Havran Mark, Scholten Joel D, Breuer Paula, Lundberg Jennifer, Kochersberger Gary, Newman Dave, Weiner Debra K
Extended Care and Rehab, VA Central Iowa Health Care Systems, De Moines, Iowa.
Rehabilitation and Prosthetics Services, Veterans Health Administration, Washington DC.
Pain Med. 2016 Dec;17(12):2230-2237. doi: 10.1093/pm/pnw270.
To present the last in a 12-part series designed to deconstruct chronic low back pain (CLBP) in older adults. This article focuses on leg length discrepancy (LLD) and presents an algorithm outlining approaches to diagnosis and management of LLD in older adults, along with a representative clinical case. METHODS : Using a modified Delphi approach, the LLD evaluation and treatment algorithm was developed by a multidisciplinary expert panel representing expertise in physical therapy, geriatric medicine, and physical medicine and rehabilitation. The materials were subsequently refined through an iterative process of input from a primary care provider panel comprised of VA and non-VA providers. The clinical case was taken from one of the authors. RESULTS : We present an algorithm and illustrative clinical case to help guide the care of older adults with LLD, which can be an important contributor to CLBP. Firstline assessment includes referral to physical therapy or orthopedics, depending on the context of the LLD. A variety of nonsurgical interventions may ensue depending on the etiology of the LLD, including shoe inserts, customized shoes, manual therapy, or a combination. CONCLUSIONS : To promote a patient-centered approach, providers should consider evaluating for leg length discrepancy when treating older adults with CLBP to help diminish pain and disability.
介绍旨在剖析老年人慢性下腰痛（CLBP）的12部分系列文章中的最后一篇。本文聚焦于腿长差异（LLD），并给出一种算法，概述老年人LLD的诊断和管理方法，以及一个典型临床病例。方法：采用改良的德尔菲法，由代表物理治疗、老年医学以及物理医学与康复专业知识的多学科专家小组制定LLD评估和治疗算法。随后，通过由退伍军人事务部（VA）和非VA提供者组成的初级保健提供者小组的反复输入过程，对材料进行完善。临床病例取自其中一位作者。结果：我们给出一种算法和说明性临床病例，以帮助指导对LLD老年人的护理，LLD可能是CLBP的一个重要促成因素。一线评估包括根据LLD的情况转诊至物理治疗或骨科。根据LLD的病因，可能会采取多种非手术干预措施，包括鞋垫、定制鞋、手法治疗或联合使用。结论：为推广以患者为中心的方法，提供者在治疗CLBP老年人时应考虑评估腿长差异，以帮助减轻疼痛和残疾。
