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

de Souza, Ingred Merllin Batista; Sakaguchi, Tina Fujii; Yuan, Susan Lee King; Matsutani, Luciana Akemi; do Espírito-Santo, Adriana de Sousa; Pereira, Carlos Alberto de Bragança; Marques, Amélia Pasqual

doi:10.6061/clinics/2019/e789

Ingred Merllin Batista de Souza ^**Corresponding author. E-mail: ingredmerllin@usp.br

Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR

http://orcid.org/0000-0003-3101-9604

Tina Fujii Sakaguchi

Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR

http://orcid.org/0000-0001-9626-7962

Susan Lee King Yuan

Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR

http://orcid.org/0000-0002-8336-7873

Luciana Akemi Matsutani

Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR

http://orcid.org/0000-0002-1961-5115

Adriana de Sousa do Espírito-Santo

Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR

http://orcid.org/0000-0001-7199-6704

Carlos Alberto de Bragança Pereira

Departamento de Estatistica e Medicina Legal, Universidade de Sao Paulo, Sao Paulo, SP, BR

http://orcid.org/0000-0001-6315-7484

Amélia Pasqual Marques

Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR

http://orcid.org/0000-0001-6705-7763

^*Corresponding author. E-mail: ingredmerllin@usp.br

No potential conflict of interest was reported.

Souza IMB designed the study, edited the manuscript and critically reviewed its final version. Sakaguchi TF acquired some of the data. Yuan SLK, Espirito-Santo AS and Matsutani LA critically reviewed the final version of the manuscript. Pereira CAB conducted the statistical analysis. Marques AP performed the data collection and analysis, and critically reviewed the final version of the manuscript. All authors read and approved the final version of the manuscript.

Author/Year	Gender	Age (years)	Population	Country	Instrument	Sample Size	Sample with LBP	Prevalence (%)	Prevalence period^* * = period prevalence investigate;	LBP Definition	Functional disability
Hartvigsen et al., (2003) (18)	Both	80	Interview data from the Longitudinal Study of Aging Danish Twins, dealing with a population-based sample of Danish twins aged 70-102.	Denmark	Itself questionnaire	4486	1121	Total 25 M 20 F 29	1 month	Not informed	2.78 for participants with LB vs 3.16 forparticipants without LBP
Blay et al., (2007) (19)	Both	≥60	Respondents selected were from a multistage area probability sample of non-institutionalized population in the state of the Rio Grande of Sul, Brazil.	Brazil	Itself questionnaire	6963	2997	42.5	1 month	Not informed	Not informed
Meyer et al., (2007) (20)	Both	75	Subjects at Centers for Medicare & Medicaid Services (CMS) started the Health Outcomes Survey (HOS) collecting health status data to monitor healthcare outcomes over time in different Medicare settings.	USA	Itself questionnaire	55.690	13.244	24.1	1 month	Not informed	Participants with no functional limitations was 64.7%
Lima et al., (2009) (21)	Both	69.9±0.3	Elderly residents the cities of Botucatu and Campinas; an area encompassing the cities of Itapecerica da Serra, Embu, and Taboão da Serra; and the District of Butantã, in the city of São Paulo.	Brazil	Itself questionnaire Sf-36 - Physical functioning	1958	621	30.1	Not informed	Not informed	With LBP (64.7%)
Rana et al., (2009) (22)	Both	69.1±6.9	Elderly residents in the rural area of the Matlab city, Dhaka.	Bangladesh	Itself questionnaire	471	341	Total 72.4 M 64.6 F 78.8	At exactly moment	Not informed	Not informed
Gálvez-Barrón et al., (2015) (23)	Both	≥80	Elderly non-institucionalized residents in the rural and urban area.	Spain	Face Pain Scale Katz index	551	289	Total 52.5 M 40.7 F 58.1	1 month	Pain in dorso-lumbar region	Functional status (median and interquartile range): Pain 1 (0-3)
Tomita et al., (2015) (24)	Female	72.6±5.2	Community-dwelling women, who were non-institutionalized and lived independently in Oshima Town, Nagasaki Prefecture.	Japan	Itself questionnaire Timed up and Go test Time of walking a 6m distance Chair Stand time Grip strengh	278	61	22	1 month	Not informed	Poor physical performance and pain were significantly associated with fear of falling
Cedraschi et al., (2016) (25)	Both	≥65	Was conducted in five Swiss cantons: two French- speaking ones, Geneva and Wallis, two German-speaking ones, Bern and Basel, and the only Italian-speaking one, i.e. Ticino.	Swiss	A scale assessing LBP for use in prevalence studies	3042	889	29	Last month	Standardized Back Pain Definition	Not informed
						Total	73,439	18,942

Author/Year	Gender	Age (years)	Population	Country	Instrument	Sample Size	Sample with LBP	Prevalence (%)	Prevalence period^* * = period prevalence investigate;	LBP Definition	Functional disability
Lavsky-Shulan et al., (1985) (26)	Both	≥65	Two rural counties adjacent to the county in which the University of Iowa, USA.	USA	Itself questionnaire	3097	671	21.7	1 year	Not informed	Women had the most difficulty doing household chores (42.3%), while men had the most difficulty bending over (28.3%)
Weiner et al., (2003) (27)	Both	73.6	Caucasians recruited were from a random sample of Medicare beneficiaries in designated zip codes in Pittsburgh, Pennsylvania and Memphis, Tennessee, and African Americans.	USA	Itself questionnaire EPESE performance battery + Health ABC functional capacity scale	2776	987	36	1 year	Back pain location was categorized as upper, middle, lower, or buttocks	Functional difficulty was more common with greater severity of LBP among both genders
Cecchi et al., (2006) (28)	Both	65	A representative cohort of persons aged 65 or more (65+) selected was from the registries of Greve in Chianti (rural area) and Bagno a Ripoli (urban area near Florence).	Italy	Itself questionnaire	1008	318	31.5	1 year	Presence of frequent back pain (quite often-almost every day).	The 7.4% of the overall study population had LBP related functional limitation
Dellaroza et al., (2008) (29)	Both	69.5	Population sample of community-dwelling elderly residents in the city of São Paulo, Brazil.	Brazil	Itself questionnaire Lawton Scale	1271	95	25.4	≥6 months	Lumbar region (below waist)	Dependent in the basic activities of daily living with chronic pain (33.7%) and instrumental activities of daily living (62.4%)
Hicks et al., (2008) (30)	Both	81.3	The Retirement Community Back Pain Study is a population-based survey study of adults ages 62 years or older.	USA	Itself questionnaire	522	251	48.1	1 year	Not informed	Participants with LBP plus leg pain had greater disruption in physical capacity than those without LBP
Kovacs et al., (2008) (31)	Both	65	All community dwelling residents in the island of Majorca who are retired from work or 65 years or older (even if they have never worked), are invited to attend such conferences at no cost.	Spain	Roland Morris Questionnaire and Visual Analogue Scale	1044	792	34.1	3 months	Pain between the costal margins and the inferior gluteal folds, usually accompanied by painful limitation of movement	In subjects with LBP, fear avoidance beliefs correlated moderately with disability
Dos Reis et al., (2008) (32)	Both	69.1	Elderly attended in the geriatrics sector of the Physical Therapy School Clinic from the Universidade Estadual of the Sudoeste of Bahia.	Brazil	Medical records	131	44	33.6	3 months	Symptom referred to at the level of the pelvic girdle, generating a clinical condition of pain	Not informed
Woo et al., (2009) (33)	Both	72.5±4.8	Elderly community of the Hong Kong.	China	Itself questionnaire} Physical Activity Scale of the Elderly Grip strength	4000	1569	Total 39.2 M 39.2 F 50.3	1 year	Not informed	Back pain affecting activities of daily living predisposed to reduced grip strength and physical activity score
Holton et al., (2011) (34)	Male	74±6	Elderly recruited at 6 US academic medical centers in Birmingham AL, Minneapolis MN, Palo Alto, CA, Pittsburgh PA, Portland OR, and San Diego, CA.	USA	The North American Spine Society questionnaires for back and neck pain Physical Activity Scale of the Elderly	298	126	66	1 year	North American Spine Society questionnaires for back and neck pain	Men with and without diffuse idiopathic skeletal hyperostosis did not vary from one another with physical activity score
Abegunde & Owaje, (2013) (35)	Both	≥60	Eldelry residents at Iseyin (urban) and Ilua (rural) of Oyo.	Nigeria	Itself questionnaire	Rural 314 Urban 316	253	Rural 38.5 Urban 41.8	3 months	Not informed	Not informed
Exarchou et al., (2013) (36)	Male	69-81	Elderly residents of Uppsala, Malmo, Gothneburg.	Sweden	Quebec Pain Disability Scale Physical Activity Scale for the Elderly questionnaire	1005	445	44.3	1 year	Not informed	Were no statistically significant differences between those with and without radiographic sacroilitis reflected by measures on physical activity, functional status and LBP
Figueiredo et al., (2013) (37)	Both	72	Healthy community-dwelling elderly in urban area	Brazil	McGill Questionnaire and Roland Morris Questionnaire	54	34	61.8	1 year	Pain, tension or stiffness located in the region between the last ribs and the gluteal line	A high and positive correlation with the presence of LBP was indicated for functional disability
Ghanei et al., (2014) (38)	Male	69-81	Men aged 69-81 years enrolled in Malmo, Gothenburg and Uppsala with the primary aim to evaluate risk factors for osteoporosis and fractures.	Sweden	Visual Analog Scales for LBP, Roland Morris Questionnaire	489	236	45	1 year	LBP was defined as pain in the lower back, SCI as pain emerging from the lower back with radiation to the lower extremity below the buttocks	50% of the men with LBP + SCI + NEU reported impairment in activity of daily living due to the disorder
Palma et al., (2014) (39)	Both	60-69	Elderly registered at the Family Health Strategy of Vila São Paulo, Bauru,SP, Brazil.	Brazil	Nordic and the Roland Morris questionnaires	360	246	Total 68.3 M 25.1 F 35.1	1 year	Pain or discomfort in the last twelve months, not related to trauma or other problem	67.5% of the elderly demonstrated an inappropriate functional capacity
Pereira et al., (2014) (40)	Both	60-80	Health Surveillance Network for Elderly People (REVISI), in Goiânia, Goiás State, Brazil	Brazil	Numerical Range Scale	934	135	29.5	6 months	Pain in lumbar region	Not informed
Santos et al., (2015) (41)	Both	86.3	Elderly participants “Long-lived Project” Federal University of São Paulo (UNIFESP).	Brazil	Verbal Numeric Scale, Visual Numeric Scale Face Pain Scale	330	61	32.7	6 months	Not informed	Not informed
Scherer et al., (2016) (42)	Both	74	Elderly residents of the cities Bonn, Dusseldorf, Frankfurt/Main, Hamburg, Jena, Leipzig, Mannheim and Munich.	Germany	Graded Chronic Pain Scale	3189	1493	M 55.2 F 41.1	6 months	Not informed	Not informed
Kherad et al., (2016) (43)	Male	69-81	Mister Osteoporosis (MrOS) Sweden is a multi-centre population-based study of 3,014 men aged 69-81 years, enrolled in the cities of Malmö, Gothenburg and Uppsala.	Sweden	Itself questionnaire	3014	1361	49	1 year	Pain in the lower back but not specified further	Not informed
Marshall et al., (2016) (44)	Male	≥65	U.S. men enrolled in MrOS, a nationwide prospective cohort study in U.S. academic medical centers in Birmingham AL, Minneapolis MN, Palo Alto CA, Pittsburgh PA, Portland OR, and San Diego CA.	USA	Itself questionnaire	5568	3707	67	1 year	Not informed	Not informed
Quintino et al., (2017) (45)	Both	≥60	Elderly people that live in the Family Health Strategy confined areas, in the neighborhood of Vila São Paulo, northern region of Bauru, São Paulo.	Brazil	Nordic questionnaire, adapted to the Brazilian culture	363	200	55.8	1 year	Pain or discomfort in the last twelve months, not related to trauma or any other problem in the lumbar region	Not informed
Machado et al., (2018) (46)	Both	≥65	Households located in 15 clusters (census regions) distributed across the city of Belo Horizonte.	Brazil	Itself questionnaire Handgrip test and a walking test	378	35	9.3	1 year	Pain or discomfort in the lower back lasting for at least 24 hours, and not related to feverish illness or spinal surgery	Those reporting a recent history of disabling LBP were more likely to have low level of physical activity
					Total	29,831	12,806

Author/Year	Gender	Age (years)	Population	Country	Instrument	Sample Size	Sample with LBP	Prevalence (%)	Prevalence period^* * = period prevalence investigate;	LBP Definition	Functional disability
Liu-Ambrose et al., (2002) (47)	Female	69.4	Identified were from a computerized database of community-dwelling women who had been referred for bone densitometry at the BC Women’s Hospital and Health Centre Osteoporosis Program between 1996 and 2000.	Canada	Oswestry Questionnaire	93	70	75	Not informed	Not informed	Not informed
Kobuke et al., (2009) (48)	Both	≥65	Elderly residentes in the Nagasaki.	Japan	Itself questionnaire	323	127	M 32.8 F 43.0	Not informed	Not informed	Back pain were associated with chair stand difficulty
Peng et al., (2009) (49)	Male	80.9±5.4	Data of the Longitudinal Older Veterans (LOVE) study.	Taiwan	Itself questionnaire	574	153	40.5	Not informed	Not informed	Subjects with pain were physically independence 92.2%
Baek et al., (2010) (50)	Both	76.4±5.7	Elderly residents of the Seongnam.	South Korea	Oswestry Questionnaire	1118	686	Total 72 M 58.4 F 82.2	Not informed	Not informed	Not informed
Barros et al., (2011) (51)	Both	60-69	Elderly residentss of the Campinas, São Paulo.	Brazil	Itself questionnaire	1518	652	43	Not informed	Not informed	Not informed
Kim et al., (2015) (52)	Female	75-84	Residents in the comunnity of the Itabashi, Tokyo.	Japan	Itself questionnaire Grip strength and usual walking speed	1399	399	28.5	Not informed	Not informed	UI was associated with LBP, pain coupled with grip strength, and mobility limitation.
					Total	5025	2087

Author/Year	1. Was the study’s target population a close representation of the national population in relation to relevant variables?	2. Was the sampling frame a true or close representation of the target population?	3. Was some form of random selection used to select the sample, OR was a census undertaken?	4. Was the likelihood of nonresponse bias minimal?	5. Were data collected directly from the subjects?	6. Was an acceptable case definition used in the study?	7. Was the study instrument that measured the parameter of interest shown to have validity and reliability?	8. Was the same mode of data collection used for all subjects?	9. Was the length of the shortest prevalence period for the parameter of interest appropriate?	10. Were the numerator and denominator for the parameter of interest appropriate?	11. Summary item on the overall risk of study bias
Hartvigsen et al., (2003) (18)	N	Y	NI	Y	Y	Y	Y	Y	Y	Y	8
Blay et al., (2007) (19)	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	10
Meyer et al., (2007) (20)	Y	Y	Y	Y	Y	Y	N	Y	Y	Y	9
Lima et al., (2009) (21)	Y	Y	Y	Y	Y	Y	N	Y	NI	Y	8
Rana et al., (2009) (22)	N	Y	N	Y	Y	Y	N	Y	Y	Y	7
Gálvez-Barrón et al., (2015) (23)	Y	Y	N	Y	Y	Y	Y	Y	Y	Y	9
Tomita et al., (2015) (24)	N	Y	N	Y	Y	Y	N	Y	Y	Y	7
Cedraschi et al., (2016) (25)	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	10
Lavsky-Shulan et al., (1985) (26)	N	Y	N	Y	Y	Y	Y	Y	NI	Y	7
Weiner et al., (2003) (27)	N	Y	Y	Y	Y	Y	Y	Y	Y	Y	9
Cecchi et al., (2006) (28)	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	10
Dellaroza et al., (2008) (29)	N	Y	Y	Y	Y	Y	Y	Y	Y	Y	9
Hicks et al., (2008) (30)	N	Y	Y	NI	N	Y	Y	Y	Y	Y	7
Kovacs et al., (2008) (31)	N	Y	N	Y	Y	Y	Y	Y	Y	Y	8
Dos Reis et al., (2008) (32)	N	Y	N	N	Y	N	NI	Y	NI	Y	4
Woo et al., (2009) (33)	N	Y	N	Y	Y	Y	N	Y	Y	Y	7
Holton et al., (2011) (34)	N	Y	Y	Y	Y	Y	Y	Y	Y	Y	9
Abegunde & Owaje, (2013) (35)	N	Y	Y	Y	Y	Y	Y	Y	NI	Y	8
Exarchou et al., (2013) (36)	Y	Y	N	Y	N	Y	N	Y	Y	Y	7
Figueiredo et al., (2013) (37)	N	Y	N	NI	Y	Y	Y	Y	Y	Y	7
Ghanei et al., (2014) (38)	N	Y	Y	Y	Y	Y	Y	Y	Y	Y	9
Palma et al., (2014) (39)	N	Y	Y	Y	Y	Y	Y	Y	Y	Y	9
Pereira et al., (2014) (40)	N	Y	Y	Y	Y	Y	Y	Y	Y	Y	9
Santos et al., (2015) (41)	N	Y	N	Y	Y	Y	Y	Y	Y	Y	8
Scherer et al., (2016) (42)	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	10
Kherad et al., (2016) (43)	Y	Y	Y	Y	Y	Y	N	Y	Y	Y	9
Marshall et al., (2016) (44)	Y	Y	Y	Y	Y	Y	N	Y	Y	Y	9
Quintino et al., (2017) (45)	N	Y	Y	N	Y	Y	Y	Y	Y	Y	8
Machado et al., (2018) (46)	N	Y	Y	N	Y	Y	Y	Y	Y	Y	8
Liu-Ambrose et al., (2002) (47)	N	Y	N	Y	Y	Y	Y	Y	NI	Y	7
Kobuke et al., (2009) (48)	N	N	N	Y	Y	Y	N	Y	NI	Y	5
Peng et al., (2009) (49)	Y	Y	N	Y	Y	Y	N	Y	NI	Y	6
Baek et al., (2010) (50)	Y	Y	Y	Y	Y	Y	Y	Y	NI	Y	9
Barros et al., (2011) (51)	Y	Y	Y	Y	Y	Y	N	Y	NI	Y	8
Kim et al., (2015) (52)	Y	Y	Y	Y	Y	Y	N	Y	NI	Y	8

[1] ^*Corresponding author. E-mail: ingredmerllin@usp.br

Brasil

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