Therapeutic Education and Physiotherapy in Low Back Pain Management

Stilyana Romanova; Kristin Grigorova; Antoaneta Dimitrova

doi:10.3889/oamjms.2021.7414

Authors

Stilyana Romanova Department of Physiotherapy and Rehabilitation, National Sports Academy ”Vassil Levski”, Sofia, Bulgaria; Rehabilitation Center “Physio-Health Sofia”, Sofia, Bulgaria
Kristin Grigorova Department of Physiotherapy and Rehabilitation, National Sports Academy ”Vassil Levski”, Sofia, Bulgaria
Antoaneta Dimitrova Department of Physiotherapy and Rehabilitation, National Sports Academy ”Vassil Levski”, Sofia, Bulgaria

DOI:

https://doi.org/10.3889/oamjms.2021.7414

Keywords:

Physiotherapy, Pain management, Complex therapy, Functional abilities

Abstract

BACKGROUND: Low-back pain (LBP) is one of the most common musculoskeletal problems; it is the leading cause of disability worldwide. Therapeutic patient education is a method that enables health care professionals to pass on their knowledge and experience to patients so that they can participate consciously and actively in their recovery.

AIM: The present study aims to examine the effect of therapeutic education (TE) combined with a specific physiotherapy (PT) approach in people with LBP.

МАTERIALS AND METHODS: This was an experimental pre- and post-study design. The study involved 25 patients, mean age 43.08 ± 12 years, divided into two groups: experimental group (EG), with TE (n =18) and control group (CG), without TE (n = 7). The PT treatment frequency and duration were consistent between groups. The patients were monitored for one month, and the intervention under supervision – face-to-face and self-monitored home-based PT have been organized. The included outcome measures were Oswestry Disability Index, Tampa Scale for Kinesiophobia, STarT Back Screening Tools, and the movement-induced pain in the lumbar spine.

RESULTS: At the end of the study improved pain-free movements in the lumbar region, functionality, reduced catastrophizing was observed in both groups. There is a tendency for better results in the EG compared to the CG in terms of functionality and pain-free movement. The subjective feeling of the catastrophizing was reduced only in the EG below the cut-off score from 45.2 ± 7.7 to 33.2 ± 3.3 points.

CONCLUSION: TE in combination with PT interventions improves functional abilities, decreases the pain during movements, and the subjective perception of kinesiophobia. The results suggest TE should be included in a LBP management approach.

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References

Traeger A, Moseley G, Hübscher M, Lee H, Skinner IW, Nicholas MK, et al. Pain education to prevent chronic low back pain: A study protocol for a randomised controlled trial. BMJ Openn. 2014;4(6):e005505. https://doi.org/10.1136/bmjopen-2014-005505 PMid:24889854 DOI: https://doi.org/10.1136/bmjopen-2014-005505

Balague F, Troussier B, Salminen J. Non-specific low back pain in children and adolescents: Risk factors. Eur Spine J. 1999;8:429-38. https://doi.org/10.1007/s005860050201 PMid:10664299 DOI: https://doi.org/10.1007/s005860050201

Tegner H, Frederiksen P, Esbensen B, Juhl C. Neurophysiological pain education for patients with chronic low back pain. Clin J Pain. 2018;34(8):778-86. https://doi.org/10.1097/AJP.0000000000000594 PMid:29443723 DOI: https://doi.org/10.1097/AJP.0000000000000594

Moseley G, Nicholas M, Hodges P. A randomized controlled trial of intensive neurophysiology education in chronic low back pain. Clin J Pain. 2004;20(5):324-30. https://doi.org/10.1097/00002508-200409000-00007 PMid:15322439 DOI: https://doi.org/10.1097/00002508-200409000-00007

Louw A, Nijs J, Puentedura E. A clinical perspective on a pain neuroscience education approach to manual therapy. J Manual Manipulat Ther. 2017;25(3):160-8. https://doi.org/10.1080/10669817.2017.1323699 PMid:28694679 DOI: https://doi.org/10.1080/10669817.2017.1323699

Louw A, Farrell, Choffin B, Foster B, Lunde G, Snodgrass M, et al. Immediate effect of pain neuroscience education for recent onset low back pain: An exploratory single arm trial. J Manual Manipulative Ther. 2019;27(5):267-76. https://doi.org/10.1080/10669817.2019.1624006 PMid:31161919 DOI: https://doi.org/10.1080/10669817.2019.1624006

Hodges Р. Hybrid approach to treatment tailoring for low back pain: A proposed model of care. J Orthop Sports Phys Ther. 2019;49:453-63. https://doi.org/10.2519/jospt.2019.8774 PMid:30759355 DOI: https://doi.org/10.2519/jospt.2019.8774

Vargas-Schaffer G, Cogan J. Patient therapeutic education: Placing the patient at the centre of the WHO analgesic ladder. Can Fam Physician. 2014;60(3):235-41. PMid:24627377

Forbes R. Patient Education Best Practice; Enhancing Physiotherapy Students’ Self-efficacy and Skills. Australia: PhD Thesis, School of Health and Rehabilitation Sciences, The University of Queensland; 2017. https://doi.org/10.14264/uql.2018.93 DOI: https://doi.org/10.14264/uql.2018.93

Stochkendahl M, Kjaer P, Hartvigsen J, Kongsted A, Aaboe J, Andersen M, et al. National clinical guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy. Eur Spine J. 2018;27(1):60-75. https://doi.org/10.1007/s00586-017-5099-2 PMid:28429142 DOI: https://doi.org/10.1007/s00586-017-5099-2

Malfliet A, Ickmans K, Huysmans E, Coppieters I, Willaert W, Van Bogaert W, et al. Best evidence rehabilitation for chronic pain part 3: Low back pain. J Clin Med. 2019;8(7):1063. https://doi.org/10.3390/jcm8071063 PMid:31331087 DOI: https://doi.org/10.3390/jcm8071063

Marris D, Theophanous K, Cabezon P, Dunlap Z, Donaldson M. The impact of combining pain education strategies with physical therapy interventions for patients with chronic pain: A systematic review and meta-analysis of randomized controlled trials. Physiother Theory Pract. 2019;37(4):461-72. https://doi.org/10.1080/09593985.2019.1633714 PMid:31250682 DOI: https://doi.org/10.1080/09593985.2019.1633714

Lim Y, Chou L, Au R, Seneviwickrama KM, Cicuttini FM, Briggs AM, et al. People with low back pain want clear, consistent and personalised information on prognosis, treatment options and self-management strategies: A systematic review. J Physiother. 2019;65(3):124-35. https://doi.org/10.1016/j.jphys.2019.05.010 PMid:31227280 DOI: https://doi.org/10.1016/j.jphys.2019.05.010

Rabey M, Beales D, Slater H, O’Sullivan P. Multidimensional pain profiles in four cases of chronic non-specific axial low back pain: An examination of the limitations of contemporary classification systems. Manual Ther. 2015;20(1):138-47. https://doi.org/10.1016/j.math.2014.07.015 PMid:25153893 DOI: https://doi.org/10.1016/j.math.2014.07.015

Chorti A, Chortis A, Strimpakos N, McCarthy CJ, Lamb SE. The prognostic value of symptom responses in the conservative management of spinal pain. Spine. 2009;34(24):2686-99. DOI: https://doi.org/10.1097/BRS.0b013e3181b43a41

Fairbank J, Pynsent P. The oswestry disability index. Spine. 2000;25(22):2940-52. https://doi.org/10.1097/00007632-200011150-00017 PMid:11074683 DOI: https://doi.org/10.1097/00007632-200011150-00017

Vlaeyen J, Kole-Snijders A, Boeren R, van Eek H. Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain. 1995;62(3):363-72. https://doi.org/10.1016/0304-3959(94)00279-N PMid:8657437 DOI: https://doi.org/10.1016/0304-3959(94)00279-N

King R, Robinson V, Elliott-Button H, Watson JA, Ryan CG, Martin DJ. Pain reconceptualisation after pain neurophysiology education in adults with chronic low back pain: A qualitative study. Pain Res Manage. 2018;12:3745651. https://doi.org/10.1155/2018/3745651 PMid:30275918 DOI: https://doi.org/10.1155/2018/3745651

O’Keeffe M, Purtill H, Kennedy N, O’Sullivan P, Dankaerts W, Tighe A, et al. Individualised cognitive functional therapy compared with a combined exercise and pain education class for patients with non-specific chronic low back pain: study protocol for a multicentre randomised controlled trial. BMJ Open. 2015;5(6):e007156. https://doi.org/10.1136/bmjopen-2014-007156 PMid:26033941 DOI: https://doi.org/10.1136/bmjopen-2014-007156

O’Sullivan P, Caneiro J, O’Keeffe M, Smith A, Dankaerts W, Fersum K, et al. Cognitive functional therapy: an integrated behavioral approach for the targeted management of disabling low back pain. Phys Ther. 2018;98(5):408-23. https://doi.org/10.1093/ptj/pzy022 PMid:29669082 DOI: https://doi.org/10.1093/ptj/pzy022

Cañeiro J, Nig L, Burnett A, Campbell A, O’Sullivan PB. Cognitive functional therapy for the management of low back pain in an adolescent male rower: A case report. J Orthop Sports Phys Ther. 2013;43(8):542-54. https://doi.org/10.2519/jospt.2013.4699 PMid:23760295 DOI: https://doi.org/10.2519/jospt.2013.4699

Vibe Fersum K, O’Sullivan P, Skouen J, Smith A, Kvåle A. Efficacy of classification‐based cognitive functional therapy in patients with non‐specific chronic low back pain: A randomized controlled trial. Eur J Pain. 2013;17(6):916-28. https://doi.org/10.1002/j.1532-2149.2012.00252.x PMid:23208945 DOI: https://doi.org/10.1002/j.1532-2149.2012.00252.x

Vibe Fersum K, Smith A, Kvåle A, Skouen JS, O’Sullivan P. Cognitive functional therapy in patients with non‐specific chronic low back pain-a randomized controlled trial 3‐year follow‐up. Eur J Pain. 2019;23(8):1416-24. https://doi.org/10.1002/ejp.1399 PMid:30974479 DOI: https://doi.org/10.1002/ejp.1399

Louw A, Zimney K, Puentedura E, Diener I. The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature. Physiother Theory Pract. 2016;32(5):332-55. https://doi.org/10.1080/09593985.2016.1194646 PMid:27351541 DOI: https://doi.org/10.1080/09593985.2016.1194646

Brinjikji W, Luetmer P, Comstock B, Bresnahan BW, Chen LE, Deyo RA, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. Am J Neuroradiol. 2015;36(4):811-6. https://doi.org/10.3174/ajnr.A4173 PMid:25430861 DOI: https://doi.org/10.3174/ajnr.A4173

Louw A, Zimney K, O’Hotto C, Hilton S. The clinical application of teaching people about pain. Physiother Theory Pract. 2016;32(5):385-95. https://doi.org/10.1080/09593985.2016.1194652 PMid:27351903 DOI: https://doi.org/10.1080/09593985.2016.1194652

Vaegter H, Ussing K, Johansen J, Stegemejer I, Palsson TS, O’Sullivan P, et al. Improvements in clinical pain and experimental pain sensitivity after cognitive functional therapy in patients with severe persistent low back pain. Pain Rep. 2020;5(1):e802. https://doi.org/10.1097/PR9.0000000000000802 PMid:32072097 DOI: https://doi.org/10.1097/PR9.0000000000000802

Traeger A, Buchbinder R, Elshaug A, Croft PR, Maher CG. Care for low back pain: Can health systems deliver? Bull World Health Organ. 2019;97(6):423. https://doi.org/10.2471/BLT.18.226050 PMid:31210680 DOI: https://doi.org/10.2471/BLT.18.226050

Janura M, Gallo J, Svoboda Z, Švidernochová D, Kristiníková J. Effect of physiotherapy and hippotherapy on kinematics of lower limbs during walking in patients with chronic low back pain: A pilot study. J Phys Educ Sport. 2015;15(4):663-670. https://doi.org/10.7752/jpes.2015.04101 DOI: https://doi.org/10.7752/jpes.2015.04101

Pappas E, Panou H, Souglis A. The effect of a pilates exercise programme using fitball on people suffering from chronic low-back pain in terms of pain reduction and function imrovement. J Phys Educ Sport. 2013;13(4):606-11. https://doi.org/10.7752/jpes.2013.04095 DOI: https://doi.org/10.7752/jpes.2013.04095

Stevans J, Hall K. Motor skill acquisition strategies for rehabilitation of low back pain. J Orthop Sports Physical Therapy. 1998;28(3):165-7. https://doi.org/10.2519/jospt.1998.28.3.165 PMid:9742473 DOI: https://doi.org/10.2519/jospt.1998.28.3.165

Nijs J, Meeus M, Cagnie B, Roussel NA, Dolphens M, Van Oosterwijck J, et al. A modern neuroscience approach to chronic spinal pain: Combining pain neuroscience education with cognition-targeted motor control training. Phys Ther. 2014;94(5):730-8. https://doi.org/10.2522/ptj.20130258 PMid:24481595 DOI: https://doi.org/10.2522/ptj.20130258

Lyubenova D, Lyubenov N. Optimizing video games in neurorehabilitation. Neurosonol Cerebral Hemodynamics. 2021;17(2):93-105.

Lubenova D. Influence of hydrokinesitherapy in the treatment of lumbar disc disease in the chronic period. Congress Proceedings. Sport Stress Adapt Sci J. 2014;1:629-32.

Lubenova D, Izov N, Maznev I. Neurorehabilitation in peripheral nervous system injuries. In: Tityanova EK, editor. Textbook of Nervous Diseases, Clinical Neurology. 1st ed. United States: Saunders; 2021. p. 521-9.

Lam O, Strenger D, Chan-Fee M, Pham PT, Preuss RA, Robbins SM, et al. Effectiveness of the McKenzie method of mechanical diagnosis and therapy for treating low Back Pain: Literature review with meta-analysis. J Orthop Sports Phys Ther. 2018;48(6):476-90. https://doi.org/10.2519/jospt.2018.7562 PMid:29602304 DOI: https://doi.org/10.2519/jospt.2018.7562

Sanchis-Sánchez E, Lluch-Girbés E, Guillart-Castells P, Georgieva S, García-Molina P, Blasco JM, et al. Effectiveness of mechanical diagnosis and therapy in patients with non-specific chronic low back pain: a literature review with meta-analysis. Braz J Phys Ther. 2020;25(2):117-34. https://doi.org/10.1016/j.bjpt.2020.07.007 PMid:32773288 DOI: https://doi.org/10.1016/j.bjpt.2020.07.007

Salem F, Alatawi F. Effectiveness of neural mobilization in the management of chronic low back pain with radiculopathy: A randomized controlled trial. Int J Physiother. 2019;6(5)217-223. DOI: https://doi.org/10.15621/ijphy/2019/v6i5/186844