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Low back pain is a highly disabling health condition that generates high costs for patients and healthcare systems. For this reason, it is considered a serious public health problem worldwide. This pilot study aimed to assess the feasibility of a future randomized controlled trial (RCT) by evaluating adherence to treatment, contamination between groups, satisfaction with treatment, and understanding of the exercise instructions provided by the physiotherapist. Additionally, we sought to identify and implement necessary modifications to the exercise protocol for better suitability in older people. We conducted a prospective, registered pilot RCT comparing an 8-week group-based exercise program with a waiting list in older people (≥60 years old) with chronic low back pain. Sixty participants were recruited through social media, pamphlets, and invitations at community referral centers. The study demonstrated the feasibility of a full RCT. Participants reported high satisfaction with the treatment (i.e., 100% indicated willingness to return for future services) and a high understanding of the exercise instructions (i.e., 81.8% reported "very easy" comprehension). Adherence to the exercise program exceeded the average reported for group exercise interventions in older adults (i.e., 82.58%). Dropout was associated solely with preexisting physical activity levels. The exercise protocol was successfully adapted to better suit the needs of the older adult population. This pilot RCT demonstrates the feasibility of a full-scale RCT to evaluate the effectiveness of group exercise in improving pain intensity and disability in older adults with chronic low back pain. The implemented adjustments to the exercise protocol and overall study approach strengthen the methodological foundation and expected accuracy of the future RCT.

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BACKGROUND: The purpose of this network meta-analysis (NMA) is to investigate the efficacy of pharmacological and non-pharmacological therapy on pain intensity and disability of older people with chronic nonspecific low back pain, providing comprehensive evidence for an informed decision-making. METHODS: We will perform a systematic search to identify randomized controlled trials of pharmacological and non-pharmacological interventions for older people with chronic nonspecific low back pain. MEDLINE, Cochrane Library, Embase, AMED, PsycINFO, and PEDro will be searched without language or date restrictions. Our primary outcomes are pain intensity and disability. Risk of bias will be assessed for all studies using the revised Cochrane risk-of-bias (RoB) tool 2.0. For each pairwise comparison between the different interventions, estimated mean differences and their 95% confidence intervals will be presented. Standard pairwise meta-analyses will be performed using random effects models in STATA version 16. The competing interventions will be ranked using the surface under the cumulative ranking curve (SUCRA) for the outcomes of interest at short and long terms. The confidence in the results from NMA will be assessed using the Confidence in Network Meta-Analysis (CINeMA) framework. DISCUSSION: This NMA compares efficacy of interventions for nonspecific chronic low back pain in older people. It will provide reliable evidence for patients, clinicians, stakeholders, and researchers in this field where competing therapies, many of extraordinarily little value, are commonly used in clinical practice. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42022312565.

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BACKGROUND: Low-back pain is one of the most common health conditions worldwide. It is defined as pain below the costal margin and above the inferior gluteal folds. Current guidelines recommend management of chronic health (e.g., low back pain) conditions in older people at primary health care settings using active strategies (e.g., exercise). In non-specific low back pain, high quality evidence supports active strategies for general population. However, the management of non-specific low back pain in the older people has been overlooked and evidence is limited to a small number of low powered randomized controlled trials with high risk of bias. METHODS: This is a prospectively registered, open, two-arm randomised controlled trial comparing the group-based exercise and waiting list in pain intensity (11-item Pain Numerical Rating Scale) and disability (Roland Morris questionnaire) of older people (i.e., 60 years old or over) with chronic non-specific low back pain. One hundred and twenty patients will be recruited from Diamantina, Brazil. Follow-ups will be conducted in post-treatment (8 week) and 6- and 12-months post-randomisation. DISCUSSION: Our hypothesis is that group-based exercise will be better than waiting list in reducing pain intensity and disability in older people with chronic non-specific low back pain. IMPACT: The practice of individualized exercise has been studied for the management of chronic non-specific low back pain in older people. However, the group exercise, even showing high quality evidence for the improvement of several important outcomes in this population, has been ignored until now. Thus, the results of this study have the potential to indicate a viable and accessible strategy for managing chronic non-specific low back pain in the older people. TRIAL REGISTRATION: The study was prospectively registered at www.ensaiosclinicos.gov.br (RBR-9j5pqs). Date-11/18/2020.

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INTRODUÇÃO: A dor lombar é um sintoma altamente incapacitante, que leva a um impacto social negativo para as pessoas que experimentam o sintoma, e econômico para os cofres públicos de diversos países, com gastos excessivos e por vezes desnecessários com procedimentos não resolutivos. OBJETIVOS: Relatar o número de procedimentos clínicos e cirúrgicos e os custos diretos da dor lombar em hospitais financiados pelo Sistema Único de Saúde. MÉTODOS: Os dados sobre os procedimentos clínicos e cirúrgicos foram coletados no Sistema de Informações Hospitalares no website do DATASUS, no período entre 2013 e 2018. Realizou-se análise descritiva dos dados. RESULTADOS: nos seis anos analisados os procedimentos para tratamento da dor lombar custaram financeiramente R$ 24.427.238. Estes custos aumentaram de forma expressiva ao longo dos anos observados. Realizou-se 1.689 procedimentos cirúrgicos e cada um custou em média R$ 3.290. A região sudeste do país foi a que teve maior gasto financeiro para o tratamento do sintoma (R$ 12.442.930). CONCLUSÃO: O custo da dor lombar ao longo dos anos para o sistema público está aumentando rapidamente e provavelmente é impulsionado pelo aumento no número de cirurgias.

INTRODUCTION: Low back pain is a highly disabling symptom, which leads to a negative social impact for people who experience the symptom, and economic, for public coffers in several countries, with excessive and sometimes unnecessary expenses with non-resolving procedures. OBJECTIVES: To report the number of clinical and surgical procedures and the direct costs of low back pain in hospitals financed by the Unified Health System. METHODS: The data on clinical and surgical procedures were collected in the Hospital Information System on the DATASUS website between 2013 and 2018. A descriptive analysis of the data was carried. RESULTS: In the six years analyzed, the procedures for the treatment of low back pain cost R$ 24,427,238. These costs have increased significantly over the years observed. 1,689 surgical procedures were performed, and each cost an average of R$ 3,290. The southeastern region of the country was the one that had the greatest financial expenditure for the treatment of the symptom (R$ 12,442,930). CONCLUSION: The cost of low back pain over the years to the public system is increasing rapidly and is probably driven by the increase in the number of surgeries.

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