Efficacy of an integrated, active rehabilitation protocol in patients ≥ 65 years of age with chronic mechanical low back pain

  • Gautam M. ShettyEmail author
  • Umesh Solanki
  • Shikha Jain
  • Sanya Linjhara
  • Garima Anandani
  • C. S. Ram
  • Harshad Thakur
Original Article



This retrospective study aimed to determine the efficacy of an integrated active, rehabilitation protocol in patients ≥ 65 years of age with chronic mechanical low back pain and compare the results in similar patients in 50–64 years age group.


Pre- and post-treatment mean numerical pain rating scale (NPRS) score, mean Oswestry disability index (ODI) score, treatment outcome category and minimal clinically important difference (MCID) thresholds achieved for NPRS and ODI scores post-treatment were compared among 697 patients in the 50–64 years and 495 patients in the ≥ 65 years age groups.


At a mean treatment duration of 57 days (range, 30–90 days), both mean NPRS score (p < 0.0001) and mean ODI score (p < 0.0001) were significantly higher in the ≥ 65 years age group when compared to the 50–64 years age group. However, post-treatment outcome categories (p = 0.17) and percentage of patients who achieved MCID thresholds for NPRS score (p = 0.13) and ODI score (p = 0.18) were not significantly different between the two groups. There was a significant correlation between post-treatment NPRS score and patient age and pre-treatment NPRS score and between post-treatment ODI score and incidence of osteoporosis and pre-treatment ODI score.


Although mean NPRS and ODI scores achieved were significantly better in patients of 50–64 years of age, our integrated active, rehabilitation protocol helped achieve significant improvement in NPRS score, MCID thresholds for NPRS and ODI scores and treatment outcomes in patients ≥ 65 years of age, similar to patients in the 50–64 years of age group, at the end of 3 months of treatment.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.


Low back pain Rehabilitation Physical therapy modalities Spine Elderly 



No benefits or funds were received in support of this study by any of the authors. This article is original and has not been published before or currently submitted to any other journal.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study has been approved by an Institutional Ethics Committee and has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Supplementary material

586_2019_6248_MOESM1_ESM.pptx (200 kb)
Supplementary material 1 (PPTX 199 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Research and Clinical ExcellenceQI Spine ClinicMumbaiIndia
  2. 2.QI Spine ClinicDelhiIndia
  3. 3.I.T.S College of PhysiotherapyGhaziabadIndia
  4. 4.Centre for Public HealthTata Institute of Social SciencesMumbaiIndia
  5. 5.QI India HealthcareMumbaiIndia
  6. 6.QI Spine ClinicMumbaiIndia

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