The inclusion criteria are:

1. Age: 65 and over,
2. Present episode of LBP greater than three months duration,
3. Greater than 20 percent Modified Oswestry disability score (MODS),
4. Primary pain localized to the lumbar spine (L1-S1),
5. No prior chiropractic or medical treatment for present episode of LBP,
6. No radicular or neurological symptoms,
7. Any three of the following positive orthopedic tests:

A. Kemp's test (include only if it increased lumbar pain),
B. Adam's and supported Adam's test (both equally cause pain in the lumbar spine),
C. Goldthwait's test (evokes lumbar pain or makes it worse, does not increase radiation

of pain into the leg),
D. Hyperextension test,
E. Pain evoked on spinous process percussion which seated patient's lumbar spine is flexed,

Exclusion criteria
1. History of serious medical illness,
2. Psychological disturbances,
3. Recent trauma (major bruises; fractures; auto accidents; etc.),
4. Leg or buttock pain of suspected neurological involvement,
5. Obesity, 6. Anomalies such as spondylolisthesis,
7. Uncertain diagnosis,
8. referred pain of viscero-somatic origin,
9. Change in diagnosis; new symptoms; deteriorating health while study is underway,
10. More than two weeks of missed appointments.

Case Study 2:

Subject: Geriatrics Research
Title: Chiropractic Care for Patients Aged 55 Years and Older: Report from a Practice-Based Research Program
Reference: Hawk C, Long CR, Boulanger KT, Morschhauser E, Fuhr AW. Chiropractic care for patients aged 55 years and older: report from a practice-based research program. J Amer Geriatric Soc 2000; 48(5): 534-45

OBJECTIVE: To characterize patients aged 55 years and older and features of chiropractic care provided to them.

DESIGN: Observational, practice-based research study.

SETTING: Chiropractic offices in the United States and Canada, 1997-1998.

PARTICIPANTS: Chiropractors in 96 practices in 32 states and two Canadian provinces collected data on 805 eligible patients aged 55 years and older during a 12-week study period.

MEASUREMENTS: In addition to questionnaires on practice characteristics, patient demographics, chief complaints, and health habits, two standardized instruments were administered: for general health status, the Medical Outcomes Study 12-Item Short-Form Health Survey (SF-12); and for disability related to chronic pain, the Pain Disability Index (PDI)

RESULTS: Of 805 study patients, 60.1% were women and 94.7% were white. Overweight patients comprised 38.6% and obese 20.6% (n = 656) of the total; 9.7% of patients were hypertensive (n = 5.90). Smoking was reported by 12.7% and 50.2% reported regular exercise. The Physical Component Summary scores of the SF-12 seemed somewhat lower than population norms, where as the Mental Component Summary scores differed very little from norms. Chief complaints were predominantly pain-related (72.3%), most commonly back pain (32.9%). The PDI mean baseline score for chronic patients was 16.3 (scale, 0-70), and 40.6% of study patients reported using at least one pain medication (prescription or nonprescription) more than three times per week. More than half of complaints (54.9%) had onsets more than 6 weeks before the baseline visit. For 66.6% of subjects, a chiropractor was the only provider for their current complaint. In addition to manipulation, most common features of care were recommendations on exercise (41.0%), heat or cold applications (40.8%), and food supplements (24.5%).

At 4 weeks, 19.6% were discharged, 58.8% continued treatment, and 20.1% had discontinued care (self-discharged). For these three groups, those with higher PDI mean baseline scores showed more change at 4 weeks. For patients who were discharged by the doctor, the proportion of reported pain medication use decreased 7.3% from baseline to 4 weeks, increased for patients who discontinued care, and remained about the same for those continuing care.

CONCLUSIONS: Further investigation of the PDI and. a, decrease in pain medication use as outcome measures seems warranted. The descriptive information in this study may assist providers of care to older adults to better understand their patients' use of chiropractic carc. J Am Geriatr Soc 48:534-545, 2000.

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