The World Health Organisation has identified low back pain as the major disabling condition in older persons. Low back pain, particularly in older people, results in reduced quality of life, reduced social participation and increased isolation, as well as being associated with co-morbidities, such as diabetes and depression.1 It is estimated that one in seven adults who consult a chiropractor are over the age of 65 years, and of these patients the majority (56%) are presenting with low back pain.2
The general aim of the Back Complaints in Elders: Chiropractic – Australia (BACE:C-A) study is to improve our knowledge base for elderly people with low back pain, so that we might provide safer and more effective care for this population. Specific objectives include describing the course of low-back pain in older patients,3 determining predictors of disability and looking at which patients are likely to benefit from care or suffer an adverse event. In addition, we will explore the types of healthcare older people use when they have low back pain.
In Australia, Dr Katie de Luca is the lead investigator of the BACE:C-A study. Dr de Luca is part of an international chiropractic research group led by Drs Sidney Rubenstein (Netherlands) and David Newell (UK), and Professor Iben Axen (Sweden). This year Annie Young joined the Australian team as a research assistant, who is doing a wonderful job managing data collection.
Recruitment for BACE:C-A started in Australia in October 2019. We quickly recruited the target number of 30 chiropractors to establish our practice-based research network. Chiropractors were recruited from all over Australia, and as we finish participant recruitment, we sincerely thank all chiropractors involved in the BACE:C-A study. Their commitment to training and dedication to ongoing recruitment has rarely wavered. Over the last year our clinical practices have been, and continue to be, extremely disrupted – where public health orders such as masks, deep cleaning, physical distancing and even closing have taken precedence.
During this time, our team has continued to remain engaged in the study. The BACE:C-A team receives a monthly newsletter, the Facebook page has had frequent social media updates, chiropractors were kept immediately informed through a WhatsApp group and email posts, and monthly chiropractor development sessions were held to share knowledge, recruitment tips and support each other, primarily through lockdowns, but also to maintain momentum as we strived towards our sample size.
“I’ve enjoyed seeing my patients eager to participate when they’re made aware of the lack of research that exists for their age group,” reports Hobart chiropractor Dr Ash Dent.
After 21 months of recruiting patients, we are pleased to say that we have completed participant recruitment. In very exciting news, our chiropractors screened 351 patients for inclusion into the study, of which 221 patients were eligible, included and baseline data was collected.
As of July 2021, 156 participants have completed their two week follow up, 143 participants have completed their six week follow up, 122 participants have completed their three month follow up, 79 participants have completed their six month follow up, 60 participants have completed their nine months follow up and 27 participants have already completed the entire 12 month study. Data was also collected on the cognitive functioning of older people with back pain, of which we have 205 completed baseline assessments, we currently have 59 imaging reports collected on older patients with back pain and have 16 reports of adverse reactions.
The achievements of our chiropractors and the research team are most outstanding, considering the current pandemic environment. Many human research studies have been stopped during this time, but due to the commitment of our chiropractors, we have reached a favorable sample size. This will provide us with an extremely rich dataset to improve our knowledge on back pain in older adults.
Excitingly, we have entered the next stage in the study where we will be following-up participants recruited to the study for 12 months. The participants continue to complete regular surveys and send SMS data on back pain intensity. As we complete each follow up time point, a lot of effort will put into cleaning and exploring the dataset, which ultimately will be pooled analyses with the international BACE:C consortium.
This will be a significantly large dataset, and we welcome chiropractic students and clinicians who are interested in pursuing research to contact us at firstname.lastname@example.org to engage with the study. The opportunities with a successfully run, 12 month, longitudinal observational study such as this are endless.
We sincerely thank the Australian Chiropractors Association for funding the BACE:C-A, we give a huge thank you to our chiropractors who have enabled us to proceed with the study and we look forward to continuing to share the updates of our study with the chiropractic profession.
Dr Katie de Luca and Annie Young
- Ferreira ML, de Luca K. Spinal pain and its impact on older people. . Best Pract Res Clin Rheumatol. 2017;31(2).
- de Luca K, Hogg-Johnson S, Funabashi M, Mior S, French SD. The profile of older adults seeking chiropractic care: a secondary analysis. BMC Geriatr. 2021;21(1):271.
- Jenks AD, Hoekstra T, Axén I, et al. BAck complaints in the elders – chiropractic (BACE-C): protocol of an international cohort study of older adults with low back pain seeking chiropractic care. Chiropr Man Therap. 2020;28(1):17.