This research was conducted to understand the societal-level challenges that adults aged 50 and older with low back pain face when trying to get rehabilitation. Rehabilitation includes treatments and therapies, such as physical therapy, that help people manage pain and improve function. The goal was to create a comprehensive map of these challenges and supports, which are called structural barriers and facilitators, and to see if people's experiences differ based on their social circumstances.
Structural factors are not about an individual's personal choices but about the broader systems in which they live. These factors include the economic and political environment, government policies, how healthcare is organized, and societal or cultural values. A barrier is a structural factor that makes it harder to get care, while a facilitator is one that makes it easier.
To do this, the researchers performed a "scoping review," which is a method of searching for and mapping out all the available research on a specific topic. They followed a formal process called the Joanna Briggs Institute methodology. They looked for studies that focused on people's experiences, known as qualitative studies. The review included studies that used only qualitative data as well as mixed-method studies that had a qualitative part.
The review focused specifically on studies about structural barriers or facilitators to accessing rehabilitation for adults 50 years or older with low back pain. The researchers searched for relevant studies published at any time up to February 2025. Two reviewers independently screened each potential study and extracted the relevant information. The findings were then organized to map out the common barriers and facilitators and to identify areas where more research is needed. An advisory committee, which included people with low back pain, their family members, and healthcare providers, provided input throughout the research process.
After screening 8,550 studies, the researchers identified 16 that were relevant to their review. Of these, three were from middle-income countries, twelve were from high-income countries, and one covered both. Twelve of the studies looked at general low back pain (LBP), while four focused on a specific condition called lumbar spinal stenosis, which is a narrowing of the spinal canal in the lower back that can put pressure on nerves and is a common cause of LBP in older adults.
The review identified several common structural factors that acted as either barriers or facilitators to accessing rehabilitation. These were consistent for people with both general LBP and lumbar spinal stenosis in middle- and high-income countries. The main factors were:
- Finances: This included the direct cost of care, the type of insurance coverage a person had, and whether they had financial support from their family.
- Location, Transportation, and Service Availability: This category included issues like not having adequate public transportation, long wait times for appointments, and whether services and resources were located nearby.
- Knowledge, Perceptions, and Stigma: This involved patients not receiving enough education about their treatment options. Some older adults also reported facing ageism from healthcare providers, such as being told to just accept back pain as a normal part of aging. Others felt a stigma, or sense of shame, associated with using certain rehabilitation approaches, such as mobility aids.
In high-income countries, studies also identified factors related to the healthcare system itself. These included challenges with getting referrals to specialists and a lack of collaboration between different healthcare providers.
The research showed that these barriers and facilitators were not the same for everyone. Experiences varied depending on social factors such as living in a rural or urban area, a person's socioeconomic level, and whether they had other disabilities.
In conclusion, older adults in middle- and high-income countries who have low back pain or lumbar spinal stenosis encounter numerous structural barriers when trying to access rehabilitation. These barriers are connected to finances, location and transportation, the availability of services, healthcare provider actions, ageism, and stigma. The specific challenges a person faces can differ based on their social situation. These findings can be used to develop strategies for making rehabilitation services more fair and accessible for everyone. The review also highlights a need for more research on this topic in low-income countries.