The Active Back Programme - A model for multidisciplinary persistent lower back pain rehabilitation.

Purpose

The RNOH Active Back Programme (ABP) is a residential multi-disciplinary rehabilitation programme for people with persistent lower back pain. The aims of the ABP are to decrease the effects of pain on lifestyle by facilitating behavioural change through building self-efficacy and confidence. The long term goal is to reduce healthcare utilisation and hence the economic burden of back pain. Recent emerging evidence has highlighted the importance of targeting patient-specific fear avoidance. This shift in approach has significantly impacted the outcomes that therapy can achieve in terms of pain reduction and disability.

The purpose of this evaluation was to gauge the short-term outcomes at three months following completion of the ABP using measures of self-efficacy, confidence and physical capacity.

Qualitative feedback
indicates high patient satisfaction with the ABP.
Furthermore, 39%
of patients reported reductions in medication use...
...61%
reported reduced pain intensity...
...and 82%
reported improvements in the effects of chronic pain on their life at 3 months.

Approach

The model of care used during the ABP is an adapted Cognitive Functional Therapy (CFT)/Cognitive Behavioural Therapy (CBT) approach. It consists of education and graded exposure to physical activity and exercise. A clinical tool was developed whereby each patient identified five meaningful activities they were no longer confident performing. These activities form the basis of education and exposure sessions. Emphasis is placed on challenging beliefs around back pain and the impact of this on feared activities, lifestyle advice and pain management strategies. Six minute timed walk (6MTW), Short Form-36 (SF-36), Pain Disability Index (PDI) and Pain Self-efficacy (PSeQ) were assessed on admission, 3 months and will be further assessed at 1 year follow up.

Outcomes

3 month follow-up results (n=18) show positive correlations in all categories measured. These include; improved self-efficacy (PSeQ +10.83/60, CI 4.08-17.59, p< 0.05), improved general health (SF-36 Physical +14.67/100, CI 4.01-25.32, p< 0.01) (SF-36 Mental +15/100, CI 0.90-29.00, p< 0.05), decreased disability (PDI -3.33, CI -9.85-3.19, p=0.3), improved confidence (S-CAT +12.5/25, CI 10.94-14.76, p< 0.001) and improved physical capacity (6MTW +64.21m, CI 18.36-110.05m, P< 0.05).

Qualitative feedback indicates high patient satisfaction with the ABP. Furthermore, 39% of patients reported reductions in medication use, 61% reported reduced pain intensity and 82% reported improvements in the effects of chronic pain on their life at 3 months. Demographic data: mean age: 47, (range 23-72) M=7 F=11, mean pain duration: 14.67 years (range 2 - 50).  

Early results have shown improvements in physical capacity, confidence, general health and self-efficacy through this model. Longer-term results will be assessed at 1 year post completion of programme. Economic evaluation will also be conducted in the future.

Implications

A multi-disciplinary model of care for persistent low back pain incorporating education, graded exposure and exercise may be effective in achieving long-term behaviour change. Patient satisfaction is high for this approach.

Top three learning points

  1. Importance of targeting patient-specific activities that they lack confidence with and that are of value to them, and therapist bravery when exploring ways of improving their confidence.
  2. Importance and benefits of MDT collaboration in rehabilitation of persistent low back pain (including physiotherapy, occupational therapy, clinical psychology, nurse specialists).
  3. This project reinforces the importance of a biopsychosocial approach to rehabilitation of persistent low back pain.

Fund acknowledgements

Nil

Additional notes

This work was presented at Physiotherapy UK 2019.

Please see the attached Innovations poster below.

For further information about this work please contact Gregory Booth.