Effects of motor control exercise and patient education program in the management of chronic low back pain among community-dwelling adults in rural Nigeria: a study protocol for a randomized clinical trial

Development and efficacy evaluation of a personalised self-care programme for reducing work-related musculoskeletal disorders among rubber farmers in Thailand

Introduction

Work-related musculoskeletal disorders (WMSDs), the most common causes of work-related pain, suffering, absenteeism, and disability, are a major health concern for rubber farmers. WMSDs are persistent and frequently recur, resulting in increased health burdens for workers. Fortunately, appropriate intervention may relieve discomfort. Specified interventions have been recommended to reduce incidences of WMSD.

Objective

This study aimed to develop and evaluate the efficacy of a personalised self-care programme (PSCP) for relieving pain caused by WMSDs among rubber farmers.

Methods

Demographic data and details concerning the prevalence of pain regions were collected using a questionnaire adapted from the Nordic Musculoskeletal Questionnaire (IOC 1.00). The evidence gained from modified questionnaires and special tests was used to develop the PSCP. The PSCP was verified by three experts (IOC 1.00). Based on the questionnaires, only participants with a pain score of 3 or higher were recruited for the study. The PSCP's efficacy was evaluated by comparing the results before application and after 28 days. A numerical rating scale was employed to estimate the degree of pain. The pathogeneses of WMSDs were confirmed with a special test performed by a physical therapist. Additionally, the levels of interleukin (IL)-6 and IL-10 were measured to determine the PSCP's effect on inflammatory molecules. The efficacy of the PSCP was analysed using a paired t-test.

Results

The results showed that farmers experienced the greatest discomfort in the lower back, followed by the shoulders, legs, and neck. Therefore, this PSCP was designed to alleviate work-related musculoskeletal pain in these body regions. A reduction in pain by two degrees was observed after 28 days of the PSCP (x ‾ before = 5.26, SD = 1.96, x ‾ after = 2.40, SD = 1.64, p < 0.001). Special tests confirmed that the number of pain regions were also decreased (x ‾ before = 0.089, SD = 0.067, x ‾ after = 0.016, SD = 0.030, p < 0.001). In addition, IL-10 levels increased (p ≤ 0.001) following the PSCP, whereas IL-6 levels remained unaltered.

Conclusions

After 28 days of use, the PSCP was effective at reducing pain levels, decreasing pain regions, and promoting the production of anti-inflammatory molecules. This finding demonstrates that the PSCP could help alleviate work-related musculoskeletal pain among rubber farmers. The PSCP may be an appropriate intervention for alleviating pain.

Effectiveness of patient education plus motor control exercise versus patient education alone versus motor control exercise alone for rural community-dwelling adults with chronic low back pain: a randomised clinical trial

BACKGROUND

Chronic low back pain (CLBP) is a common health problem in rural Nigeria but access to rehabilitation is limited. Current clinical guidelines unanimously recommend patient education (PE) including instruction on self-management, and exercises as frontline interventions for CLBP. However, the specific content of these interventions and how they are best delivered remain to be well-described, particularly for low-resource communities. This study determined the effectiveness of PE plus motor control exercise (MCE) compared with either therapy alone among rural community-dwelling adults with CLBP.

METHODS

A single-blind, three-arm parallel-group, randomised clinical trial including 120 adult rural dwellers (mean [SD] age, 46.0 [14.7] years) with CLBP assigned to PE plus MCE group (n = 40), PE group (n = 40), and MCE group (n = 40) was conducted. The PE was administered once weekly and the MCE twice weekly. Each group also received stretching and aerobic exercises twice weekly. All interventions were administered for 8 weeks. Blinded assessments for pain intensity and disability level as primary outcomes, and quality of life, global perceived recovery, fear-avoidance beliefs, pain catastrophising, back pain consequences belief and pain medication use as secondary outcomes were conducted at baseline, 8-week (immediately after intervention) and 20-week follow-ups.

RESULTS

All the groups showed significant improvements in all the primary and secondary outcomes evaluated over time. Compared with PE alone, the PE plus MCE showed a significantly greater reduction in pain intensity by an additional -1.15 (95% confidence interval [CI], -2.04 to -0.25) points at the 8-week follow-up and -1.25 (95% CI, -2.14 to -0.35) points at the 20-week follow-up. For disability level, both PE plus MCE and MCE alone showed a significantly greater improvement compared with PE alone by an additional -5.04% (95% CI, -9.57 to -0.52) and 5.68% (95% CI, 1.15 to 10.2) points, respectively, at the 8-week follow-up, and -5.96% (95% CI, -9.84 to -2.07) and 6.57% (95% CI, 2.69 to 10.4) points, respectively, at the 20-week follow-up. For the secondary outcomes, at the 8-week follow-up, PE plus MCE showed a significantly greater reduction in fear-avoidance beliefs about physical activity compared with either therapy alone, and a significantly greater reduction in pain medication use compared with PE alone. However, compared with PE plus MCE, PE alone showed a significantly greater reduction in pain catastrophising at all follow-up time points, and a significantly greater improvement in back pain consequences belief at the 20-week follow-up. Additionally, PE alone compared with MCE alone showed a significantly greater improvement in back pain consequences belief at all follow-up time points. No significant between-group difference was found for other secondary outcomes.

CONCLUSIONS

Among rural community-dwelling adults with CLBP, PE plus MCE led to greater short-term improvements in pain and disability compared with PE alone, although all intervention strategies were associated with improvements in these outcomes. This trial provides additional support for combining PE with MCE, as recommended in current clinical guidelines, to promote self-management and reduce the burden of CLBP in low-resource rural communities.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT03393104), Registered on 08/01/2018.

Clarification of the "pain neuroscience education" concept in the management of patients with persistent low back pain: A scoping review

BACKGROUND

Patient education is a recommended treatment strategy for persistent low back pain (PLBP). Pain neuroscience education (PNE) is an emerging concept with boundaries still unclear.

OBJECTIVE

To clarify the PNE concept and identify its key characteristics in PLBP management.

METHODS

A systematic search was conducted using the following databases: Pubmed, ScienceDirect, Google Scholar, Cochrane, and Pedro.

INCLUSION CRITERIA

publications in English or French on pain neuroscience education and chronic low back pain, educational books cited in white literature. Three reviewers independently selected eligible studies for final inclusion. Numerical analysis and narrative synthesis were carried out from the extracted data.

RESULTS

From 919 identified publications, 54 were selected. Ten educational resources were added. PNE refers to a theoretical framework, a specific educational intervention, and an overall care approach. It is characterized by the intention to help the patient reconceptualize their PLBP from a tissue injury marker to a protective, neurobiological perspective, and then to increase adherence to biopsychosocial rehabilitation and normalize cognitive-behavioral responses. Pain sciences concepts are presented with an optimization of learning strategies.

CONCLUSION

PNE stands out from other educational and cognitive behavioral approaches through its objective of changing the pain concept.

Translation, Cross-cultural Adaptation and Psychometric Evaluation of the Hausa Roland-Morris Disability Questionnaire in Mixed Rural and Urban Nigerian Populations with Low Back Pain

STUDY DESIGN

Cross-cultural adaptation and cross-sectional study.

OBJECTIVE

The aim of this study was to translate and cross-culturally adapt the Roland-Morris Disability Questionnaire (RMDQ) into Hausa language, and evaluate its psychometric properties in mixed rural and urban populations with low back pain (LBP).

SUMMARY OF BACKGROUND DATA

The RMDQ is one of the most commonly used and recommended condition-specific measures of disability related to LBP. However, no formal adapted and validated Hausa version exists at the time our study was initiated.

METHODS

The Hausa version of the RMDQ (Hausa-RMDQ) was developed according to established guidelines. Psychometric properties were evaluated in 125 patients with LBP recruited from rural and urban Nigerian clinics. Internal consistency (Cronbach's α), test-retest reliability using Intraclass correlation coefficient (ICC), standard error of measurement (SEM), minimal detectable change (MDC), and limits of agreement using Bland-Altman plots were calculated to evaluate reliability. Using Spearman's correlation for a priori hypotheses, the Hausa-RMDQ was correlated with Oswestry Disability Index (ODI) to evaluate concurrent validity, Numerical Pain Rating Scale (NPRS) to evaluate convergent validity, and age, educational level, and occupational status to evaluate divergent validity. Reliability and validity analyses were also conducted separately for rural and urban subgroups.

RESULTS

The Hausa-RMDQ had no major translation problems. The questionnaire had adequate internal consistency (α = 0.70), test-retest reliability (ICC = 0.79), minimal SEM (1.30) and MDC (3.60), and good agreement between test-retest values. The Hausa-RMDQ had a strong correlation with ODI (rho = 0.59), a moderate correlation with NPRS (rho = 0.46), and a null correlation with age, educational level, and occupational status (P > 0.05), thus confirming all the (5:5) a priori hypotheses constructed. These reliability and validity results were also replicated in the rural and urban subgroups.

CONCLUSION

The Hausa-RMDQ was successfully developed and proved to be a reliable and valid measure of functional disability in Hausa culture. This questionnaire is recommended for future clinical and scientific research purposes.Level of Evidence: 3.

Translation, Cross-cultural Adaptation, and Psychometric Properties of the Hausa Versions of the Numerical Pain Rating Scale and Global Rating of Change Scale in a Low-literate Population With Chronic Low Back Pain

STUDY DESIGN

Translation, cross-cultural adaptation, and psychometric testing.

OBJECTIVE

To translate, cross-culturally adapt, and validate the Numerical Pain Rating Scale (NPRS) and the Global Rating of Change Scale (GRCS) into Hausa language.

SUMMARY OF BACKGROUND DATA

The NPRS and GRCS are commonly used patient-reported outcome measures in a variety of pain-related conditions including low back pain. To date, neither the NPRS nor GROC are available in Hausa language.

METHODS

The Hausa versions of the NPRS (NPRS-H) and GRCS (GRCS-H) were developed using recommended guidelines. The final versions were then administered to 120 patients with chronic low back pain to access their psychometric properties. Reliability assessment included calculations of intraclass correlation coefficient (ICC) and minimal detectable change among the stable group. Construct validity and concurrent validity were assessed using the Spearman rank correlation coefficient. Internal responsiveness was assessed using mean change scores, standardized effect size, and standard response mean. Receiver operating characteristic curves were plotted to determine the external responsiveness of the NPRS-H using the area under the curve, and minimal important change for small, medium, and large improvements. Outcome measures consisted of the Visual Analogue Scale for pain and Oswestry Disability Index.

RESULTS

The NPRS-H and GRCS-H were successfully developed. High test-retest reliability was demonstrated for both the NPRS-H (ICC = 0.95) and GRCS-H (ICC = 0.94) with minimal detectable change points of 1.0 and 1.2 respectively. The scales showed moderate to strong correlation with the Visual Analogue Scale for pain and Oswestry Disability Index. The mean change of the NPRS-H scores correlated moderately with the GRCS-H. Both scales demonstrated good internal responsiveness. External responsiveness of the NPRS-H was demonstrated at three levels with area under the curve  = 0.875 to 0.972, and minimal important change  = 2.5 to 3.5.

CONCLUSIONS

The NPRS and GRCS were successfully adapted into Hausa language with acceptable reliability, validity, and responsiveness. These measures are appropriate for clinical and research use among Hausa-speaking patients.

LEVEL OF EVIDENCE

2.