The ultimate goal of this project is to help fill the substantial gap in knowledge about safe and effective treatments for older adults with chronic low back pain. This deficiency is a particular problem because treatments that have been found safe and effective for younger adults may not be appropriate for an older population that is at higher risk of adverse effects and that may have different needs and treatment preferences. Tai Chi, which has been found effective for chronic back pain in younger adults, seems particularly well-suited for older adults with chronic low back pain because it includes multiple therapeutic elements, is gentle and has been found beneficial for a variety of health conditions more common to older adults. The goal of this project is to prepare the foundation for successfully conducting a full-scale trial evaluating the effectiveness of two doses of Tai Chi (Standard and Enhanced, which includes Standard + Maintenance Tai Chi) for improving chronic low back pain in older adults over the course of a year. In the first phase of this study (Aim 1), we will focus n finalization of a Standard Tai Chi protocol, development of the maintenance Tai Chi protocol and assessment of the feasibility of developing a credible attention control group. In the course of finalizing our feasibility trial documents, we will work with patient partners (older adults wit chronic low back pain) to adapt strategies for recruitment, adherence to Tai Chi, safety, and optimizing follow-up rates for this population and we will finalize the inclusion/exclusion criteri to maximize safety and generalizability. After finalizing the key study components, we will conduct a randomized feasibility trial comparing Enhanced Tai Chi with Usual Medical Care. Sixty-four older adults with cLBP - 65+ years of age will be randomized---32 to the Enhanced (standard + maintenance) Tai Chi and 32 to Usual Medical Care. Outcomes will be collected at 12, 26, and 52 weeks. We will evaluate the adequacy of key elements of the study developed in Aim 1 for inclusion in a full-scale trial. Finally, we will conduct debriefing discussion groups wih 30 trial participants to elicit their ideas for improving the procedures and protocols. This evaluation will address the overall feasibility of conducting a large trial and the value of includng the Enhanced dose Tai Chi treatment arm. If successful, this feasibility study will pave the way for conducting an adequately-powered randomized controlled trial evaluating the ability of Tai Chi to reduce the impact of chronic low back pain on older adults. In view of the absence of knowledge about clearly safe and effective treatments for this population, this line of research has the potential for substantially reducing the suffering of many Americans with back pain.
There is a major gap in knowledge about safe and effective treatment options for older adults with chronic low back pain. This project will determine the feasibility of conducting a full-scale trial evaluating Tai Chi, a promising 'mind-body' intervention that seems particularly well-suited for older adults with chronic low back pain.
