A study to evaluate the effectiveness of a total back care programme for group rehabilitation of selected patients with chronic low back pain
Date
1998
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Stellenbosch : Stellenbosch University
Abstract
AFRIKAANSE OPSOMMING : Kroniese laer rugpyn (KLRP) is 'n algemene toestand geassosieer met gestremdheid, imperking van funksie en aktiwiteit, verlies aan produktiwiteit en aansienlike onkoste. Oefening-terapie is 'n algemene voorskrif vir die hantering van KLRP, maar is nog nie genoegsaam evalueer of as effektief bewys nie. Nuwe inligting dui daarop dat terapeutiese oefeninge wat spinale stabilisasie verbeter 'n belangrike komponent behoor te vorm in die hantering van KLRP. Opvoeding oor rugversorging word as belangrik beskou en tesame met 'n oefenprogram vorm dit die basis van 'n totale rugversorgingsprogram (TRVP) benadering.
'n Beskrywende voor-na studie is gebruik om die effektiewe van 'n TRVP te evalueer. Dertig (30) pasiente is gekies na aanleiding van spesifieke in- en uitsluitingskriteria en het deelgeneem aan oefeninge twee maal per week oor 'n vier-weke periode. Opsionele groep oefeninsklasse was hierna beskikbaar. Pasiente is ge-evalueer voor en na die TRVP, en na drie en ses maande. Subjektiewe metings het vier verskillende pyn skale, metings van gestremdheid, gebreklikheid, angstigheid en pasient tevredenheid ingesluit. Objektiewe metings het spinale fleksie, reguit been optel (RBO) en dinamiese lumbale stabiliteit ge-evalueer. Data is prospektief versamel oor een jaar en retrospektief geanaliseer met toepaslike statistiese ontledings.
Subjektiewe verbetering is gevind in die torale groep soos gemeet deur verminderde pyn, verbetering in gestremdheid gemeet op die Roland-Morris skaal (56% op een maand en 80% op drie maande) en verminderde angstigheid. Gebreklikheid het betekenisvol verminder van 10,6 by basislyn tot 6,7 op een maand (p<0.01) en 4,6 by drie maanse (p<0.01). Pasienet tevredenheid was hoog geskat met 'n gemiddelde van 91%. Na deelname aan die TRVP het spinale fleksie verbeter tot 37% in vergelyking met die eerste metings en hierdie neiging het op drie en ses maande voortgeduur. RBO het min verandering en wisselende resultate getoon. Dinamiese lumbale stabiliteit het verbeter op een maand en behoue gebly op drie maande.
Die TRVP wat in hierdie studie ondersoek is, blyk 'n effektiewe intervensie vir die groepsrehabilitasie van geselkteerde pasiente met KLRP te wees. Betekenisvolle voordele is getoon in metings van pyn, gestremheid, gebreklikheid en angstigheid sowel as verbetering in funksie. Interpretsie van die data word egter beperk deur die studie-ontwerp wat die randomiseerd en gekontroleer was nie. Die resultate bevestig egter dat 'n TRVP betekenisvolle verbetering bewerkstellig in 'n groep geselekteerde pasiente met KLRP en verder toepaslike studies is nodig om die terapeutiese waarde vir pasiente met hierdie kroniese en stremmende toestand te bevestig.
ENGLISH SUMMARY : Chronic low back pain (CLBP) is a prevalent condition which is associated with disability, activity intolerance, lost productivity and considerable expense. Exercise therapy has been a popular prescription in the management of CLBP but has been poorly researched and there is scant evidence for efficacy. Recent evidence suggests that therapeutic exercise which enhance spinal stabilisation should be an important component of the management of CLBP. Back care education is considered to be valuable and together with an exercise programme forms the basis of the total back care programme (TBCP) approach. A descriptive before-after study was implemented to evaluate the effectiveness of the TBCP approach. A subgroup of 30 patients was selected according to specific inclusion and exclusion criteria. Patients participated in the TBCP which consisted of two sessions per week over a four week period, thereafter optional group exercise classes were available. Patients were assessed before and after the TBCP and after three and six months. Subjective measures included four different pain scales and measures of functional impairment (disability), handicap, distress and patient satisfaction. Objective measures consisted of spinal flexibility, straight leg raise and a test for dynamic lumbar stability. Data was collected prospectively over a one year period and results were analysed retrospectively using appropriate statistics. Subjective improvement was noted for the group as a whole as reflected by reduction in pain ratings, marked improvement in Roland-Morris disability ratings (56% improvement at one month and 80% at three months) and reduced levels of distress. Mean ratings of handicap were significantly reduced from 10,6 at baseline to 6,7 at one month (p<0,01) and to 4,6 at three months (p<0,01). Patient satisfaction with the TBCP was very highly rated averaging 91%. After participation in the TBCP spinal flexibility was assessed to be 37% improved with respect to baseline and this trend continued at three and six months. Straight leg raise showed little change reflected high variability. Dynamic lumbar stability was improved at one month and this improvement was maintained at the three month follow up. The TBCP investigated in this research appears to be an effective intervention for group rehabilitation of selected patients with CLBP as suggested by significant reduction in levels of pain, disability, handicap and distress and by improvement in function. However, interpretation of the results is limited due to the lack of a randomised, controlled design. This study establishes that a TBCP may be of considerable benefit in the management of selected patients with CLBP. Further appropriate studies are required to validate the therapeutic value of a TBCP for patients with this chronic and disabling condition.
ENGLISH SUMMARY : Chronic low back pain (CLBP) is a prevalent condition which is associated with disability, activity intolerance, lost productivity and considerable expense. Exercise therapy has been a popular prescription in the management of CLBP but has been poorly researched and there is scant evidence for efficacy. Recent evidence suggests that therapeutic exercise which enhance spinal stabilisation should be an important component of the management of CLBP. Back care education is considered to be valuable and together with an exercise programme forms the basis of the total back care programme (TBCP) approach. A descriptive before-after study was implemented to evaluate the effectiveness of the TBCP approach. A subgroup of 30 patients was selected according to specific inclusion and exclusion criteria. Patients participated in the TBCP which consisted of two sessions per week over a four week period, thereafter optional group exercise classes were available. Patients were assessed before and after the TBCP and after three and six months. Subjective measures included four different pain scales and measures of functional impairment (disability), handicap, distress and patient satisfaction. Objective measures consisted of spinal flexibility, straight leg raise and a test for dynamic lumbar stability. Data was collected prospectively over a one year period and results were analysed retrospectively using appropriate statistics. Subjective improvement was noted for the group as a whole as reflected by reduction in pain ratings, marked improvement in Roland-Morris disability ratings (56% improvement at one month and 80% at three months) and reduced levels of distress. Mean ratings of handicap were significantly reduced from 10,6 at baseline to 6,7 at one month (p<0,01) and to 4,6 at three months (p<0,01). Patient satisfaction with the TBCP was very highly rated averaging 91%. After participation in the TBCP spinal flexibility was assessed to be 37% improved with respect to baseline and this trend continued at three and six months. Straight leg raise showed little change reflected high variability. Dynamic lumbar stability was improved at one month and this improvement was maintained at the three month follow up. The TBCP investigated in this research appears to be an effective intervention for group rehabilitation of selected patients with CLBP as suggested by significant reduction in levels of pain, disability, handicap and distress and by improvement in function. However, interpretation of the results is limited due to the lack of a randomised, controlled design. This study establishes that a TBCP may be of considerable benefit in the management of selected patients with CLBP. Further appropriate studies are required to validate the therapeutic value of a TBCP for patients with this chronic and disabling condition.
Description
Thesis (MScPhysio)--Stellenbosch University, 1998.
Keywords
Backache -- Exercise therapy -- South Africa, Backache -- Physical therapy -- South Africa, Backache -- Treatment -- Effectiveness -- South Africa, Stellenbosch University. Department of Physiotherapy -- Dissertations, Academic, UCTD