Patients’ perceptions of self-management of chronic low back pain:

evidence for enhancing patient education and support

Abstract

Objectives To explore the extent to which physiotherapy facilitated chronic lowback pain (CLBP) patients to self-manage following discharge, and to explore patients’' perceptions of their need for self-management interventions or support and their preferences in terms of delivery.

Design Qualitative study using semi-structured interviews to explore patients’' perceptions of various aspects of physiotherapy management of CLBP.

Setting Physiotherapy departments in one geographical area of the UK National Health Service.

Participants Twenty-five people who had received physiotherapy for CLBP within the previous 6 months.

Results Adoption of self-management strategies was not achieved consistently in this group of participants. There was a strongly perceived need for self-management support following discharge from physiotherapy. Exercises were reportedly the most common self-management strategy in use. However, it was common for participants to perceive that physiotherapy had little influence on their CLBP management following discharge.

Conclusions These results suggest that CLBP patients could be better facilitated to manage their condition. Providing self-management education in addition to the patient information and education provided traditionally, and providing self-management support in the form of direct access and/or review appointments or telephone calls is worthy of further investigation in this patient group.

© 2008 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Key words: Chronic low back pain; Self-management; Qualitative

Individual advice in addition to standard guideline care in patients

with acute non-specific low back pain: A survey on feasibility among

physiotherapists and patients

Abstract

The medical costs associated with low back pain (LBP) potentially pose an enormous economic burden to society. Prevention (secondary) might be beneficial when there is no definitive conclusion on the most appropriate intervention. For this purpose, individual advice focusing on modification of spinal mechanical load obtained with the 24 Hour Scheduled24HSd(an instrument for quantifying spinal mechanical load) in addition to standard care of guideline-recommendations might be effective. Naturally, this should be examined in controlled studies. Considering the costs involved carrying out a controlled study, the feasibility of 24HS-advice should be assessed first.

We performed two surveys in primary care setting in 97 patients with acute (<6 weeks) non-specific LBP (who received a 24HS assessment and 24HS-advice at baseline), and 18 physiotherapists (all involved in 24HS baseline assessments). Patients and physiotherapists were first contacted by telephone after 6 months by a research assistant and requested to complete a questionnaire developed to assess feasibility. During this interview patients again completed a follow-up 24HS assessment.

Eighty-eight patients and 17 physiotherapists participated in the follow-up. The median score of patients’ questionnaire was 7(interquartile range 5.9e8.3) and of physiotherapists’ questionnaire 8 (interquartile range 7e8.5). Both questionnaires exceeded the criteria for feasibility, which we had previously set at seven or higher (out of 10). Subsequently, 24HS-advice was considered feasible for use in primary care healthcare providers and patients with LBP. In patients, the absence of LBP during the follow-up period and in physiotherapists ‘lack of time’ were identified as factors that could potentially threaten the feasibility in 24HS-advice.

2007 Elsevier Ltd. All rights reserved.

Key words: Feasibility study; Low back pain; Prevention; 24 Hour Schedule

The immediate and long-term effects of exercise and patient

education on physical, functional, and quality-of-life outcome

measures after single-level lumbar microdiscectomy: a randomized

controlled trial protocol

Abstract

Background: Low back pain remains a costly quality-of-life-related health problem.

Microdiscectomy is often the surgical procedure of choice for a symptomatic, single-level, lumbar disc herniation in younger and middle-aged adults. The question of whether a postmicrodiscectomy exercise program enhances function, quality of life, and disability status has not been systematically explored. Thus, the overall purpose of this study is to assess immediate and long-term outcomes of an exercise program, developed at University of Southern California (USC), targeting the trunk and lower extremities (USC Spine Exercise Program) for persons who have undergone a single-level microdiscectomy for the first time.

Methods/design: One hundred individuals between the ages of 18 and 60 who consent to undergo lumbar microdiscectomy will be recruited to participate in this study. Subjects will be randomly assigned to one of two groups: 1) one session of back care education, or 2) a back care education session followed by the 12-week USC Spine Exercise Program. The outcome examiners (evaluators), as well as the data managers, will be blinded to group allocation.

Education will consist of a one-hour "one-on-one" session with the intervention therapist, guided by an educational booklet specifically designed for post-microdiscectomy care. This session will occur four to six weeks after surgery. The USC Spine Exercise Program consists of two parts: back extensor strength and endurance, and mat and upright therapeutic exercises. This exercise program is goal-oriented, performance-based, and periodized. It will begin two to three days after the education session, and will occur three times a week for 12 weeks.

Primary outcome measures include the Oswestry Disability Questionnaire, Roland-Morris Disability Questionnaire, SF-36 quality of life assessment, Subjective Quality of Life Scale, 50-foot Walk, Repeated Sit-to-Stand, and a modified Sorensen test. The outcome measures in the study will be assessed before and after the 12-week post-surgical intervention program. Long-term follow up assessments will occur every six months beginning one year after surgery and ending five years after surgery.

Immediate and long-term effects will be assessed using repeated measures multivariate analysis of variance (MANOVA). If significant interactions are found, one-way ANOVAs will be performed followed by post-hoc testing to determine statistically significant pairwise comparisons.

Discussion: We have presented the rationale and design for a randomized controlled trial evaluating the effectiveness of a treatment regimen for people who have undergone a single-level lumbar microdiscectomy.

Stabilisation exercises for low back pain : a systematic review

abstract

objectives To examine the literature to determine if stabilisation exercises are effective for the treatment of pain and dysfunction in patient with low back pain.

data sources PubMed(MEDLINE), CINAHL, AMED, PED개 and the Cochrane Library were searched up to October 2006.

Review methods Inclusion criteria were : randomised clinical trials; in English; full publications; subjects were adults with low back pain; one group received specific stabilisation exercises as the primary intervention; and outcome measures included some measure of pain and/or functional. following a systematic search of major databases, articles were scored according to the PEDro criteria for quality. Due to heterogeneity of specific interventions, control groups, duration of follow-up. outcome measures and study population, a meta-analysis was not conducted. A qualitative review was undertaken that focused on study quality. study population, a nd type of control proup.

Results In Total, 18 trials were included in the review; a large number of trials were excluded. There was little evidence to support the use if stabilisation exercises on chronic back pain, with the majority of high-quality trials showing a significant difference in favour of stabilisation exercises. Overall, however, the evidence was conflicting, and significant differences favouring stabilisation exercises were less likely when they were compared with active treatment control groups rather than inactive control groups.

Conclusions There may be a role for specific stabilisation exercises in some patients with chronic low back pain, but these are no more effective than orher active interventions.

©2007 Chartered society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

key words : low back pain; Exercise therapy; Review