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Low back pain, physical activity, and disability in older adults: a mediation analysis

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posted on 2022-10-12, 05:33 authored by Megan YanzMegan Yanz

Low back pain (LBP) is a disabling condition in older adults, with a significant socioeconomic burden, globally. Physical activity (PA) has also shown to be associated with disability however, a multi-variable relationship between pain intensity, PA, and disability, has not been explored in the older population. The objectives of this thesis were to i) review current literature of PA effects in older adults with LBP, and ii) explore if PA mediates the relationship between pain intensity and disability in older adults with LBP through secondary analysis of the BACE:Chiropractic – Netherlands dataset. A three-step model was developed using structural equation modelling to estimate relationship effects between 1) the crude relationship between pain and disability, 2) the relationship between pain and disability when mediated by PA, 3) the relationship between pain and disability when mediated by PA and adjusted for confounders (age, sex, and education). The literature review found no statistically significant effects of multicomponent exercise programs, or yoga or qigong on pain and disability in older adults with LBP. The secondary analysis found PA appeared to mediate the relationship between pain intensity and disability, however this effect was not statistically significant. The total proportion of this mediation effect accounted for 30% in the model, indicating PA does play a role in the progression to disability. The results of this thesis encourage further refinement of the mediation model. Furthermore, clinical trials are critically needed to determine the effect of PA and exercise on clinical outcomes for older adults with LBP. 


2020 Chiropractic Australia (CA) Research Foundation Scholarship


Table of Contents

Chapter one: introduction to low back pain, physical activity, and disability in older adults -- Chapter two: effectiveness of physical activity and exercise for pain and disability improvement in older adults with low back pain: a literature review -- Chapter three: methods of a Secondary Analysis of the BACE: Chiropractic - Netherlands data -- Chapter four: results of the secondary analysis -- Chapter five: discussion


A thesis submitted in fulfilment of the requirements for the degree of Master of Research

Awarding Institution

Macquarie University

Degree Type

Thesis MRes


Thesis (MRes), Macquarie University, Faculty of Medicine, Health and Human Sciences, Department of Chiropractic, 2021

Department, Centre or School

Department of Chiropractic

Year of Award


Principal Supervisor

Katie de Luca

Additional Supervisor 1

Aron Downie


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70 pages

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