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Background Low back pain (LBP) is common among older adults, and it is a frequent reason for seeking chiropractic care. The STarT Back Screening Tool (SBT) was developed to stratify patients with LBP into low, medium, and high-risk treatment pathways, so that the treatment can be matched to each participant’s risk profile. But its prognostic performance varies across settings and populations. No studies have focused on the SBT’s utility as a stratified-care tool in older adults with LBP in a chiropractic setting. Therefore, our aim was to evaluate the ability of the SBT to predict three-, six-, and 12-month disability and pain outcomes in older adults (≥55 years) with a new episode of LBP consulting chiropractors in the Netherlands, Sweden, and Australia. Methods This was a secondary analysis of the Back Complaints in Older Adults – Chiropractic (BACE-C) cohort. Participants visiting chiropractors with LBP completed baseline questionnaires for demographic and clinical characteristics, including the SBT. Follow-up questionnaires assessed disability (Roland Morris Disability Questionnaire (RMDQ)) and pain intensity (11-point Numerical Rating Scale (NRS)). “No improvement” on disability and pain intensity was defined as less than 30% reduction in baseline scores. We used logistic regression models to estimate discrimination metrics including the area under the receiver operating characteristic curve (AUC). Subgroup analyses were conducted by country, sex, and LBP duration; sensitivity analyses employed alternative “no improvement” definitions and linear regression on continuous outcome scores. Results A total of 738 participants were included. The mean age of the study sample was 66.2 ± 7.5 years and 50.9% of the participants were female. The SBT showed poor discrimination for predicting no improvement in disability and pain intensity. All AUC values were below 0.60 regardless of whether SBT risk subgroups (i.e. low/medium/high) or the SBT sum score were used. Subgroup and sensitivity analyses did not meaningfully improve discrimination. Conclusion The SBT presented limited prognostic ability to predict outcomes of disability and pain intensity in older adults with LBP in a chiropractic setting. These findings suggest insufficient evidence for the prognostic ability of the SBT risk stratification tool. Future research should explore reasons behind the limited prognostic accuracy and consider potential modifications or alternative tools.

Background To describe the societal costs during one year of follow-up among older adults seeking chiropractic care due to a new episode of low back pain (LBP), and to determine what factors predict high societal costs in this population. Methods Prospective cohort study, within chiropractic private practices (n = 38) in the Netherlands. 223 people ≥ 55 years of age with a new episode of LBP seeking chiropractic care participated. The primary outcome was total societal costs. High societal costs were defined as patients with costs in the top 20th percentile. The final prediction models were obtained using forward selection. Results were presented for the total population and stratified for retirement status. The model’s prognostic accuracy (Hosmer–Lemeshow X 2 , Nagelkerke’s R 2 ) and discriminative ability [area under the receiver operating curve (AUC)] were assessed, and the models were internally validated using bootstrapping. Results The mean total annual societal cost per patient was €5297 [95% confidence interval (CI): 4191–6403]. The biggest cost driver was presenteeism (65% of total costs), and costs were higher among non-retired participants (€7759; 95% CI 6047–9470) than retired participants (€1892; 95% CI 1088–2695). In the total population, younger age [odds ratio (OR): 0.87 for each additional year; 95% CI 0.80–0.95], being male instead of female (OR 2.96; 95% CI 1.19–7.44), less alcohol intake (OR 0.49; 95% CI 0.20–1.19), working instead of retirement (OR 9.37; 95% CI 1.83–48.04), and more disability at baseline (OR 1.08; 95% CI 1.00–1.16) were found to be predictive of high societal costs. Working was found to be the strongest predictor for high societal costs. After internal validation, the model’s fit was good, it’s explained variance was moderate (28%) and their AUCs could be interpreted as moderate (0.85). For non-pensioners, the same predictive factors were identified as for the entire population. The costs for the retired participants showed too little variation to be able to predict high costs. Conclusions This study estimated the mean total annual societal cost of older adults seeking chiropractic care due to a new episode of LBP at €5297 (95% CI 4191–6403).These costs were mainly due to high levels of presenteeism, and extensively differed based upon work status.

Background Low back pain is a common condition among older adults that significantly influences physical function and participation. Compared to their younger counterparts, there is limited information available about the clinical course of low back pain in older people, in particularly those presenting for chiropractic care. Improving our understanding of this patient population and the course of their low back pain may provide input for studies researching safer and more effective care than is currently provided. Objectives The primary objectives are to examine the clinical course over one year of pain intensity, healthcare costs and pain, functional status and recovery rates of low back pain in people 55 years and older who visit a chiropractor for a new episode of low back pain. Methods An international prospective, multi-center cohort study with one-year follow-up. Chiropractic practices are to be recruited in the Netherlands, Sweden, United Kingdom and Australia. Treatment will be left to the discretion of the chiropractor. Inclusion/Exclusion criteria: Patients aged 55 and older who consult a chiropractor for a new episode of low back pain, meaning low back pain for the first time or those patients who have not been to a chiropractor in the previous six months. This is independent of whether they have seen another type of health care provider for the current episode. Patients who are unable to complete the web-based questionnaires because of language restrictions or those with computer literacy restrictions will be excluded as well as those with cognitive disorders. In addition, those with a suspected tumor, fracture, infection or any other potential red flag or condition considered to be a contraindication for chiropractic care will be excluded. Data will be collected using online questionnaires at baseline, and at 2 and 6 weeks and at 3, 6, 9 and 12 months. Discussion This study, to our knowledge, is the first large-scale, prospective, multicenter, international cohort study to be conducted in a chiropractic setting to focus on older adults with low back pain consulting a chiropractor. By understanding the clinical course, satisfaction and safety of chiropractic treatment of this common debilitating condition in the aged population, this study will provide input for informing future clinical trials. Trial registration Nederlandse Trial Registrar NL7507 .

PurposeMany systematic reviews have reported on the effectiveness of spinal manipulative therapy (SMT) for low back pain (LBP) in adults. Much less is known about the older population regarding the effects of SMT.ObjectiveTo assess the effects of SMT on pain and function in older adults with chronic LBP in an individual participant data (IPD) meta-analysis.SettingElectronic databases from 2000 until June 2020, and reference lists of eligible trials and related reviews.Design and subjectsRandomized controlled trials (RCTs) which examined the effects of SMT in adults with chronic LBP compared to interventions recommended in international LBP guidelines.MethodsAuthors of trials eligible for our IPD meta-analysis were contacted to share data. Two review authors conducted a risk of bias assessment. Primary results were examined in a one-stage mixed model, and a two-stage analysis was conducted in order to confirm findings.Main outcomes and measuresPain and functional status examined at 4, 13, 26, and 52 weeks.Results10 studies were retrieved, including 786 individuals, of which 261 were between 65 and 91 years of age. There is moderate-quality evidence that SMT results in similar outcomes at 4 weeks (pain: mean difference [MD] − 2.56, 95% confidence interval [CI] − 5.78 to 0.66; functional status: standardized mean difference [SMD] − 0.18, 95% CI − 0.41 to 0.05). Second-stage and sensitivity analysis confirmed these findings.ConclusionSMT provides similar outcomes to recommended interventions for pain and functional status in the older adult with chronic LBP. SMT should be considered a treatment for this patient population.

LAST YEAR wasn't a good one for initial public offerings of Georgia companies. That shouldn't be a surprise, considering that the 1987 new issues market lasted only 282 days. Wall Street's Oct. 19 crash, the worst one-day plunge in stock market history, brought the issuance of stock in new public companies to a halt throughout the country. There weren't any initial public offerings (IPOS) of Georgia companies in the final 83 days of 1987 nor in the first three months of 1988, although corporate finance experts reported rumblings of renewed IPO activity as Wall Street moved to post-crash highs in the early spring. (excerpt)

CARACAS (UPI)--Caracas has accomplished more in the last 20 years of its existence than in the first 380.