The effectiveness of immediate physiotherapy intervention for patients with acute non-specific low back pain in an accident and emergency department

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The effectiveness of immediate physiotherapy intervention for patients with acute non-specific low back pain in an accident and emergency department

 

Author: Lau, Mo-yee
Title: The effectiveness of immediate physiotherapy intervention for patients with acute non-specific low back pain in an accident and emergency department
Degree: D.H.Sc.
Year: 2008
Subject: Hong Kong Polytechnic University -- Dissertations.
Backache -- Physical therapy.
Physical therapy.
Emergency medicine.
Department: Dept. of Health Technology and Informatics
Pages: xix, 210 leaves : ill. (some col.) ; 30 cm.
Language: English
InnoPac Record: http://library.polyu.edu.hk/record=b2321667
URI: http://theses.lib.polyu.edu.hk/handle/200/4561
Abstract: Introduction: Acute LBP is one of the commonest causes for patients seeking medical consultation. Yet, its symptoms, pathology, and radiological appearances are poorly correlated and the pain is non-specific in about 95% of the patients. In a local district hospital, physiotherapists had launched an immediate physiotherapy (PT) service in the Accident and Emergency Department (AED). This program targeted to alleviate pain, maximize function, minimize disability and reduce injury recurrence. Question: Did non-specific low back pain (LBP) patients treated with immediate PT intervention in an AED differ significantly at discharge, short-term and long-term follow-ups from those who received no PT intervention in an AED? Design: Single-blind, randomized, repeated measures control group design. Participants: Participants aged 18 years old or above and presented with acute non-specific LBP with or without associated leg pain. Methodology: One hundred and ten participants were randomly allocated into the intervention group (n=55) or control group (n=55) by random number tables method. Participants in the intervention group received immediate PT intervention, including reassurance, providing adequate information, mobility and gait training, advice on staying active, interferential therapy, back care and advice. Participants in the control group received no active PT intervention except the prescription of appropriate walking aids whenever indicated. All subjects received a course of PT outpatient department (OPD) intervention after discharged home from AED or in-patient hospitalization from the local district hospital. The first appointment to begin PT treatment in the PT OPD was arranged within 1 week upon discharge from the AED or hospital. The interaction and main effects between the intervention and control groups were analyzed by general linear model repeated measures analysis of variance. The level of significance (alpha) was set at 0.05 and Bonferroni criterion was used to control the family-wise error for multiple comparisons. Outcome measures: Primary outcomes included Numeric Pain Rating Scale (NPRS) and Numeric Global Rating of Change Scale (NGRCS). Secondary outcomes included Roland-Morris Disability Questionnaire, Modified Rivermead Mobility Index, Back Performance Scale, and Short Form 12v2 Health Survey. Measures were taken at baseline, at discharge from AED, initial PT outpatient session, at 1-month, 3-month and 6-month. Results: Participants in the intervention group had significantly lower pain score than those in the control group prior to discharge from the AED (mean difference: NPRS -1.58, 95%CI: -2.25 to -0.90, NGRCS: 2.08, 95%CI: 1.34 to 2.81). Reduction in pain score maintained till the first PT outpatient session (mean difference: NPRS: -0.87, 95%CI: -1.55 to -0.20). However, outcomes were similar for both groups at subsequent follow-ups. Conclusions: Immediate PT intervention was effective in reducing pain and improving self-perception of overall condition for patients with acute non-specific LBP in an AED and the effects gradually tailed off at follow-ups. This program was a pioneer project on re-engineering of PT service.

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