INTRODUCTION
Frailty and low back pain (LBP) may negatively influence each other in older adults, yet no review has comprehensively examined their cross-sectional, temporal, or causal associations. A better understanding of their association can inform clinical practice. The objective of this systematic review was to consolidate evidence on the potential link between frailty and LBP in older adults.
METHODS
We conducted a systematic search of four databases (EMBASE, CINAHL, MEDLINE, and SPORTDiscus) from their inception until July 31, 2024. Two independent reviewers screened abstracts and full-texts, extracted data, assessed risk of bias of included studies, and evaluated quality of evidence using the GRADE approach. Studies exploring the association between LBP or LBP-related disability and frailty in older adults were considered for inclusion, based on the authors' definitions of older adults. LBP was defined as pain occurring between the 12th ribs and inferior gluteal folds, while frailty was identified by the presence of three or more of the five criteria outlined in the Cardiovascular Health Study (CHS) or Frailty Phenotype Questionnaire, or the criteria of different modified frailty indices.
RESULTS
The search resulted in 1,690 articles. Following screening of titles, abstracts, and full texts, six cross-sectional studies and one longitudinal study met the inclusion criteria. Low-quality evidence indicated significant relationships between acute or chronic LBP, LBP intensity, and LBP-related disability with frailty. Very low-quality evidence suggested that higher acute LBP intensity and LBP-related disability were linked to a worsening transition from non-frail to prefrail or frail status.
DISCUSSION
Our systematic review found consistent evidence of a significant correlation between LBP intensity or related disability and frailty in older adults. However, the findings were limited by the small number of studies and the lack of high-quality prospective research. Future high-quality studies are needed to clarify the causal relationship and explore potential mediators or moderators affecting the LBP-frailty association. These findings can guide the development of effective prevention and rehabilitation strategies to address the impacts of LBP on frailty, or vice versa.