Lower Back Pain in the Elderly in Institutionalised Centres

Lower Back Pain in the Elderly in send CentresDISCUSSIONINTRODUCTIONIn this section, the result findings leave alone be discussed. The aims of this ask was to de edgeine the preponderance of LBP among the institutionalized centers in Malaysia, to compare the vigour changes in term of muscular tissue domination, flexibility and strength between two groups of elderly LBP group and non-LBP group, and to determine the functional status of the elderly in institutionalized centers. The discussion will be foc utilize on the finding of comparison for muscle changes between more or less(prenominal) groups and also the functional status of elderly in institutionalized centers.harmonize to Malaysian Department of Statistics, the commonwealth of Malaysian will be increased by 2020. The annual growth rate of the elderly increased from 3.1% in 1980-1990s periods to 4.0% in period between years 2000-2010. The leading factor for this life expectancy improvement was number one fertility and mortality. By the year of 2020, Malaysia would qualify to be an aging tribe where the population of elderly reached nearly 7% and 5 years later will be increased over 9% (Tengku Aizan et al., 2006). new studies on global prevalence of LBP was found that with the highest prevalence among those ripened 40-80 years and among female individuals, LBP became the major problem throughout the world (Hoy et al., 2012). People with LBP has been found to had changes in automatic control of TrA (Jacobs, Hammerman-rozenberg, Cohen, Stessman, 2006), reduced trunk muscle strength (Bel et al., 2010), and spinal stiffness (Freddolini, Strike, Lee, 2014). However, none of the postulate make in Malaysia concentrates on elderly shape upd 60 and above especially elderly in institutionalized centers. Therefore, our understanding of the muscles changes happened between LBP elderly population and hale population especially in Asian country is critically ill.PREVALENCE OF LOW BACK PAINThere has be en undefined conclusion for the epidemiology for stake agony especially in elderly. The present theater of operations found similar findings with other Hirsch, (1959) that the prevalence of LBP peak in the middle and declined after 60 years old. In this study, the prevalence for elderly who had LBP was 62.6% of total sample. Traditionally, it verbalise that back pain is common in early adulthood, peaks in middle age and declines in beyond than 60 years (Papageorgiou et al., 1995 Hirsch, 1959). Others stated that there may be because of degenerative spine and brain that caused reduces levels of back pain. Elderly also had tendency to have an age-related decline in pain sensitivity. In contrast, study through by Adams et al., proclaimed that ageing is not closely related with back pain (Wiesel, 2013). However, based on personal opinion by Dr. Richard, he agrees with study by Papageorgiou et al., (1995). In this study, the results presented that the prevalence of LBP was higher in elderly with age range from 60-69 years old than more than 70 years old. The prevalence of pain is gradually decrease with age as in this study the number of subjects was limited for age more than 80 years. A study found that symptoms of back pain began in the late twenties, highest between the ages of thirty to fifty years and then the decline or remain stable with age (Wiesel, 2013). However, when the researchers looked at the prevalence of severe back pain, it was highest among seniors, increasing from 5.4% in those aged 40 years or less to 10% in persons over 80 years of age (MacFarlane et al., 2012).MUSCLE CHANGES BETWEEN LBP AND NON-LBP GROUPSThe main results showed that there is no significant difference in term of muscle changes between LBP and non-LBP elderly boot out for muscle control and muscle flexibility for left side flexion. Although many studies had been done on trunk muscle strength for patients with LBP, there is no reliable opinion reason out (Ikeda et al., 19 94 Goto, 2001 Sakamoto et al., 1991 Ito et al., 2001 Ota, 2011 Murakami et al., 2011). Contrary to the previous study, the present study found similar finding of trunk muscle strength between both group LBP and non-LBP. Interestingly, study done by Lee et al, (1999) showed that there was a difference in trunk muscle strength where extensor muscle strength is lower than flexor muscle strength. Besides, other study done by Demoulin et al., (2007) also showed positive finding where LBP and muscle changes (fatigue) that lead to muscle weakness are correlated and was supported with study by Fryer et al., (2004) where decreased trunk muscle strength and muscle bodily function were associated with LBP. The result from this study is differ from other previous studies because of this result was touch by aging factor. Most of the previous study were done among the young and middle age population (Keller et al., 2004 Klein, Snyder-Mackler, Roy, DeLuca, 1991 Taechasubamorn, Nopkesorn, Panna runothai, 2010 Yasuda, Minami, Daikuya, 2013) and there is very limited for studies done among gerontology population.Study by Ferreira et al., (2004) demonstrated evidence for changes in automatic control of TrA in individual with LBP where individual with LBP had reduced abdominal muscles recruitment and TrA muscle activity (P. H. Ferreira, Ferreira, Hodges, 2004 Hodges, 1996) . Their study supported this study, as the result in this study for muscle control showed significant difference between both groups. Thus, it showed that LBP group had lower muscle control than non-LBP group. It can be one of causes that will lead to LBP as Cholewicki, (1996) and Panjabi, (1992) had expressed in their studies that possible causes of some low back pain disorders and inveterate back pain are motor control errors and muscular dysfunction (Cholewicki, Panjabi, Khachatryan, 1997). The PBU was used in this study as it showed high reliability with Intraclass Correlation Coefficient (ICC2,1) of 0.74 (95% CI 0.54 to 0.85) and 0.76 (95% CI 0.58 to 0.86) (Olavo et al., 2012). It provides strong support that proved the result of this study. Another study was done to measure the precision muscle control in reasoned and low back pain patients using a spiral-tracking task and trunk muscle electromyography and was found that tracking errors were higher in the LBP patients and increased with trunk inclination compared to healthy controls (Willigenburg, Kingma, Hoozemans, Dien, 2013). Thus, the results from this study can be additional evidence that showed the difference of trunk muscle control between LBP and non-LBP individuals. Interestingly, a research on postural activity of abdominal muscles was differ between body position and these showed various contribution of abdominal muscle regions to stability of the trunk (Urquhart, Hodges, Story, 2005).The result for trunk muscle flexibility in this study showed similar results tho for trunk left side flexion where it showed sign ificant difference (pFUNCTIONAL STATUS AMONG ELDERLY IN INSTITUTIONALIZED CENTERSAge-related diminished physical fitness has showed contribution to the development of sarcopenia, frailty and reduced functional status (Garatachea Lucia, 2013). The gait speed test using 10 m walk test, upper limbs strength test using hand dynamometer, lower limb strength using 30 sec sit-to-stand test, and seat-reach test was used in the study field. These subjects were ranged from age of 60 and above. In the study sample, there is no significant difference of functional status between both groups LBP and non LBP except for gait speed test and right hand grip strength. According to Kubickis (2014) in his study stated that a study done by Fried et al., (2001) showed that a score for the gait speed test that under 0.65 m by second reveals a frailty status (Kubicki, 2014).LIMITATION OF landing fieldThe limitation of the current study was lack of probability sampling method as this study used convenient sampling method. It caused the unequal distribution of both groups sample which may lead to non-significant results at the end. The size, convenience, and homogeneity of the sample limit the generalizability of this study.Another limitation was that the measurement was done by different researches which have caused some error during the measurement due to different level of skills. Due to the lack of training for the tools from the experts and inexperience researches, limited tools and modified position, the study was under-powered, and thus, did not reach statistically significance. Other than that, the duration for data collection was too short with lead to reduced man-power. Subjects consents also became one of the limitations in this study. Research that involves humans being was challenging as dealing with unstable emotion especially elderly. A lot of subjects were refused to participate in this research because of depression and unstable emotion.In addition, previous researc h done among the institutionalized centers in Malaysia was very limited which lead to limitation of evidence to support this research. Most of the study done was among the healthy and young population, and elderly without back pain in community dwelling. Very limited source was present in the time being that study on the comparison between elderly in community setting and institutionalized setting especially in Malaysia. On the other hand, to compare more very(prenominal) the differences between LBP and healthy subjects, more complex methods using higher order kinematics should be done to assess spinal biomechanical function. This has been attempted by few researches and the stop that to achieve better evaluation and discrimination, more complex tasks such complex motion parameters were needed (Mieritz et al., 2014).Even though the normality was not normally distributed and the results was peanut when comparing both groups, however this is first evidence of comparison on muscle ch anges among elderly with LBP and non-LBP among our local institutionalized center. The results should serve as a substructure for future studies with larger population and normal distribution to investigate further this matter. Thus, further investigation and research need to be done among the Malaysian population especially in elderly setting and institutionalized setting. These will help in future research development and better management for the elderly population as the elderly population has been increased dramatically.CONCLUSIONThe main findings of this study show higher prevalence of low back pain among the elderly in institutionalized centers. Muscle changes generally happened in elderly as the aging process takes place. There is no significant difference when comparing both groups except for muscle control and left side trunk flexion. Only gait speed showed difference between both groups where LBP individuals had slower gait speed compared to non-LBP individual. Therefore , for plan of intervention for LBP elderly, they should consider gait speed as their one of outcome measure.