, well-functioning older adults? Evidence from the Health ABC Cohort and implications for the future. Pain Med. 2003;4(4):311-20. https://doi.org/10.1111/j.1526-4637.2003.03042.x.
https://doi.org/10.1111/j.1526-4637.2003...
,2929. Dellaroza MS, Pimenta CA, Duarte YA, Lebrão ML. [Chronic pain among elderly residents in São Paulo, Brazil: prevalence, characteristics, and association with functional capacity and mobility (SABE Study)]. Cad Saude Publica. 2013;29(2):325-34. https://doi.org/10.1590/S0102-311X2013000200019.
https://doi.org/10.1590/S0102-311X201300...
,3434. Holton KF, Denard PJ, Yoo JU, Kado DM, Barrett-Connor E, Marshall LM, et al., editors. Diffuse idiopathic skeletal hyperostosis and its relation to back pain among older men: the MrOS Study. Semin Arthritis Rheum. 2011;41(2):131-8. https://doi.org/10.1016/j.semarthrit.2011.01.001.
https://doi.org/10.1016/j.semarthrit.201...
,3535. Abegunde KA, Owoaje ET. Health problems and associated risk factors in selected urban and rural elderly population groups of South-West Nigeria. Ann Afr Med. 2013;12(2):90-7. https://doi.org/10.4103/1596-3519.112398.
https://doi.org/10.4103/1596-3519.112398...
,3737. Figueiredo VF, Pereira LS, Ferreira PH, Pereira AM, Amorim JS. Incapacidade funcional, sintomas depressivos e dor lombar em idosos. Fisioter Mov. 2013;26(3):549-57. https://doi.org/10.1590/S0103-51502013000300008.
https://doi.org/10.1590/S0103-5150201300...
,4141. Santos FC, Moraes NS, Pastore A, Cendoroglo MS. Chronic pain in long-lived elderly: prevalence, characteristics, measurements and correlation with serum vitamin D level. Revista Dor. 2015;16(3):171-5. https://doi.org/10.5935/1806-0013.20150034.
https://doi.org/10.5935/1806-0013.201500...
,5151. Barros MB, Francisco PM, Lima MG, César CL. Social inequalities in health among the elderly. Cad Saude Publica. 2011;27 Suppl 2:S198-208. https://doi.org/10.1590/S0102-311X2011001400008.
https://doi.org/10.1590/S0102-311X201100...
,5353. Manchikanti L, Singh V, Datta S, Cohen SP, Hirsch JA; American Society of Interventional Pain Physicians. Comprehensive review of epidemiology, scope, and impact of spinal pain. Pain Physician. 2009;12(4):E35-70.). In the remaining studies, convenience sampling was the technique of choice to obtain quick, low-cost information (5858. Cassidy JD, Cote P, Carroll LJ, Kristman V. Incidence and course of low back pain episodes in the general population. Spine. 2005;30(24):2817-23. https://doi.org/10.1097/01.brs.0000190448.69091.53.
https://doi.org/10.1097/01.brs.000019044...
). Regarding internal validity, which was involved in this criterion (77. Katz JN. Lumbar disc disorders and low-back pain: socioeconomic factors and consequences. J Bone Joint Surg Am. 2006;88 Suppl 2:21-4.), 53.3% of the studies (1818. Hartvigsen J, Christensen K, Frederiksen H. Back pain remains a common symptom in old age. a population-based study of 4486 Danish twins aged 70-102. https://doi.org/Eur Spine J. 2003;12(5):528-34. 10.1007/s00586-003-0542-y.
https://doi.org/Eur Spine J. 2003;12(5):...

19. Blay SL, Andreoli SB, Gastal FL. Chronic painful physical conditions, disturbed sleep and psychiatric morbidity: results from an elderly survey. Ann Clin Psychiatry. 2007;19(3):169-74. https://doi.org/10.1080/10401230701468099.
https://doi.org/10.1080/1040123070146809...

20. Meyer T, Cooper J, Raspe H. Disabling low back pain and depressive symptoms in the community-dwelling elderly: a prospective study. Spine. 2007;32(21):2380-6. https://doi.org/10.1097/BRS.0b013e3181557955.
https://doi.org/10.1097/BRS.0b013e318155...

21. Lima MG, Barros MB, César CL, Goldbaum M, Carandina L, Ciconelli RM. Impact of chronic disease on quality of life among the elderly in the state of São Paulo, Brazil: a population-based study. Rev Panam Salud Publ. 2009;25(4):314-21. https://doi.org/10.1590/S1020-49892009000400005.
https://doi.org/10.1590/S1020-4989200900...
-2222. Rana AM, Wahlin A, Streatfield PK, Kabir ZN. Association of bone and joint diseases with health-related quality of life among older people: a population-based cross-sectional study in rural Bangladesh. Ageing Soc. 2009;29(05):727-43. https://doi.org/10.1017/S0144686X09008411.
https://doi.org/10.1017/S0144686X0900841...
,2626. Lavsky-Shulan M, Wallace RB, Kohout FJ, Lemke JH, Morris MC, Smith IM. Prevalence and functional correlates of low back pain in the elderly: the Iowa 65+ Rural Health Study. J Am Geriatr Soc. 1985;33(1):23-8. https://doi.org/10.1111/j.1532-5415.1985.tb02855.x.
https://doi.org/10.1111/j.1532-5415.1985...

27. Weiner DK, Haggerty CL, Kritchevsky SB, Harris T, Simonsick EM, Nevitt M, et al. How does low back pain impact physical function in independent, well-functioning older adults? Evidence from the Health ABC Cohort and implications for the future. Pain Med. 2003;4(4):311-20. https://doi.org/10.1111/j.1526-4637.2003.03042.x.
https://doi.org/10.1111/j.1526-4637.2003...

28. Cecchi F, Debolini P, Lova RM, Macchi C, Bandinelli S, Bartali B, et al. Epidemiology of back pain in a representative cohort of Italian persons 65 years of age and older: the InCHIANTI study. Spine. 2006;31(10):1149-55. https://doi.org/10.1097/01.brs.0000216606.24142.e1.
https://doi.org/10.1097/01.brs.000021660...

29. Dellaroza MS, Pimenta CA, Duarte YA, Lebrão ML. [Chronic pain among elderly residents in São Paulo, Brazil: prevalence, characteristics, and association with functional capacity and mobility (SABE Study)]. Cad Saude Publica. 2013;29(2):325-34. https://doi.org/10.1590/S0102-311X2013000200019.
https://doi.org/10.1590/S0102-311X201300...
-3030. Hicks GE, Gaines JM, Shardell M, Simonsick EM. Associations of back and leg pain with health status and functional capacity of older adults: findings from the retirement community back pain study. Arthritis Rheum. 2008;59(9):1306-13. https://doi.org/10.1002/art.24006.
https://doi.org/10.1002/art.24006...
,3333. Woo J, Leung J, Lau E. Prevalence and correlates of musculoskeletal pain in Chinese elderly and the impact on 4-year physical function and quality of life. Public Health. 2009;123(8):549-56. https://doi.org/10.1016/j.puhe.2009.07.006.
https://doi.org/10.1016/j.puhe.2009.07.0...
,3535. Abegunde KA, Owoaje ET. Health problems and associated risk factors in selected urban and rural elderly population groups of South-West Nigeria. Ann Afr Med. 2013;12(2):90-7. https://doi.org/10.4103/1596-3519.112398.
https://doi.org/10.4103/1596-3519.112398...
,3737. Figueiredo VF, Pereira LS, Ferreira PH, Pereira AM, Amorim JS. Incapacidade funcional, sintomas depressivos e dor lombar em idosos. Fisioter Mov. 2013;26(3):549-57. https://doi.org/10.1590/S0103-51502013000300008.
https://doi.org/10.1590/S0103-5150201300...
,4040. Pereira LV, de Vasconcelos PP, Souza LA, Pereira Gde A, Nakatani AY, Bachion MM. Prevalence and intensity of chronic pain and self-perceived health among elderly people: a population-based study. Rev Lat Am Enfermagem. 2014;22(4):662-9. https://doi.org/10.1590/0104-1169.3591.2465.
https://doi.org/10.1590/0104-1169.3591.2...
,4242. Scherer M, Hansen H, Gensichen J, Mergenthal K, Riedel-Heller S, Weyerer S, et al. Association between multimorbidity patterns and chronic pain in elderly primary care patients: a cross-sectional observational study. BMC Fam Pract. 2016;17:68. https://doi.org/10.1186/s12875-016-0468-1.
https://doi.org/10.1186/s12875-016-0468-...
,4848. Kobuke Y, Abe Y, Ye Z, Honda S, Tomita M, Osaki M, et al. Association of Age, Obesity, Joint Pain, and Chewing Ability with Chair Stand Difficulty among Community-dwelling Elderly People in Nagasaki, Japan. Acta Med Nagasaki. 2009;53:65-8. https://doi.org/10.11343/amn.53.65.
https://doi.org/10.11343/amn.53.65...
,4949. Peng LN, Lin MH, Lai HY, Hwang SJ, Chen LK, Lan CF. Pain and health-care utilization among older men in a veterans care home. Arch Gerontol Geriatr. 2009;49 Suppl 2:S13-6. https://doi.org/10.1016/S0167-4943(09)70006-8.
https://doi.org/10.1016/S0167-4943(09)70...
,5151. Barros MB, Francisco PM, Lima MG, César CL. Social inequalities in health among the elderly. Cad Saude Publica. 2011;27 Suppl 2:S198-208. https://doi.org/10.1590/S0102-311X2011001400008.
https://doi.org/10.1590/S0102-311X201100...
,5252. Kim H, Yoshida H, Hu X, Saito K, Yoshida Y, Kim M, et al. Association between self-reported urinary incontinence and musculoskeletal conditions in community-dwelling elderly women: a cross-sectional study. Neurourol Urodyn. 2015;34(4):322-6. https://doi.org/10.1002/nau.22567.
https://doi.org/10.1002/nau.22567...
) used their own questionnaires. These studies only questioned whether the individuals had LBP or not. Nonetheless, the lack of standardization of instruments used in data collection may have influenced the results (3535. Abegunde KA, Owoaje ET. Health problems and associated risk factors in selected urban and rural elderly population groups of South-West Nigeria. Ann Afr Med. 2013;12(2):90-7. https://doi.org/10.4103/1596-3519.112398.
https://doi.org/10.4103/1596-3519.112398...
).

We attempted to minimize these limitations by evaluating the methodological criteria of the eligible studies, but unlike other reviews (7272. Kim W, Jin YS, Lee CS, Hwang CJ, Lee SY, Chung SG, et al. Relationship between the type and amount of physical activity and low back pain in Koreans aged 50 years and older. PM R. 2014;6(10):893-9. https://doi.org/10.1016/j.pmrj.2014.04.009.
https://doi.org/10.1016/j.pmrj.2014.04.0...
,7373. Hoy D, Bain C, Williams G, March L, Brooks P, Blyth F, et al. A systematic review of the global prevalence of low back pain. Arthritis Rheum. 2012;64(6):2028-37. https://doi.org/10.1002/art.34347.
https://doi.org/10.1002/art.34347...
), we did not establish a cut-off point based on this methodological evaluation to include the studies in this review.

Based on previous findings and the most recent global prevalence of occasional LBP, including all age groups (i.e., 9.4%, 95% CI 9 to 9.8) (5454. Macfarlane G, Jones G, McBeth J. Epidemiology of pain. Wall and Melzack’s textbook of pain. 2005.), this review estimates that LBP is a health problem in the elderly population. The adequate epidemiological description of LBP in the elderly can improve the distribution of resources for the clinical management of this condition, especially in developing countries (5858. Cassidy JD, Cote P, Carroll LJ, Kristman V. Incidence and course of low back pain episodes in the general population. Spine. 2005;30(24):2817-23. https://doi.org/10.1097/01.brs.0000190448.69091.53.
https://doi.org/10.1097/01.brs.000019044...
,6969. Makris UE, Fraenkel L, Han L, Leo-Summers L, Gill TM. Epidemiology of restricting back pain in community-living older persons. J Am Geriatr Soc. 2011;59(4):610-4. https://doi.org/10.1111/j.1532-5415.2011.03329.x.
https://doi.org/10.1111/j.1532-5415.2011...
,7474. Ferreira ML, Machado G, Latimer J, Maher C, Ferreira PH, Smeets RJ. Factors defining care-seeking in low back pain: a meta-analysis of population based surveys. Eur J Pain. 2010;14(7):747.e1-7. https://doi.org/10.1016/j.ejpain.2009.11.005.
https://doi.org/10.1016/j.ejpain.2009.11...
). Data show that both the number and proportion of individuals aged older than 65 years have been increasing in most western populations (6061. Celich KL, Galon C. Dor crônica em idosos e sua influência nas atividades da vida diária e convivência social. Rev Bras Geriatr Gerontol. 2009;12(3):345-59. https://doi.org/10.1590/1809-9823.2009.00004.
https://doi.org/10.1590/1809-9823.2009.0...
). It is believed that LBP will lead to even greater health care costs in the future (5858. Cassidy JD, Cote P, Carroll LJ, Kristman V. Incidence and course of low back pain episodes in the general population. Spine. 2005;30(24):2817-23. https://doi.org/10.1097/01.brs.0000190448.69091.53.
https://doi.org/10.1097/01.brs.000019044...
).

This study helped to reveal the main shortcomings of the current studies on the prevalence of LBP in the elderly population worldwide. These findings can guide actions to produce robust evidence on this topic in future studies and in clinical practice. We strongly recommend the performance of further robust studies with low risk of bias and consistent LBP definitions.

Limitations

The limitation of the study was the different definitions of LBP used in the studies, which may lead to a misunderstanding about the actual location of LBP. In addition, a uniform definition of LBP for the purpose of LBP epidemiological studies would significantly enhance our ability to compare and pool results across studies.

CONCLUSIONS

This systematic review indicates a high prevalence of LBP in the elderly population and that functional disability affects factors that are important for independence. However, the investigated studies present diverse methodologies, and different definitions of LBP were used, suggesting that more research should be carried out with scientific accuracy, methodological quality and low risk of bias to contribute towards developing preventive actions for the elderly population affected by LBP. Finally, such studies will provide information to devise public policy plans by health managers and professionals.

APPENDIX

Search strategies data bases

MEDLINE

tw:(low back pain AND prevalence AND elderly) AND (instance:“regional“) AND (db:(“MEDLINE“) AND la:(“en” OR “pt“) AND year_cluster:(“2017” OR “2018” OR “2014” OR “2013” OR “2015” OR “2012” OR “2009” OR “2011” OR “2006” OR “2010” OR “2005” OR “2007” OR “2008” OR “2016” OR “2004” OR “2002” OR “2003” OR “2001” OR “2000” OR “1998” OR “1999” OR “1997” OR “1995” OR “1993” OR “1994” OR “1996” OR “1991” OR “1987” OR “1990” OR “1992” OR “1989” OR “1988” OR “1985“) AND type:(“article“))

EMBASE

“low back pain” OR “back pain” OR “lower back pain” AND prevalence AND elderly#1 AND (1980:py OR 1984:py OR 1985:py OR 1986:py OR 1987:py OR 1988:py OR 1989:py OR 1990:py OR 1991:py OR 1992:py OR 1993:py OR 1994:py OR 1995:py OR 1996:py OR 1997:py OR 1998:py OR 1999:py OR 2000:py OR 2001:py OR 2002:py OR 2003:py OR 2004:py OR 2005:py OR 2006:py OR 2007:py OR 2008:py OR 2009:py OR 2010:py OR 2011:py OR 2012:py OR 2013:py OR 2014:py OR 2015:py OR 2016:py OR 2017:py OR 2018:py)

SCOPUS

TITLE-ABS-KEY(“low back pain” OR “back pain” OR “lower back pain” ) AND TITLE-ABS-KEY(prevalence) AND TITLE-ABS-KEY(elderly) AND (LIMIT-TO (PUBYEAR,2018) OR LIMIT-TO (PUBYEAR,2017) OR (PUBYEAR,2016) OR LIMIT-TO (PUBYEAR,2015) LIMIT-TO (PUBYEAR,2014) OR LIMIT-TO (PUBYEAR,2013) OR LIMIT-TO (PUBYEAR,2012) OR LIMIT-TO (PUBYEAR,2011) OR LIMIT-TO (PUBYEAR,2010) OR LIMIT-TO (PUBYEAR,2009) OR LIMIT-TO (PUBYEAR,2008) OR LIMIT-TO (PUBYEAR,2007) OR LIMIT-TO (PUBYEAR,2006) OR LIMIT-TO (PUBYEAR,2005) OR LIMIT-TO (PUBYEAR,2004) OR LIMIT-TO (PUBYEAR,2003) OR LIMIT-TO (PUBYEAR,2002) OR LIMIT-TO (PUBYEAR,2001) OR LIMIT-TO (PUBYEAR,2000) OR LIMIT-TO (PUBYEAR,1999) OR LIMIT-TO (PUBYEAR,1998) OR LIMIT-TO (PUBYEAR,1997) OR LIMIT-TO (PUBYEAR,1996) OR LIMIT-TO (PUBYEAR,1995) OR LIMIT-TO (PUBYEAR,1994) OR LIMIT-TO (PUBYEAR,1993) OR LIMIT-TO (PUBYEAR,1992) OR LIMIT-TO (PUBYEAR,1990) OR LIMIT-TO (PUBYEAR,1989) OR LIMIT-TO (PUBYEAR,1988) OR LIMIT-TO (PUBYEAR,1985) OR LIMIT-TO (PUBYEAR,1980) )

SCIELO (http://search.scielo.org/)

low back pain AND prevalence AND elderly

dor lombar OR low back pain AND prevalência OR prevalence AND idoso OR elderly AND la:(“pt” OR “en“) AND year_cluster:(“2015” OR “2017” OR “2018” OR “2011” OR “2013” OR “2014” OR “2016” OR “2012” OR “2010” OR “2006” OR “2007” OR “2009” OR “2001” OR “2004” OR “2008” OR “1997” OR “2003” OR “2005“)

LILACS

“dor lombar” OR “low back pain” AND prevalência OR prevalence AND idoso OR elderly

WEB OF SCIENCE

(low back pain) AND Tópico: (prevalence) AND Tópico: (elderly) Refinado por: Idiomas: (ENGLISH OR PORTUGUESE) Tempo estipulado: 1985-2018. ĺndices: SCI-EXPANDED, SSCI, A&HCI, CPCI-S, CPCI-SSH, ESCI.



ACKNOWLEDGMENTS

The authors would like to thank all collaborators in the Laboratory of Professor PhD Marques for their collaboration and support since 2016.

REFERENCES

  • 1
    Rapoport J, Jacobs P, Bell NR, Klarenbach S. Refining the measurement of the economic burden of chronic diseases in Canada. Chronic Dis Can. 2004;25(1):13-21.
  • 2
    Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, et al. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006;15 Suppl 2:S192-300. https://doi.org/10.1007/s00586-006-1072-1
    » https://doi.org/10.1007/s00586-006-1072-1
  • 3
    Martins MR, Foss MH, Santos Junior R, Zancheta M, Pires IC, Cunha AMR, et al. A eficácia da conduta do grupo de postura em pacientes com lombalgia crônica. Rev Dor. 2010;11(2):116-21.
  • 4
    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. https://doi.org/10.1590/S0102-311X2004000200005
    » https://doi.org/10.1590/S0102-311X2004000200005
  • 5
    Institucionais IT. Programa Nacional de Promoção da Atividade Física “Agita Brasil”: Atividade física e sua contribuição para a qualidade de vida. Rev Saude Publica. 2002;36(2):254-6. https://doi.org/10.1590/S0034-89102002000200022
    » https://doi.org/10.1590/S0034-89102002000200022
  • 6
    Andersson GB. Epidemiological features of chronic low-back pain. Lancet. 1999;354(9178):581-5. https://doi.org/10.1016/S0140-6736(99)01312-4
    » https://doi.org/10.1016/S0140-6736(99)01312-4
  • 7
    Katz JN. Lumbar disc disorders and low-back pain: socioeconomic factors and consequences. J Bone Joint Surg Am. 2006;88 Suppl 2:21-4.
  • 8
    Freburger JK, Holmes GM, Agans RP, Jackman AM, Darter JD, Wallace AS, et al. The rising prevalence of chronic low back pain. Arch Intern Med. 2009;169(3):251-8. https://doi.org/10.1001/archinternmed.2008.543
    » https://doi.org/10.1001/archinternmed.2008.543
  • 9
    Woolf AD, Pfleger B. Burden of major musculoskeletal conditions. Bull World Health Organ. 2003;81(9):646-56.
  • 10
    Edmond SL, Felson DT. Function and back symptoms in older adults. J Am Geriatr Soc. 2003;51(12):1702-9. https://doi.org/10.1046/j.1532-5415.2003.51553.x
    » https://doi.org/10.1046/j.1532-5415.2003.51553.x
  • 11
    Cooper JK, Kohlmann T. Factors associated with health status of older Americans. Age Ageing. 2001;30(6):495-501. https://doi.org/10.1093/ageing/30.6.495
    » https://doi.org/10.1093/ageing/30.6.495
  • 12
    Teixeira MJ, Teixeira WGJ, Santos FPS, Andrade DCA, Bezerra SL, Figueiró JB, et al. Epidemiologia clínica da dor músculo-esquelética. Rev Med. 2001;80(ed. esp. pt.1):1-21.
  • 13
    Bressler HB, Keyes WJ, Rochon PA, Badley E. The prevalence of low back pain in the elderly. A systematic review of the literature. Spine. 1999;24(17):1813-9. https://doi.org/10.1097/00007632-199909010-00011
    » https://doi.org/10.1097/00007632-199909010-00011
  • 14
    Gallagher RM. Low back pain, health status, and quality of life in older adults: challenge and opportunity. Pain Med. 2003;4(4):305-7. https://doi.org/10.1111/j.1526-4637.2003.03049.x
    » https://doi.org/10.1111/j.1526-4637.2003.03049.x
  • 15
    Moher D, Liberati A, Tetzlaff J, Altman DG; Prisma Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264-9, W64. https://doi.org/10.7326/0003-4819-151-4-200908180-00135
    » https://doi.org/10.7326/0003-4819-151-4-200908180-00135
  • 16
    World Health Organization. Active Ageing: A Policy Framework. A Contribution of the World Health Organization to the Second United Nations World Assembly on Ageing. Available from: https://extranet.who.int/agefriendlyworld/wp-content/uploads/2014/06/WHO-Active-Ageing-Framework.pdf [Accessed Oct, 2019].
    » https://extranet.who.int/agefriendlyworld/wp-content/uploads/2014/06/WHO-Active-Ageing-Framework.pdf
  • 17
    Hoy D, Brooks P, Woolf A, Blyth F, March L, Bain C, et al. Assessing risk of bias in prevalence studies: modification of an existing tool and evidence of interrater agreement. J Clin Epidemiol. 2012;65(9):934-9. https://doi.org/10.1016/j.jclinepi.2011.11.014
    » https://doi.org/10.1016/j.jclinepi.2011.11.014
  • 18
    Hartvigsen J, Christensen K, Frederiksen H. Back pain remains a common symptom in old age. a population-based study of 4486 Danish twins aged 70-102. https://doi.org/Eur Spine J. 2003;12(5):528-34. 10.1007/s00586-003-0542-y
    » https://doi.org/10.1007/s00586-003-0542-y
  • 19
    Blay SL, Andreoli SB, Gastal FL. Chronic painful physical conditions, disturbed sleep and psychiatric morbidity: results from an elderly survey. Ann Clin Psychiatry. 2007;19(3):169-74. https://doi.org/10.1080/10401230701468099
    » https://doi.org/10.1080/10401230701468099
  • 20
    Meyer T, Cooper J, Raspe H. Disabling low back pain and depressive symptoms in the community-dwelling elderly: a prospective study. Spine. 2007;32(21):2380-6. https://doi.org/10.1097/BRS.0b013e3181557955
    » https://doi.org/10.1097/BRS.0b013e3181557955
  • 21
    Lima MG, Barros MB, César CL, Goldbaum M, Carandina L, Ciconelli RM. Impact of chronic disease on quality of life among the elderly in the state of São Paulo, Brazil: a population-based study. Rev Panam Salud Publ. 2009;25(4):314-21. https://doi.org/10.1590/S1020-49892009000400005
    » https://doi.org/10.1590/S1020-49892009000400005
  • 22
    Rana AM, Wahlin A, Streatfield PK, Kabir ZN. Association of bone and joint diseases with health-related quality of life among older people: a population-based cross-sectional study in rural Bangladesh. Ageing Soc. 2009;29(05):727-43. https://doi.org/10.1017/S0144686X09008411
    » https://doi.org/10.1017/S0144686X09008411
  • 23
    Gálvez-Barrón C, Narvaiza L, Dapena MD, Macho O, Rodríguez-Molinero A. Prevalence and treatment of pain in non-institutionalized very old population: transversal study at national level. Aging Clin Exp Res. 2016;28(2):347-53. https://doi.org/10.1007/s40520-015-0387-3
    » https://doi.org/10.1007/s40520-015-0387-3
  • 24
    Tomita Y, Arima K, Kanagae M, Okabe T, Mizukami S, Nishimura T, et al. Association of Physical Performance and Pain With Fear of Falling Among Community-Dwelling Japanese Women Aged 65 Years and Older. Medicine. 2015;94(35):e1449. https://doi.org/10.1097/MD.0000000000001449
    » https://doi.org/10.1097/MD.0000000000001449
  • 25
    Cedraschi C, Luthy C, Allaz AF, Herrmann FR, Ludwig C. Low back pain and health-related quality of life in community-dwelling older adults. Eur Spine J. 2016;25(9):2822-32. https://doi.org/10.1007/s00586-016-4483-7
    » https://doi.org/10.1007/s00586-016-4483-7
  • 26
    Lavsky-Shulan M, Wallace RB, Kohout FJ, Lemke JH, Morris MC, Smith IM. Prevalence and functional correlates of low back pain in the elderly: the Iowa 65+ Rural Health Study. J Am Geriatr Soc. 1985;33(1):23-8. https://doi.org/10.1111/j.1532-5415.1985.tb02855.x
    » https://doi.org/10.1111/j.1532-5415.1985.tb02855.x
  • 27
    Weiner DK, Haggerty CL, Kritchevsky SB, Harris T, Simonsick EM, Nevitt M, et al. How does low back pain impact physical function in independent, well-functioning older adults? Evidence from the Health ABC Cohort and implications for the future. Pain Med. 2003;4(4):311-20. https://doi.org/10.1111/j.1526-4637.2003.03042.x
    » https://doi.org/10.1111/j.1526-4637.2003.03042.x
  • 28
    Cecchi F, Debolini P, Lova RM, Macchi C, Bandinelli S, Bartali B, et al. Epidemiology of back pain in a representative cohort of Italian persons 65 years of age and older: the InCHIANTI study. Spine. 2006;31(10):1149-55. https://doi.org/10.1097/01.brs.0000216606.24142.e1
    » https://doi.org/10.1097/01.brs.0000216606.24142.e1
  • 29
    Dellaroza MS, Pimenta CA, Duarte YA, Lebrão ML. [Chronic pain among elderly residents in São Paulo, Brazil: prevalence, characteristics, and association with functional capacity and mobility (SABE Study)]. Cad Saude Publica. 2013;29(2):325-34. https://doi.org/10.1590/S0102-311X2013000200019
    » https://doi.org/10.1590/S0102-311X2013000200019
  • 30
    Hicks GE, Gaines JM, Shardell M, Simonsick EM. Associations of back and leg pain with health status and functional capacity of older adults: findings from the retirement community back pain study. Arthritis Rheum. 2008;59(9):1306-13. https://doi.org/10.1002/art.24006
    » https://doi.org/10.1002/art.24006
  • 31
    Kovacs F, Noguera J, Abraira V, Royuela A, Cano A, Gil del Real MT, et al. The influence of psychological factors on low back pain-related disability in community dwelling older persons. Pain Med. 2008;9(7):871-80. https://doi.org/10.1111/j.1526-4637.2008.00518.x
    » https://doi.org/10.1111/j.1526-4637.2008.00518.x
  • 32
    dos Reis LA, Mascarenhas CH, Marinho Filho LE, Borges PS. Lombalgia na terceira idade: distribuição e prevalência na Clínica Escola de Fisioterapia da Universidade Estadual do Sudoeste da Bahia. Rev Bras Geriatr Gerontol. 2008;11(1):93-103. https://doi.org/10.1590/1809-9823.2008.11019
    » https://doi.org/10.1590/1809-9823.2008.11019
  • 33
    Woo J, Leung J, Lau E. Prevalence and correlates of musculoskeletal pain in Chinese elderly and the impact on 4-year physical function and quality of life. Public Health. 2009;123(8):549-56. https://doi.org/10.1016/j.puhe.2009.07.006
    » https://doi.org/10.1016/j.puhe.2009.07.006
  • 34
    Holton KF, Denard PJ, Yoo JU, Kado DM, Barrett-Connor E, Marshall LM, et al., editors. Diffuse idiopathic skeletal hyperostosis and its relation to back pain among older men: the MrOS Study. Semin Arthritis Rheum. 2011;41(2):131-8. https://doi.org/10.1016/j.semarthrit.2011.01.001
    » https://doi.org/10.1016/j.semarthrit.2011.01.001
  • 35
    Abegunde KA, Owoaje ET. Health problems and associated risk factors in selected urban and rural elderly population groups of South-West Nigeria. Ann Afr Med. 2013;12(2):90-7. https://doi.org/10.4103/1596-3519.112398
    » https://doi.org/10.4103/1596-3519.112398
  • 36
    Exarchou S, Redlund-Johnell I, Karlsson M, Mellström D, Ohlsson C, Turesson C, et al. The prevalence of moderate to severe radiographic sacroiliitis and the correlation with health status in elderly Swedish men--the MrOS study. BMC Musculoskelet Disord. 2013;14:352. https://doi.org/10.1186/1471-2474-14-352
    » https://doi.org/10.1186/1471-2474-14-352
  • 37
    Figueiredo VF, Pereira LS, Ferreira PH, Pereira AM, Amorim JS. Incapacidade funcional, sintomas depressivos e dor lombar em idosos. Fisioter Mov. 2013;26(3):549-57. https://doi.org/10.1590/S0103-51502013000300008
    » https://doi.org/10.1590/S0103-51502013000300008
  • 38
    Ghanei I, Rosengren BE, Hasserius R, Nilsson JÅ, Mellström D, Ohlsson C, et al. The prevalence and severity of low back pain and associated symptoms in 3,009 old men. Eur Spine J. 2014;23(4):814-20. https://doi.org/10.1007/s00586-013-3139-0
    » https://doi.org/10.1007/s00586-013-3139-0
  • 39
    Palma R, de Conti MH, Quintino NM, Gatti MA, Simeão SF, de Vitta A. Functional capacity and its associated factors in the elderly with low back pain. Acta Ortop Bras. 2014;22(6):295-9. https://doi.org/10.1590/1413-78522014220600890
    » https://doi.org/10.1590/1413-78522014220600890
  • 40
    Pereira LV, de Vasconcelos PP, Souza LA, Pereira Gde A, Nakatani AY, Bachion MM. Prevalence and intensity of chronic pain and self-perceived health among elderly people: a population-based study. Rev Lat Am Enfermagem. 2014;22(4):662-9. https://doi.org/10.1590/0104-1169.3591.2465
    » https://doi.org/10.1590/0104-1169.3591.2465
  • 41
    Santos FC, Moraes NS, Pastore A, Cendoroglo MS. Chronic pain in long-lived elderly: prevalence, characteristics, measurements and correlation with serum vitamin D level. Revista Dor. 2015;16(3):171-5. https://doi.org/10.5935/1806-0013.20150034
    » https://doi.org/10.5935/1806-0013.20150034
  • 42
    Scherer M, Hansen H, Gensichen J, Mergenthal K, Riedel-Heller S, Weyerer S, et al. Association between multimorbidity patterns and chronic pain in elderly primary care patients: a cross-sectional observational study. BMC Fam Pract. 2016;17:68. https://doi.org/10.1186/s12875-016-0468-1
    » https://doi.org/10.1186/s12875-016-0468-1
  • 43
    Kherad M, Rosengren BE, Hasserius R, Nilsson JA, Redlund-Johnell I, Ohlsson C, et al. Age Ageing. 2017;8;46(1):64-71. https://doi.org/10.1093/ageing/afw152
    » https://doi.org/10.1093/ageing/afw152
  • 44
    Marshall LM, Litwack-Harrison S, Makris UE, Kado DM, Cawthon PM, Deyo RA, et al. A Prospective Study of Back Pain and Risk of Falls Among Older Community-dwelling Men. J Gerontol A Biol Sci Med Sci. 2017;72(9):1264-9. https://doi.org/10.1097/AJP.0000000000000564
    » https://doi.org/10.1097/AJP.0000000000000564
  • 45
    Quintino NM, De Conti MHS, Palma R, Gatti MAN, Simeão SFAP, Vitta A. Prevalence and factors associated with low back pain in elderly registered in the Family Health Strategy. Fisioter Mov. 2017;30(2):367-77. https://doi.org/10.1590/1980-5918.030.002.ao17
    » https://doi.org/10.1590/1980-5918.030.002.ao17
  • 46
    Machado LAC, Viana JU, da Silva SLA, Couto FGP, Mendes LP, Ferreira PH, et al. Correlates of a Recent History of Disabling Low Back Pain in Community-dwellin Older Persons: The Pain in the Elderly (PAINEL) study. Clin J Pain. 2018;34(6):515-24. https://doi.org/10.1097/AJP.0000000000000564
    » https://doi.org/10.1097/AJP.0000000000000564
  • 47
    Liu-Ambrose T, Eng JJ, Khan KM, Mallinson A, Carter ND, McKay HA. The influence of back pain on balance and functional mobility in 65- to 75-year-old women with osteoporosis. Osteoporos Int. 2002;13(11):868-73. https://doi.org/10.1007/s001980200119
    » https://doi.org/10.1007/s001980200119
  • 48
    Kobuke Y, Abe Y, Ye Z, Honda S, Tomita M, Osaki M, et al. Association of Age, Obesity, Joint Pain, and Chewing Ability with Chair Stand Difficulty among Community-dwelling Elderly People in Nagasaki, Japan. Acta Med Nagasaki. 2009;53:65-8. https://doi.org/10.11343/amn.53.65
    » https://doi.org/10.11343/amn.53.65
  • 49
    Peng LN, Lin MH, Lai HY, Hwang SJ, Chen LK, Lan CF. Pain and health-care utilization among older men in a veterans care home. Arch Gerontol Geriatr. 2009;49 Suppl 2:S13-6. https://doi.org/10.1016/S0167-4943(09)70006-8
    » https://doi.org/10.1016/S0167-4943(09)70006-8
  • 50
    Baek SR, Lim JY, Lim JY, Park JH, Lee JJ, Lee SB, et al. Prevalence of musculoskeletal pain in an elderly Korean population: results from the Korean Longitudinal Study on Health and Aging (KLoSHA). Arch Gerontol Geriatr. 2010;51(3):e46-51. https://doi.org/10.1016/j.archger.2009.11.011
    » https://doi.org/10.1016/j.archger.2009.11.011
  • 51
    Barros MB, Francisco PM, Lima MG, César CL. Social inequalities in health among the elderly. Cad Saude Publica. 2011;27 Suppl 2:S198-208. https://doi.org/10.1590/S0102-311X2011001400008
    » https://doi.org/10.1590/S0102-311X2011001400008
  • 52
    Kim H, Yoshida H, Hu X, Saito K, Yoshida Y, Kim M, et al. Association between self-reported urinary incontinence and musculoskeletal conditions in community-dwelling elderly women: a cross-sectional study. Neurourol Urodyn. 2015;34(4):322-6. https://doi.org/10.1002/nau.22567
    » https://doi.org/10.1002/nau.22567
  • 53
    Manchikanti L, Singh V, Datta S, Cohen SP, Hirsch JA; American Society of Interventional Pain Physicians. Comprehensive review of epidemiology, scope, and impact of spinal pain. Pain Physician. 2009;12(4):E35-70.
  • 54
    Macfarlane G, Jones G, McBeth J. Epidemiology of pain. Wall and Melzack’s textbook of pain. 2005.
  • 55
    [No authors listed]. Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. Prepared by the International Association for the Study of Pain, Subcommittee on Taxonomy. Pain Suppl. 1986;3:S1-226.
  • 56
    Dionne CE, Dunn KM, Croft PR. Does back pain prevalence really decrease with increasing age? A systematic review. Age Ageing. 2006;35(3):229-34. https://doi.org/10.1093/ageing/afj055
    » https://doi.org/10.1093/ageing/afj055
  • 57
    Schillewaert N, Langerak F, Duharnel T. Non probability sampling for WWW surveys: a comparison of methods. J Market Res Soc. 1998;40(4):1-13. https://doi.org/10.1177/147078539804000403
    » https://doi.org/10.1177/147078539804000403
  • 58
    Cassidy JD, Cote P, Carroll LJ, Kristman V. Incidence and course of low back pain episodes in the general population. Spine. 2005;30(24):2817-23. https://doi.org/10.1097/01.brs.0000190448.69091.53
    » https://doi.org/10.1097/01.brs.0000190448.69091.53
  • 59
    Hoy D, March L, Brooks P, Blyth F, Woolf A, Bain C, et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014;73(6):968-74. https://doi.org/10.1136/annrheumdis-2013-204428
    » https://doi.org/10.1136/annrheumdis-2013-204428
  • 60
    Fejer R, Ruhe A. What is the prevalence of musculoskeletal problems in the elderly population in developed countries? A systematic critical literature review. Chiropr Man Therap. 2012;20(1):31. https://doi.org/10.1186/2045-709X-20-31
    » https://doi.org/10.1186/2045-709X-20-31
  • 61
    Celich KL, Galon C. Dor crônica em idosos e sua influência nas atividades da vida diária e convivência social. Rev Bras Geriatr Gerontol. 2009;12(3):345-59. https://doi.org/10.1590/1809-9823.2009.00004
    » https://doi.org/10.1590/1809-9823.2009.00004
  • 62
    Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global burden of disease and risk factors. New York: Oxford University Press New York. 2006. https://doi.org/10.1596/978-0-8213-6262-4
    » https://doi.org/10.1596/978-0-8213-6262-4
  • 63
    Leveille SG, Zhang Y, McMullen W, Kelly-Hayes M, Felson DT. Sex differences in musculoskeletal pain in older adults. Pain. 2005;116(3):332-8. https://doi.org/10.1016/j.pain.2005.05.002
    » https://doi.org/10.1016/j.pain.2005.05.002
  • 64
    Sjogren P, Ekholm O, Peuckmann V, Gronbaek M. Epidemiology of chronic pain in Denmark: an update. Eur J Pain. 2009;13(3):287-92. https://doi.org/10.1016/j.ejpain.2008.04.007
    » https://doi.org/10.1016/j.ejpain.2008.04.007
  • 65
    Lima e Costa MF. A saúde dos adultos na Região Metropolitana de Belo Horizonte: um estudo epidemiológico de base populacional. A saúde dos adultos na Região Metropolitana de Belo Horizonte: um estudo epidemiológico de base populacional. UFMG; FIOCRUZ; 2004. 120p.
  • 66
    Turk DC, Okifuji A. Psychological factors in chronic pain: evolution and revolution. J Consult Clin Psychol. 2002;70(3):678-90. https://doi.org/10.1037/0022-006X.70.3.678
    » https://doi.org/10.1037/0022-006X.70.3.678
  • 67
    Fillingim RB. Sex, gender and pain: The biopsychosocial model in action XX vs. XY. The International Journal of Sex Differences in the Study of Health, Disease and Aging. 2003;1:98-101.
  • 68
    Rollman GB, Lautenbacher S. Sex differences in musculoskeletal pain. Clin J Pain. 2001;17(1):20-4. https://doi.org/10.1097/00002508-200103000-00004
    » https://doi.org/10.1097/00002508-200103000-00004
  • 69
    Makris UE, Fraenkel L, Han L, Leo-Summers L, Gill TM. Epidemiology of restricting back pain in community-living older persons. J Am Geriatr Soc. 2011;59(4):610-4. https://doi.org/10.1111/j.1532-5415.2011.03329.x
    » https://doi.org/10.1111/j.1532-5415.2011.03329.x
  • 70
    Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2224-60. https://doi.org/10.1016/S0140-6736(12)61766-8
    » https://doi.org/10.1016/S0140-6736(12)61766-8
  • 71
    Klineberg E, Mazanec D, Orr D, Demicco R, Bell G, McLain R. Masquerade: medical causes of back pain. Cleve Clin J Med. 2007;74(12):905-13. https://doi.org/10.3949/ccjm.74.12.905
    » https://doi.org/10.3949/ccjm.74.12.905
  • 72
    Kim W, Jin YS, Lee CS, Hwang CJ, Lee SY, Chung SG, et al. Relationship between the type and amount of physical activity and low back pain in Koreans aged 50 years and older. PM R. 2014;6(10):893-9. https://doi.org/10.1016/j.pmrj.2014.04.009
    » https://doi.org/10.1016/j.pmrj.2014.04.009
  • 73
    Hoy D, Bain C, Williams G, March L, Brooks P, Blyth F, et al. A systematic review of the global prevalence of low back pain. Arthritis Rheum. 2012;64(6):2028-37. https://doi.org/10.1002/art.34347
    » https://doi.org/10.1002/art.34347
  • 74
    Ferreira ML, Machado G, Latimer J, Maher C, Ferreira PH, Smeets RJ. Factors defining care-seeking in low back pain: a meta-analysis of population based surveys. Eur J Pain. 2010;14(7):747.e1-7. https://doi.org/10.1016/j.ejpain.2009.11.005
    » https://doi.org/10.1016/j.ejpain.2009.11.005

Publication Dates

  • Publication in this collection
    28 Oct 2019
  • Date of issue
    2019

History

  • Received
    8 June 2018
  • Accepted
    14 Aug 2019
Creative Common - by 4.0
This is an Open Access article distributed under the terms of the Creative Commons License (https://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.
Faculdade de Medicina / USP Rua Dr Ovídio Pires de Campos, 225 - 6 and., 05403-010 São Paulo SP - Brazil, Tel.: (55 11) 2661-6235 - São Paulo - SP - Brazil
E-mail: clinics@hc.fm.usp.br