Back School as an Effective Intervention in Managing Chronic LBP

Back School as an Effective Intervention in Managing Chronic Low Back Pain

Nicole Davis, SPT

UNC PT Outreach 2016

¡Bienvenidos a mi página de Capstone! – Welcome to my Capstone page!

Background

At the end of April, I will travel to Guatemala with a group of UNC PT students and faculty members. During our time there, we will work alongside the Guatemalan physical therapists and students, treating children and adults with physical and cognitive disabilities. We will also be providing educational presentations and sponsoring health fairs in the local communities.  After discussing the current needs for the 2016 service-learning trip with a UNC faculty member who has previously participated in these outreach efforts, I decided to develop my Capstone in conjunction with UNC’s PT Outreach program.

Throughout my time in the UNC DPT program, patient-centered care and cultural competence have become reoccurring themes in many of the courses. The importance of these themes are defined in our profession’s Core Values: accountability, altruism, compassion/caring, excellence, integrity, professional duty, and social responsibility.¹ Though our profession continues to strive for exceptional care for our patients at home, our commitment to society extends beyond American borders.

In Evidence-Based Practice II, I prepared a Critically Appraised Topic (CAT) paper that summarized my systematic search and critical appraisal of research evidence related to the efficacy of stabilization exercise and massage on chronic low back pain (LBP). Current evidence reflects the effectiveness of both interventions in the short-term with questionable efficacy in the long-term. An interesting observation I made during my review of the literature was that patient education further validated significant results and had residual benefits in the long-term. After recognizing this finding, I was interested in investigating the effectiveness of an educational Back School approach on chronic LBP management.

Statement of Need

Chronic LBP is a debilitating condition with a lifetime prevalence of 84%.⁶ It is the fourth leading musculoskeletal ailment in Guatemala and Central America.⁵ Chronic LBP accounts for nearly half the cost of treated musculoskeletal conditions.⁴ The physiological origin of chronic LBP and factors that precipitate recurrence are poorly understood among the research community.² For this reason, successfully treating individuals with chronic LBP can be challenging.

Current evidence suggests major risk factors for chronic LBP are related to poor lifestyle choices, improper body mechanics and corresponding muscle imbalances.  In addition to these factors, inadequate working conditions and occupational hazards may also contribute to chronic LBP.³ The majority of Guatemalans are self-employed and nearly a third work more than 48 hours a week.³ Under these circumstances many workers report that they frequently work on slippery surfaces, carry heavy loads and do a lot of repetitive movements.³ These factors likely influence back pain.

Recent investigations have studied the effect of managing chronic LBP through structured patient education.⁷ Positive reports have been stated with a Back School approach.⁷ Given the high lifetime prevalence of chronic LBP and the physical demands that Guatemalans experience daily, implementing a Back School for treating physical therapists in Guatemala would be beneficial to its residents. Guatemalan physical therapists’ lack of time and access to evidence-based interventions further support this need for this program.

Project Overview

To prepare for my Capstone, I performed a review of the current literature and developed an Evidence Table investigating the benefits of Back School for managing chronic LBP. A reference list of the articles used in the table can be accessed HERE. Articles provided in this table reflect a systematic search of the literature but do not include all articles related to Back School for managing chronic LBP, as that was out of scope for this project.  The effectiveness of Back School for the management of chronic low back pain was the basis of my presentation materials.

In order to deliver an effective and clinically useful presentation, I utilized materials from the DPT Capstone site and also completed a Health Literacy Assessment to ensure that my presentation materials were appropriate for my audience.^8-11 These resources along with the feedback I obtained from my Capstone advisor, Lisa Johnston, guided the final drafts of my presentation handouts. These materials will be translated to Spanish prior to traveling to Guatemala and will be laminated for long-term use in the clinic. Links to the handouts are listed below:

Physical Therapist Handout: A guide that teaches the physical therapist how to educate their patients on managing chronic LBP by addressing the functional anatomy of the spine, LBP etiology and risk factors, proper posture and lifting mechanics. (English/ Spanish)

Patient Handout: A brief handout with visual representations of things to do and things to avoid when managing chronic LBP. (English/Spanish)

The physical therapist and patient handouts will guide my presentation in Guatemala. I will discuss how the physical therapists and students may incorporate this Back School approach in their plan of care for patients with chronic LBP. The presentation will also include short lab sessions where the physical therapists and patients can practice having these conversations and using these materials.  Because my target audience for my materials are the patients in rural Guatemala, I will synthesize the information in my evidence table in a brief paper to reflect the effectiveness of the Back School for the management of chronic low back pain.

In order to assess the true benefit and clarity of my presentation, I will provide a Presentation Evaluation Form for my audience members. The feedback form will assess the organization of my presentation, the quality of my content and its usefulness in clinical practice.

Acknowledgements

My genuine thanks goes to my Capstone advisor, Lisa Johnston, for helping me find the direction for my Capstone project, offering her continued guidance and keeping me level-headed throughout this semester. Additionally, I would like to thank my Capstone committee members, Kristel Maes, PT, DPT, Dip MDT and Jennifer Cooke, PT, DPT for their patience and feedback. My sincerest gratitude goes to Sarah van der Horst, PT, DPT for translating all of my presentation materials. Lastly, I would like to recognize the family, friends, classmates and faculty members that have provided their suggestions and support throughout this entire process. You are appreciated!

 References

(1) Professionalism in Physical Therapy: Core Values. APTA. [Website] https://www.apta.org/uploadedFiles/APTAorg/About_Us/Policies/BOD/Judicial/ProfessionalisminPT.pdf. Updated December 14, 2009. Accessed April 17, 2016.

(2) Andrusaitis SF, Brech GC, Vitale GF, Greve JM. Trunk stabilization among women with chronic lower back pain: a randomized, controlled, and blinded pilot study. Clinics. 2011;66(9):1645-1650.

(3) Benavides FG, Wesseling C, Delcios GL, Felknor S, Pinilla J, Rodrigo F. Working conditions and health in Central America: a survey of 12,024 workers in six countries. Occup Envrion Med. 2014;71(7):459-65.

(4) Moussouli M, Vlachopoulos SP, Kofotolis ND, Theodarakis Y, Malliou P, Kellis E. Effets of stabilization exercise on health-related quality of life in women with chronic low back pain. Journal of Physical Activity and Health. 2014;11:1295-1303

(5) Obregon-Ponce A, Iraheta I, Garcia-Ferrer H, Mejia B, Garcia-Kutzbach A. Prevalence of musculoskeletal disease in Guatemala, Central America: the COPCORD study of 2 populations. J Clin Rheumatol. 2012;18(4):170-4.

(6) Violante FS, Mattioli S,Bonfigiloli R. Low-back pain. Handb Clin Neurol. 2014;131:397-410.

(7) Sahin N, Albayrak I, Durmus B, et al. Effectiveness of back school for treatment of pain and functional disability in patients with chronic low back pain: a randomized controlled trial. J Rehabil Med. 2011;43(3):224-9.

(8) Integral Family Literacy: Guatemala. United Nations Educational, Scientific and Cultural Organization [Website]. http://www.unesco.org/uil/litbase/?menu=16&programme=94. Updated February 10, 2012. Accessed March 7, 2016.

(9) Jensen GM, Monstrom E. Handbook of Teaching and Learning Physical Therapy. Third Edition. Chapter 12: Patient Education and Health Literacy.

(10) Plack M, Driscoll M. Teaching and Learning in Physical Therapy From Classroom to Clinic. Chapter 4: Systematic Effective Instruction: Keys to Designing Effective Presentations.

(11) Readability Score. Readbility-Score.com [Website] https://readability-score.com/. Accessed March 7, 2016.