Back Complaints in Elders (BACE)

A prospective, longitudinal analysis of older people with low-back pain in chiropractic care



Low-back pain is the most important non-fatal disease in Europe and is associated with increasing healthcare costs. These costs are likely to become greater as the population becomes older. Low-back pain, particularly in older people, results in reduced quality of life, reduced social participation and increased isolation, as well as being associated with co-morbidities.

One conservative treatment for the treatment of low-back pain which is safe and effective is spinal manipulative therapy. In contrast to their younger counterparts, relatively little investigation has been conducted amongst older people with low-back pain in a chiropractic setting. This study would provide the necessary knowledge to improve our understanding for this patient population in order to provide safer and more effective care.

This study is modelled after the BACE study (BAck Complaints in Elders), which is an international cohort study devoted to examining back complaints in older people in primary care.

This study includes an international consortium and is currently running in the Netherlands, Australia and Brazil. Aligning ourselves with this consortium represents a unique chance for chiropractic. It will, among other things, allow us to compare the course of back complaints as well as the factors which influence that course and costs of care.

Aim. This ambitious pan-European project would provide the necessary data to fill the gap in knowledge about older people with low-back pain and improve standards of chiropractic care for this patient population.


  • Examine the duration, severity, and clinical course of low-back pain in older people who visit a chiropractor for a new episode of low-back pain.
  • Identify prognostic factors which may influence this course of low back pain.
  • Determine effects (e.g. functional disability, quality of life) as well as associated costs and safety of care in older people visiting the chiropractor for low-back pain.
  • Identify barriers and facilitators which can influence access to chiropractic care.

Methods.Recruitment of chiropractors and patients. All members of The Netherlands Chiropractors’ Association, the Swedish Chiropractors’ Association and the Royal College of Chiropractic in the UK will be invited to participate. Recruitment of the chiropractors will be conducted in a multi-faceted manner (e.g. through personal email communication to all members, an email sent by the respective professional associations to all their members, and/or through a presentation at a general meeting organized by the professional associations). Each chiropractor will be asked to recruit 15 patients who present to their practice and fulfill the inclusion criteria.

This project fulfills the top three items (i.e. cost-effectiveness, identification of subgroups likely to respond to treatment and collaboration between institutes) as defined by the research agenda (Rubinstein et al) in the following manner: data will be collected on societal costs (i.e. all costs related to the condition, regardless who pays or benefits from them). In addition, data generated from this study will make it possible to identify which patients are most likely to benefit from care and which therapies are most likely to facilitate this. Finally, the international flavor of this study will not only facilitate collaboration and exchange between institutes but will also stimulate collaboration across disciplines.

Published articles:
Back complaints in the elders (BACE); design of cohort studies in primary care: an international consortium


Project team:
Alan Jenks PhD Student VU Amsterdam
Sidney Rubinstein Assistant Professor VU Amsterdam
Maurits Van Tulder Director Dept of Health Sciences VU Amsterdam
Trynke Hoestra Assistant Professor VU Amsterdam
Iben Axen Associate Professor Karolinska Institutet
Dave Newell Director of Research AECC University College
Johnathan Field Chair Royal College of Chiropractors

Financial Support Dutch Study:
European Center for Chiropractic Research Excellence
Nederlands Chiropractie Associatie

Research Partners

Alan Jenks