"They knew how to take care of people": a qualitative study on older adults with chronic low back pain perspectives of an exercise plus education program.

Abstract

Background: Exercise therapy and education are first-line care for those with chronic low back pain (CLBP), but information on its applicability in older adults is limited, and adherence to non-pharmacological treatments in this population is challenging. This study explored perspectives of older adults with CLBP on a group-based exercise plus education program supported by text messages-PAT-Back.

Methods: This descriptive qualitative study was embedded in a feasibility randomized controlled trial (RCT) with older adults aged ≥ 60 with CLBP who participated PAT-Back. PAT-Back consisted of pain education, group and home-based exercises, with the latter being supported by text messages. After the feasibility RCT finished, we conducted 14 (13 women, 1 man) semi-structured interviews with participants. Interview questions were designed to elicit participants' reflections on the program, including its impact on symptoms and factors that facilitated and hindered participation. Transcripts were thematically analyzed.

Results: We identified four themes related to participants' perspectives on PAT-Back: 1) It takes more than intrinsic motivation: Participation in the PAT-Back program was linked to family and peer social support, clinician's supervision, caring clinicians and inaccessibility to treatments; 2) PAT-Back exceeded expectations: Before the intervention older adults did not expect or believed exercise would reduce pain, but this changed as they experienced improvements while engaging in the program; 3) Coexisting comorbidities, challenges with mobility and transport got in the way: at times, having pain in other body sites and not having access to transport and/or safe environments hindered exercise participation; 4) Technology can be both helpful and challenging: motivational text messages were perceived as beneficial by some, but others highlighted challenges related to access and technology literacy.

Conclusions: Older adults' experiences in exercise and education programs for CLBP may be enhanced by social support (from clinicians, peers, family members), access to healthcare and embodied experiences of improvement. Such experiences can also be hindered by comorbidities and broader factors, such as safety to exercise outdoors. Exercise and education interventions for this population should be tailored at the conception phase to meet their needs, especially regarding social support and environmental infrastructure to promote participation and improve symptoms.