Developing Patient Understanding - The Effectiveness of an Educational and Exercise Programme for Persistent Lower Back Pain
Lower back pain (LBP) is one of the ten leading causes of disease burden globally. It is widely recognised that LBP produces significant detrimental effects on physical and emotional wellbeing whilst having a substantial economic burden for society. There is an inverse relationship between socio-economic status and the prevalence of pain. Increasing patients understanding of non-specific lower back pain including pain physiology, combined with completing exercises can provide optimal management. Therefore, the effectiveness of a locally run 'Back to Fitness Programme' (education and exercises) in the most deprived local authority area in England was evaluated.
The purpose was to evaluate the effectiveness of the Back to Fitness programme upon patients' understanding of pain, ability to function, symptom-report and physical outcomes.
This prospective service evaluation was conducted at Blackpool Teaching Hospitals NHS Foundation Trust, UK. Consecutive patients meeting the inclusion criteria over a 6-month timeframe were included. The programme consisted of: a 1-hour group educational presentation on pain mechanisms, pacing and goal setting, and weekly 1-hour exercise classes for four weeks. Changes in scores on the Revised Neurophysiology of Pain, Roland Morris Disability, and Pain Self Efficacy Questionnaires were collected alongside lumbar flexion measurements by treating physiotherapists and analysed by JW and VB.
Data was managed according to the Data Protection Act 1998 and Caldicott Principles and stored in an anonymised format in an electronic database.
Initial data were collected from 49 patients (mean age 53.4 years, 67% female). The amount of final data collected varied per outcome measure due to a range of factors. Following course completion, participants reported the programme had helped with their understanding of pain (n=16, 100%), ability to move around and function (n=15, 94%), and level of pain (n=14, 88%).
Looking at RMDQ scores (n=17), 88% (n=15) of patients indicated a reduction (n=12, 71%) or no change (n=3, 18%) in perceived disability.
The PSEQ scores (n=18) showed that 78% (n=14) of participants perceived an increase in their average level of confidence to move despite pain.
There was an overall improvement in understanding of pain reflected by RNPQ scores (n=44): 89% (n=39) improved (n=36, 82%) or did not change (n=3, 7%).
Regarding lumbar flexion post-programme (n=17), 77% (n=13) of participants demonstrated an improvement (n=9, 53%) or no change (n=4, 24%).
The majority of clinical outcomes improved following participation, predominantly in relation to understanding of pain. To further enhance the management of non-specific LBP, it may be beneficial to compare the current structure with other programmes in the literature. A recent Randomised Controlled Trial evaluating a longer duration of intervention has demonstrated significant reduction in disability and pain at 12 months. Expanding the current programme may enable exploration of deep rooted thoughts surrounding LBP, increase patient efficacy in managing flare ups, thereby addressing the complex biopsychosocial needs of this diverse patient demographic.
Cost and savings
This project was undertaken through a funded internship through the University of Central Lancashire.
Study findings could be used to inform focus groups exploring patient perceptions and experiences. This could lead to further changes to programme content and delivery, improving patient care and provide NHS cost efficiencies.
Top three learning points
This study is supported by The University of Central Lancashire in partnership with The Blackpool Teaching Hospitals NHS Foundation Trust.
This work was presented at Physiotherapy UK 2019 and as poster presentation at The World Congress of Physical Therapy, Geneva 2019.
For further information about this work please contact Jacinta Walsh.