Topic: Effects of combined graded activity and motor control exercises on selected biopsychosocial parameters among nonspecific chronic low back pain patients in Nigeria-A pilot study

Abstract

Background

 Low back pain is increasingly recognised as a major health problem in Africa. Individuals with this condition are burdened not only by pain and disability but by an array of psychosocial dysfunctions as unhealthy behaviours, beliefs and reduced quality of life. Non-specific chronic low back pain is multifactorial in nature, and no single intervention is optimal for these patients.

Objectives

To evaluate the logistics, feasibility and minimum sample size of conducting a randomised controlled trial (RCT) on effects of combined graded activity and motor control exercises on selected biopsychosocial parameters among nonspecific chronic low back pain patients. To determine minimal clinically important changes of the selected biopsychosocial parameters. 

Methods

The study is a pre-test post-test single-group experimental design. Ten patients with non-specific chronic low back pain were managed twice a week for six-weeks using a combined graded activity with motor control exercise intervention. Primary outcome measured were pain intensity and functional disability measured using the numerical pain rating scale and Oswestry disability index questionnaire. Secondary outcome measured were pain catastrophizing, fear avoidance beliefs, quality of life, and kinesiophobia measured using the pain catastrophic scale, fear avoidance beliefs questionnaire, SF-36 and Tampa scale of kinesiophobia (TSK-11) respectively. All outcomes were assessed at baseline and immediately after six-week intervention. Descriptive statistics of frequencies, percentages, mean and standard deviation was used to describe the participants’ sociodemographic variables and the questionnaires. Paired sample t-test was used to determine if significant changes in primary and secondary outcomes were observed.

Results

Feasibility findings show (77%) recruitment rate, (100%) patients’ adherence, and retention respectively. Adverse events due to intervention were not reported. Pain intensity, functional disability, pain catastrophizing, quality of life, and kinesiophobia demonstrated statistically significant improvement (p<0.01) and clinically relevant changes among the patients. Pain intensity and functional disability show a minimal clinical important change (MCIC); MCIC_NPRS=4.2±1.68 and MCIC_ODI=13.6±3.9 respectively.

Conclusions

Feasibility findings show a high recruitment rate, patients’ adherence, and retention respectively. Adverse events due to intervention were not found. Pain intensity, functional disability, pain catastrophizing, quality of life, and kinesiophobia demonstrated statistically significant improvement (p<0.01) and clinically relevant changes among the patients. Pain intensity and functional disability show a minimal clinical important change (MCIC); MCIC_NPRS=4.2±1.68 and MCIC_ODI=13.6±3.9 respectively.

Keywords: Graded activity exercises; Motor control exercises; Chronic low back pain; Non-specific; Biopsychosocial factors; Combined graded activity and motor control exercise (CGAMCE)