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A record review of reported musculoskeletal pain in an Ontario long term care facility



Musculoskeletal (MSK) pain is one of the leading causes of chronic health problems in people over 65 years of age. Studies suggest that a high prevalence of older adults suffer from MSK pain (65% to 80%) and back pain (36% to 40%). The objectives of this study were:

1. To investigate the period prevalence of MSK pain and associated subgroups in residents of a long-term care (LTC) facility.

2. To describe clinical features associated with back pain in this population.

3. To identify associations between variables such as age, gender, cognitive status, ambulatory status, analgesic use, osteoporosis and osteoarthritis with back pain in a long-term care facility.


A retrospective chart review was conducted using a purposive sampling approach of residents' clinical charts from a LTC home in Toronto, Canada. All medical records for LTC residents from January 2003 until March 2005 were eligible for review. However, facility admissions of less than 6 months were excluded from the study to allow for an adequate time period for patient medical assessments and pain reporting/charting to have been completed. Clinical data was abstracted on a standardized form. Variables were chosen based on the literature and their suggested association with back pain and analyzed via multivariate logistic regression.


140 (56%) charts were selected and reviewed. Sixty-nine percent of the selected residents were female with an average age of 83.7 years (51–101). Residents in the sample had a period pain prevalence of 64% (n = 89) with a 40% prevalence (n = 55) of MSK pain. Of those with a charted report of pain, 6% (n = 5) had head pain, 2% (n = 2) neck pain, 21% (n = 19) back pain, 33% (n = 29) extremity pain and 38% (n = 34) had non-descriptive/unidentified pain complaint. A multivariate logistic regression analysis revealed that osteoporosis was the only significant association with back pain from the variables studied (P = 0.001).


Residents with back pain represent 13.6% (n = 19) of the sample population studied. This is as frequent as other serious conditions commonly found in LTC. Of the variables studied, only osteoporosis and the self-report of back pain were found to be associated. The back pain resident in this facility can typically be described as female, osteoporotic, with mild to moderate dementia, an independent or assisted walker having low levels of depression. Further research using other sites is needed to determine the overall prevalence of this condition and its impact on quality of life issues. The results of this study should inform future research in this area.

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Musculoskeletal (MSK) pain is a significant burden on the Canadian health care system. It is considered the third most expensive disorder in terms of expended health care dollars, surpassed only by cancer and heart disease [1]. The most common MSK complaint in the elderly population is back pain, second to joint arthritis [24]. In Ontario, back pain is the 3rd leading cause of chronic health problems in the over 65 year old category for women and the fourth leading cause of chronic health problems for men in the same age group [5]. The estimated cost of back pain in Ontario is 2.4 billion dollars per year and its prevalence is estimated at 64% of the adult population per year [1, 611]. The prevalence of pain in the elderly is not accurately known, some studies suggest that older adults have an even higher prevalence of MSK pain, between 65%–85% [12, 13] with 36% to 70% reportedly suffer from a back pain condition [24, 13].

Older adults aged 65 plus, are the fastest growing segment of the Canadian population. By 2011, the number of people age 65 and older is expected to rise to over 1.9 million [13]. By 2050 it is projected that the ratio of people 65 years or older to those 15–64 years of age, worldwide, will double and that 1 in 5 people will be in the age 65 plus category [2]. With this increasing age comes an associated increase in chronic daily pain [2, 12, 14]. A U.S. national survey of patients aged 75 and older demonstrated that back pain is the third most frequently reported symptom and may well be the reason for physician visits. [15] In another study, 17.3% of total back problem visits occurred in the 65 years and older age group [15, 16]. Edmond et al conducted a study on 1037 surviving members (aged 68–100) of the Framingham Heart Study and found that 22.3% of elders experience back pain everyday; low back pain being the most prevalent. They also found that elders confined mostly to their homes had an especially high prevalence of back symptoms [3].

Although there is variability, the literature reports that 45–80% of long term care (LTC) geriatric residents have substantial MSK pain that is under-reported and inadequately managed [2, 4, 12, 13, 1725]. The literature also suggests several variables that may be well associated with MSK pain in the aging population such as age, gender, a medical history of osteoarthritis, depression, osteoporosis, and difficulty ambulating (i.e., wheel chair bound or requiring assistance) [21, 2634].

Detection and management of MSK conditions is a growing health care concern as our population continues to age and as healthcare costs surmount. It is vital that MSK pain conditions, including back pain, are identified as soon as possible and non- pharmaceutical strategies implemented as an integral part of care plans for the geriatric long-term care (LTC) patient in the management of MSK pain [2, 24, 25, 35, 36]. The first study in the U.S. to determine the quality of chronic pain care provided to older persons was conducted recently by Chodosh et al. The authors evaluated quality indicators for chronic pain in a random sample of 372 older community dwelling patients using medical record review and interviews. They concluded that chronic pain management in older vulnerable patients is inadequate and that improvement is needed in screening, clinical evaluation, follow up and attention to potential toxicities of therapy. [37]. There is empirical evidence of the associations between the prevalence of MSK pain and physical as well as psychological disability in the older adult. Consequences of poorly managed pain in this population may include depression, social isolation, sleep disturbance, decreased ambulation and increased healthcare utilization and costs [2, 37]. As a management strategy, the literature supports the integration of a conservative MSK pain specialist, within a collaborative pain management team [35]. Currently, however, the integration of a spinal care specialist in LTC homes is in its infancy with little research conducted in this area.

The primary objectives of this study were to:

1. To investigate the period prevalence of MSK pain and associated subgroups in residents of a LTC home.

2. To describe clinical features associated with back pain in this population.

3. To identify associations between variables such as age, gender, ambulatory status, analgesic use, cognitive status, osteoporosis and osteoarthritis with back pain in a LTC home.

The results of this study may inform future research in this area.


A retrospective chart review of residents from a 250-bed LTC home in Toronto, Ontario was conducted. This study was approved by the home's ethics review board. Residents of various ages and medical status are integrated throughout the facility, thus every wing has essentially similarly distributed patient types as it relates to medical and functional status. It was the intent of the investigators to try to include in the study as many of the medical records as possible. However, it was necessary to limit the inclusion criteria to only records that were 6 months or older. Consequently, a purposive sampling approach was utilized. This selection process was chosen in an effort to allow for an adequate period of time for the necessary patient medical assessments and pain reporting/charting to occur as well as address resident facility turnover at that time. Although this would result in a smaller sample size for this type of analysis, resulting in reduced statistical power, the authors felt that excluding recent records (less than 6 months) enabled a more reliable picture of the long term care resident at this home.

All medical records from each of the four wings were therefore initially reviewed and charts indicating an admission date less than 6 months (110 charts) were excluded from the study, resulting in a non randomized sample size of 140 (purposive sampling). Charting methods in LTC typically include scheduled nursing and medical assessments and volunteered complaints either to physician, nurses or healthcare aids found throughout the medical file. Thus, all sections of the chart were reviewed for data including progress notes (which includes nursing and medical assessments), problem sheets (medical diagnoses), nursing daily records, physician's orders, resident quarterly assessments, medical administration records, interdisciplinary team assessments and conference records and outcome evaluations. Twenty-minutes were allocated for each chart review. Data concerning age, gender, length of stay, report of pain, pain location, analgesic use, depression, cognitive status, ambulatory status and co-morbidities were abstracted on a standardized form. An examination called the Mini Mental Status Exam (MMSE) is routinely used to assess cognitive function at this facility. The results of the MMSE were used to classify the degree of cognitive impairment among the LTC residents. The MMSE is based on a scoring range from 0–30 with lower scores indicating greater mental impairment. The following categories and ranges were used: 0–10 (severely impaired); 11–19 (moderately impaired); 20–25 (mild dementia); 26–30 (cognitive/coherent).

Variables were chosen based on the literature and their suggested correlation with MSK and back pain. The numbers of co-morbidities for each case were also included in the data abstraction and were identified from attending physicians' diagnoses, ICD 9 codes, and diagnostic assessments and test results. The charts were selected by one reviewer (CD) and examined from the period of January 2003 to March 2005. For quality assurance (accuracy of the review/abstraction process), 15 charts were randomly selected and independently reviewed for a second time and then compared to the original data extracted.

Prior to the study, the investigators predicted a lower period prevalence of residents would have a report of MSK or back pain in this study compared to that reported in the literature. Reasons for a hypothesized lower occurrence include the smaller sample size due to the exclusion of recent admissions and the method of case ascertainment. This study attempted to identity whether or not the resident had MSK pain and their subgroups on the basis of whether it was recorded in their medical record. In order to be recorded in the medical record, residents would have complained to a healthcare aid, nurse or a doctor that they have a pain complaint or in some way demonstrated pain behaviour (for those who were cognitively challenged) to a care giver/provider. Consequently it was hypothesized that this would lead to a lower occurrence of pain than if one had individually assessed and examined the LTC resident and charted the presence and diagnosis/aetiology of the pain. Nevertheless, this study sample provides a realistic description of the prevalence of MSK and back pain as it is currently being reported and charted at this home.

The objective of the study was to identity residents with recorded MSK pain and its associated subgroups. MSK pain was defined as pain originating from the MSK system, specifically mechanical in origin and not originating from visceral or cardiovascular disease, rheumatic disease or malignancies. Subgroups of MSK pain (including head pain, neck pain, back pain and extremity pain) were identified specifically from the location and description of the pain complaint recorded and through exclusion of any possible co-morbid malignancy or visceral disorder as a cause of the pain. It was therefore assumed through process of exclusion, that the pain most probably had a MSK origin. Any pain complaint which was unidentifiable as purely mechanical in origin through the medical record was grouped in a separate category, nonspecific pain. Those with no pain reported in their charts throughout the period were classified as having no pain.

All statistical analyses were performed with SPSS version 12.0 for windows. Distribution and summary statistics were examined for all variables and inconsistency checks were also performed. Descriptive statistics were used to summarize the residents' characteristics between study subgroups. These categorical variables were then analyzed via multivariate stepwise regression to determine any significantly associated variables for the report of back pain, no pain or extremity pain.


There were no inconsistencies identified from the quality review process and no missing data for the cohort. Of the 140 residents, 20% of patients were admitted between 6 months to 1 year, 28% had been living at the home for more than one year, 40% between 2 and 6 years and 12% had been residents for grater than 6 years. The mean age of the entire home was 83.3; the mean age of the study cohort was 83.7; the mean age of the back pain group was equivalent to the study group. Gender demographics and the number of co-morbidities were also similar across all groups. (Table 1)

Table 1 A comparison of clinical and demographic data for all study groups

Period prevalence: general pain and back pain

The results from this study identified a general pain period prevalence of 64% (n = 89) with a 40% (n = 55) prevalence of MSK pain. Of those with a pain report charted, 6% (n = 5) had head pain, 2% (n = 2) neck pain, 21% (n = 19) back pain, 33% (n = 29) extremity pain and 38% (n = 34) had non-descriptive/un-identified pain complaint. In all cases where the admitting complaint was pain, the problem remained unresolved.

A stepwise multivariate logistic regression analysis was performed between the subgroup with back pain, those without pain, those with extremity pain and head/neck to control for known confounders. The only variable that appeared to be significantly associated was back pain and osteoporosis (p = 0.001). (See Table 1) Although there are no other significant differences between the groups (i.e., age, gender, co-morbidities, ambulatory and cognitive status), some findings are worth noting. In particular, 8% of the "pain free" group was taking prescribed analgesics and 20% of those who do not report pain were diagnosed with osteoporosis (a variable that appears to be highly associated with back pain). Sixty percent of the extremity pain group has a diagnosis of osteoarthritis and 80% were in the mild to moderate level of dementia. Of those with nonspecific/unidentified pain, 22% were not prescribed analgesics for their pain, whereas 100% of those with back pain and extremity pain were prescribed analgesics. Seventy percent of those residents with unspecified pain were wheelchair bound and 40% had severe cognitive dysfunctions. (See Table 1.)


This retrospective chart review study provides a general description of back pain sufferers and its period prevalence within a sample of residents within a LTC home. As a comparison, a review of the facility diagnosis database revealed 8% of total residents were diagnosed with diabetes, 6% have atherosclerotic heart disease, 36% have hypertension and 13% were diagnosed with depression. Although the above conditions are typically viewed by clinicians as more life threatening and are given clinical priority, the occurrence of back pain (13.6%) appears to be just as common. These results suggest the need for better charting, recording and identification of patient pain complaints, as back pain is likely under-reported.

The study sample for chart review (56%) was similar to the total resident population in the facility in terms of demographics, i.e. age (83.7 years versus 83.3 years) and gender (69.3% female versus 62% female). However, there were notable differences between the total resident population and the study cohort with relation to severe dementia (2% versus 26.4%) and ambulatory status (38% independent walkers versus 8.6% independent walkers) respectively. However, since the total resident population data were taken from initial admission documents and the study population reflects a group of these residents, months to years post-admission, this discrepancy may be explained at least in part by the deterioration in health status associated with advancing age in long term care residents [39, 40].

Due to the small sample size, the results have limited generalizability but could serve as a starting point for future work. The results of this study indicate that residents with back pain compromise 13.6% of the study sample and 21% of those who reported pain. For those with back pain, 72% are female and 11% suffer with severe dementia (Alzheimer's disease) in comparison to 62% female and 26.4% having severe dementia in the entire study sample. In addition, 35.3% of back pain residents have a diagnosis of osteoarthritis and 64.7% have osteoporosis. Although all patients in the back pain subgroup had reported and charted complaints of back pain, 84% were prescribed analgesics. Analgesics were typically prescribed as a 'prn' (take as needed) by the attending physician. Given the higher percentage of back pain sufferers that have or develop moderate dementia, 'prn' may not be the most effective way to prescribe medication for these patients. Additionally, it appears that only 11% of the back pain subgroup was independent walkers while 50% needed assistance for ambulation (38% are in wheelchairs). In future, it may be interesting to look at possible associations between back pain and immobility.

Although there appears to be a significant correlation between back pain and clinical depression in the literature [30, 41], only 5.9% of the patients studied were diagnosed with depression. However, this sub group appears to have a considerable number of co-morbidities (mean of 4.6 ± 2 medical conditions) in addition to their back complaint, including some of the most prevalent disorders (osteoporosis, hypertension, dementia, and diabetes). It is of interest to note that 50% of the entire LTC cohort was found to have between 3 to 4 co-morbidities and 30% had 5 to 10 medical conditions. An interesting focus of future work may be to identify the prevalence of back pain and whether it increases with increasing number of co-morbidities.

Limitations to this study

This retrospective record review study, due to necessary chart exclusions, resulted in a small sample size; reducing statistical power. Data abstraction from the patient record, as with all administrative data, also has inherent limitations. For example, not all information is gathered in the same way and is often limited in description. Information documented is sometimes inconsistent, untimely and incomplete. Much of the diagnoses from the patient record are based on self reporting and there are no validity studies of either clinical or self report for location of pain in the elderly patient [13]. Cognitive problems (comprehension, memory and pain recall) may also influence the reporting of back pain [39]. Depression may lead to either a decrease or increase of patient pain reporting [30, 41]. In addition decreased pain perception or increased pain tolerance (stoicism) can affect back pain prevalence rates. Language and cultural barriers, proxy reporting, illiteracy, inactivity (avoidance of pain provoking activities), attitudes towards pain (stoicism), patient physical/sensory impairments, complexity and co-morbidity of existing health conditions (respondent focus on other more life threatening health issues), lack of standardized terminology, diagnostic procedures and skilled clinicians for MSK pain conditions are also complicating factors [13, 1720, 30, 35, 42, 43].

Notwithstanding the above difficulties in retrieving valid data from chart reviews in an institutionalized geriatric population, this study provides hitherto unreported information to inform future studies on back pain in this population.


Back pain appears to be as prevalent as other serious conditions commonly found in long term care. Of the variables studies, only osteoporosis and the self-report of back pain were found to be associated. The back pain resident in this facility can be typically described as female, osteoporotic, with mild to moderate dementia, an independent or assisted walker and with low levels of depression. Although there are problems in retrieving accurate information from chart reviews, under-reporting of pain in general and back pain specifically is likely in this population. Further research including multiple sites is needed to determine the overall prevalence of this condition and its impact on quality of life issues.


  1. 1.

    Coyte PC, Asche CV, Croxford R, Chan B: The economic cost of musculoskeletal disorders in Canada. Arthritis Care & Research. 1998, 11: 315-25.

    CAS  Article  Google Scholar 

  2. 2.

    Podichetty VK, Mazanec DJ, Biscup RS: Chronic non-malignant musculoskeletal pain in older adults: clinical issues and opioid intervention. Postgrad Med J. 2003, 79: 937-627. 10.1136/pmj.79.937.627.

    Article  Google Scholar 

  3. 3.

    Edmond SL, Felson DT: Prevalence of Back Pain in Elders. Journal of Rheum. 2000, 27 (1): 220-225.

    CAS  Google Scholar 

  4. 4.

    Malek J, Kurzova A, Benes M, Umlaufova D: Prevalence of pain, its detection and treatment among geriatric nursing home residents. Bolest. 2001, 4 (3): 171-178.

    Google Scholar 

  5. 5.

    Goel V: Indicators of health determinants and health status. Patterns of HealthCare in Ontario, the ICES practice atlas. 1996, Ottawa: CMA, 5-26. 2

    Google Scholar 

  6. 6.

    Woolf AD, Pfleger B: Burden of major musculoskeletal conditions. 2003, Bulletin of theWorld Health Organization, 81: 646-656.

    Google Scholar 

  7. 7.

    Canadian Institute for Health Information (CIHI): Health Care in Canada 2002. 2002, Ottawa, Canadian Institute for Health Information

    Google Scholar 

  8. 8.

    Canadian Institute for Health Information (CIHI): Preliminary Provincial and Territorial Government Health Expenditure Estimates 1974/1975 to 2002/2003. 2002

    Google Scholar 

  9. 9.

    Manga P, Angus D, Papadopoulos C: The effectiveness and cost-effectiveness of chiropractic management of low back pain. Ontario Ministry of Health. 1993

    Google Scholar 

  10. 10.

    Manga P: Enhanced chiropractic coverage under OHIP as a means of reducing health care costs, attaining better health outcomes and achieving equitable access to health services. 1998, University of Ottawa

    Google Scholar 

  11. 11.

    Badley EM, Webster GK, Rasooly I: The impact of musculoskeletal disorders in the population: are they just aches and pains? Findings from the 1990 Ontario health survey. J Rheumatol. 1995, 22: 733-739.

    CAS  PubMed  Google Scholar 

  12. 12.

    Podichetty VK, Mazaneck D, Biscup RS: Chronic nonmalignant musculoskeletal pain in older adults: clinical issues and opiod intervention. Post Grad Med Journal. 2003, 79: 627-633. 10.1136/pmj.79.937.627.

    CAS  Article  Google Scholar 

  13. 13.

    Bressler HB, Keyes WJ, Rochon PA, Badley E: The prevalence of low back pain in the elderly. Spine. 1999, 24: 1813-1819. 10.1097/00007632-199909010-00011.

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Teno J, Kamumoto G, Wetle T, Roy J, Mor V: Daily pain that was excruciating at some time in the previous week: Prevalence, characteristics and outcomes in nursing home residents. JAGS. 2004, 52: 762-767. 10.1111/j.1532-5415.2004.52215.x.

    Article  Google Scholar 

  15. 15.

    Cypress BK: Characteristics of physician visits for back symptoms. A national perspective. Am J Public Health. 1983, 73: 389-95.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Hart LG, Deyo RA, Cherkin DC: Physician office visits for low back pain: frequency, clinical evaluation and treatment patterns from a US National survey. Spine. 1995, 20: 11-19.

    CAS  Article  PubMed  Google Scholar 

  17. 17.

    Ferrell BA: Pain evaluation and management in the nursing home. Ann Intern Med. 1995, 123: 681-7.

    CAS  Article  PubMed  Google Scholar 

  18. 18.

    Ferrell BA: Pain management in elderly people. J Am Geriatr Soc. 1991, 39: 64-73.

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    Ferrell BA: The assessment and control of pain in the nursing home. Improving care in the nursing home–comprehensive reviews of clinical research. Edited by: Rubenstein LZ, Wieland, D. 1993, Newbury Park (CA): Sage Publication

    Google Scholar 

  20. 20.

    Sengstaken EA, King SA: The problem of pain and its detection among geriatric nursing home residents. J Am Geriatr Soc. 1993, 41: 541-544.

    CAS  Article  PubMed  Google Scholar 

  21. 21.

    Thomas E, Silman AJ, Croft PR, Papageorgiou AC, Jayson MI, Macfarlane GJ: Predicting who develops chronic low back pain in primary care: a prospective study. Br Med J. 1999, 318: 1662-

    CAS  Article  Google Scholar 

  22. 22.

    Yates P, Dewar A, Fentiman B: Pain: the views of elderly people living in long-term residential care settings. J Adv Nurs. 1995, 21: 667-74. 10.1046/j.1365-2648.1995.21040667.x.

    CAS  Article  PubMed  Google Scholar 

  23. 23.

    Tarzian A, Hoffman D: Barriers to managing pain in the nursing home: Findings from a statewide survey. Journal of the American Medical Directors Association. 2005, 6-

    Google Scholar 

  24. 24.

    Weiner D, Hanlon J: Pain in Nursing Home Residents: Management Strategies. Drugs and Aging. 2001, 18 (1): 13-29. 10.2165/00002512-200118010-00002.

    CAS  Article  PubMed  Google Scholar 

  25. 25.

    Argoff C, Cranmer W: The pharmacological management of chronic pain in the long term care settings. Balancing efficacy and safety. 2003, 18: 4-18.

    Google Scholar 

  26. 26.

    Acello B: Meeting JCAHO standards for pain control. Nursing. 2000, 30: 52-54.

    CAS  Article  PubMed  Google Scholar 

  27. 27.

    Statistics Canada: A portrait of seniors in Canada. 1997, (APS) Ottawa: Statistics Canada

    Google Scholar 

  28. 28.

    Fox PL, Raina P, Jadad AR: Prevalence and treatment of pain in older adults in nursing homes and LTC institutions: a systematic review. CMAJ. 1999, 160: 329-333.

    CAS  PubMed  PubMed Central  Google Scholar 

  29. 29.

    Won A, Lapane K, Gambassi G: Correlates and management of nonmalignant pain in the nursing home. SAGE study group. Systematic assessment of geriatric drug use via epidemiology. J Am Geriatr Soc. 1999, 47: 936-942.

    CAS  Article  PubMed  Google Scholar 

  30. 30.

    King SA: Depression and pain: assessment and therapeutic strategies. Journal of Back and Musculoskeletal Rehabilitation. 1997, 9: 223-231. 10.1016/S1053-8127(97)10004-5.

    CAS  Article  PubMed  Google Scholar 

  31. 31.

    Papageorgiou AC, Croft PR, Ferry S, Jayson MIV, Silman AJ: Estimating the prevalence of low back pain in the general population. Evidence from the South Manchester Back Pain Survey. Spine. 1995, 20: 1889-1894.

    CAS  Article  PubMed  Google Scholar 

  32. 32.

    Jacox A, Carr DB, Payne R: Management of cancer pain. Clinical Practice Guideline No. 9. 1994, Rockville, Md: Agency for Health Care Policy and Research

    Google Scholar 

  33. 33.

    Liebeskind JC: Pain can kill. Pain. 1991, 44: 3-4. 10.1016/0304-3959(91)90141-J.

    CAS  Article  PubMed  Google Scholar 

  34. 34.

    Lavsky-Shulan M, Wallace RB, Kohout FJ: Prevalence and functional correlates of low back pain in the elderly: The Iowa 65+ Rural Health Study. J Am Geriatr Soc. 1985, 33: 23-28.

    CAS  Article  PubMed  Google Scholar 

  35. 35.

    American Geriatrics Study Panel: The American Geriatrics Society guidelines for the management of pain: implications in the LTC setting. 29th Annual Meeting of the AGS. 1998

    Google Scholar 

  36. 36.

    Joint Commission on Accreditation of Healthcare Organizations (JCAHO): Implementing the new pain management standards. 2000, Oakbrook Terrace: JCAHO

    Google Scholar 

  37. 37.

    Davis MP, Horvitz HR: Demographics, assessment and management of pain in the elderly. Drugs and Aging. 2003, 20 (1): 23-57. 10.2165/00002512-200320010-00003.

    CAS  Article  PubMed  Google Scholar 

  38. 38.

    Chodosh J, Solomon D, Roth C, Chang J, MacLean C, Ferrell B, Shekelle P, Wenger N: The quality of medical care provided to vulnerable older patients with chronic pain. JAGS. 2004, 52: 756-761. 10.1111/j.1532-5415.2004.52214.x.

    Article  Google Scholar 

  39. 39.

    Parmelee PA, Smith B, Katz IR: Pain complaints and cognitive status among elderly institution residents. J Am Geriatr Soc. 1993, 41: 517-522.

    CAS  Article  PubMed  Google Scholar 

  40. 40.

    Tseng S, Wang R: Quality of life and related factors among elderly nursing home residents in southern Taiwan. Public Health Nursing. 2001, 18: 304-311. 10.1046/j.1525-1446.2001.00304.x.

    CAS  Article  PubMed  Google Scholar 

  41. 41.

    Croft PR, Papageorgiou AC, Ferry S, Thomas E, Jayson M, Silman A: Psychological distress and low back pain. Evidence from a prospective study in the general population. Spine. 1995, 20: 2731-2737.

    CAS  Article  PubMed  Google Scholar 

  42. 42.

    Stein WM, Ferrell BA: Pain in the nursing home. Clin Geriatr Med. 1996, 12: 601-613.

    CAS  PubMed  Google Scholar 

  43. 43.

    American Society of Consultant Pharmacists: Improving outcomes of pain management in long term care patients. American Society of Consultant Pharmacists' Annual Meeting Nov 13. 1998

    Google Scholar 

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We would like to acknowledge the clinical and administrative staff at Tendercare Living Centre, LTC facility in Toronto Canada, for allowing us access to the clinical data for this study. Special thanks to Dr. Judy Waalen for her suggestions on study design, interpretation of data and critical revision of the manuscript. Funding for the design and data collection was provided by the Canadian Memorial Chiropractic College, Toronto, Canada.

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Correspondence to Connie J D'Astolfo.

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The author(s) declare that they have no competing interests.

Authors' contributions

CJD conceived the study, participated in the study design, did the literature search, performed the data collection and statistical analysis and drafted the manuscript. BKH participated in the design of the study, consulted on the statistical analysis and interpretation of data, participated in the drafting and critical revision of the manuscript. All authors read and approved the final manuscript.

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D'Astolfo, C.J., Humphreys, B.K. A record review of reported musculoskeletal pain in an Ontario long term care facility. BMC Geriatr 6, 5 (2006).

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  • Back Pain
  • Long Term Care
  • Mini Mental Status Exam
  • Ambulatory Status
  • Chronic Health Problem