Patient Age Is Related to the Types of Physical Therapy Interventions Provided for Chronic Low Back Pain: An Observational Study

STUDY DESIGN: Retrospective analysis of a longitudinal cohort of patients treated for chronic low back pain (CLBP). OBJECTIVES: To determine whether patient age is associated with types of physical therapy interventions received for CLBP. BACKGROUND: Advancing age is associated with less positive treatment outcomes in patients with CLBP. If patient age influences a therapist's choice of interventions, it may partially explain the difference in treatment outcomes. METHODS: Data were examined in a sample of 7392 patients (62% women, 38% men; mean +/- SD age, 56.7 +/- 16.5 years) with CLBP. We used a generalized estimating equation to examine the probability of each subject receiving each of the individual intervention categories in the presence of the other intervention categories. RESULTS: A significant interaction between intervention category and age existed after controlling for gender, duration of symptoms, comorbidities, payer source, and functional status at initial intake (chi(2) = 130.27, df = 8, P<.0001). The changes in probability of receiving an intervention category averaged 10% as patient age increased. The probability of receiving exercise or task-specific training did not change with advancing age. The probability of receiving postural exercises, pain modalities, joint mobility techniques, ice, or McKenzie exercises decreased with advancing age. The probability of receiving augmented soft tissue mobilization and balance/mobility training increased as age increased. CONCLUSION: The impact of age on physical therapist treatment choices varies depending on the type of intervention. Other variables in addition to age may have an impact on treatment choice. Further research is needed to determine how therapists incorporate age into their clinical decision making. J Orthop Sports Phys Ther 2012;42(11):902-911, Epub 21 September 2012. doi:10.2519/jospt.2012.4147