Effect of an aggressive versus conservative, multi-modal rehabilitation programme on chronic lower back pain

Low back pain has become one of the most influential musculoskeletal diseases of modern society. It is one of most expensive diseases in terms of medical costs and increased worker absenteeism, which can lead to permanent disability and places strain on the economy as a whole. Pain has been recognised as a disease in itself, which has certain consequences when it becomes chronic. Many kinds of treatment options exist with varying degrees of success. The question is thus which treatment option is the most favourable and cost-effective. Conservative treatment is the most recommended form of treatment when no serious underlying diseases are present. Exercise has been shown to be very effective in the treatment of chronic low back pain but there are still questions regarding the use of exercise therapy. The predetermined goal of the study was to ascertain whether an aggressiveprogressive exercise programme, and specifically what kind of exercises, would be more effective in the treatment of chronic low back pain. This was achieved through a number of steps, which included an extensive literature review, the identification of an appropriate test battery with related minimum physical requirements and cut scores, subject recruitment and screening of subjects, the implementation of the intervention and the subsequent re-testing of the subjects. Once the data was completed, the next step was to make use of two case studies to assist in illustrating the effectiveness of individual patients compared to the sample as a whole. These case studies were of patients who completed the entire programme but one took longer to complete the programme. This assists in illustrating the value of maintaining exercise protocol. The results from the present study are extremely positive. The two case studies provided a glimpse of the potential value that could be added through the implementation of more aggressive-progressive exercise interventions in the treatment of chronic low back pain. The final product will greatly assist exercise therapists concerned with the treatment of chronic low back pain along with cognitive-behavioural techniques. Hopefully this study will provide insight into managing chronic low back pain in South Africa from an exercise standpoint. Secondly the study will provide practical techniques to implement in an era in which economic difficulties are rife.AFRIKAANS: Laerugpyn het een van die invloedrykste muskuloskeletale siektes van die moderne samelewing geword. Dit is een van die duurste siektes in terme van mediese koste en verhoogde siekverlof deur werkers, wat kan lei tot permanente ongeskiktheid en ’n verhoogde las plaas op die ekonomie as ’n geheel. Pyn word erken as ’n siekte op sy eie wat sekere gevolge het wanneer dit chronies begin raak. Verskeie soorte behandelingsopsies is beskikbaar met variërende grade van sukses. Die vraag is dus watter behandelingsopsie is die bruikbaarste en koste-doeltreffendste. Konserwatiewe behandeling is die mees aanbevole metode van behandeling wanneer daar geen ernstige onderliggende siektetoestande teenwoordig is nie. Dit is reeds bewys dat oefening baie doeltreffend is in die behandeling van chroniese laerugpyn. Daar bestaan egter steeds vrae rondom die gebruik van oefening as terapie.Die vooropgestelde doelwit van die studie was om te bepaal of ’n aggressiewe-progressiewe inoefeningsprogram doeltreffend sal wees in die behandeling van chroniese laerugpyn, en meer spesifiek watter tipe oefening die doeltreffendste sal wees. Die navorsing het bestaan uit ’n paar stappe wat ingesluit het ’n intensiewe literatuursoektog, die identifisering van ’n gepaste toetsbattery met verwante minimum fisieke vereistes en afsnytellings, die verkryging en evaluering van proefpersone, die implementering van die intervensieprogram en die daaropvolgende hertoetsing van die proefpersone.Nadat die invordering van die data en die gepaardgaande analise van die data voltooi is, was die volgende stap om gebruik te maak van twee gevallestudies ten einde die doeltreffendheid van die intervensieprogram vir individuele proefpersone te ilustreer deur dit te vergelyk met die groep as ’n geheel. Die twee gevallestudies was van proefpersone wat die intervensieprogram volledig voltooi het, alhoewel die een proefpersoon langer geneem het om die intervensieprogram te voltooi. Dit help om die navolgingswaarde van ’n inoefeningsprotokol te illustreer. Die resultate van die huidige studie is uiters positief. Die twee gevallestudies gee ’n mate van insig wat betref die potensiële waarde wat verkry kan word deur die implementering van ’n meer aggressiewe-progressiewe inoefeningsintervensie vir die behandeling van chroniese lae rugpyn. Die finale produk sal die nodige ondersteuning aan oefeningsterapeute bied wat onseker is oor die behandeling van chroniese laerugpyn deur middel van aggressiewe-progressiewe inoefeningsintervensies en kognitiewe gedragstegnieke. Hierdie studie sal dus die begrip en insig van die behandeling van chroniese laerugpyn in Suid-Afrika verhoog vanuit ’n oefeningsuitgangspunt. Tweedens sal die studie die gebruik van praktiese oefentegnieke aanmoedig in ’n era waarin ekonomiese tye moeilik is.Thesis (DPhil)--University of Pretoria, 2011.Biokinetics, Sport and Leisure Sciencesunrestricte

The effect of a conservative versus an aggressive-progressive exercise programme on chronic low back pain and disability

Thirty-two (N= 32) full-time working subjects between the ages of 20 and 55 years participated in a 12-week exercise intervention study. Subjects were randomly divided into a control group receiving conservative exercises and low intensity back school and an experimental group receiving aggressive-progressive exercises and high intensity back school. Pain and disability were measured with the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI). The ODI is used to determine the impact of low back pain on the activities of daily living. Results showed that both groups improved significantly from baseline, but there was no significant difference between the groups. The experimental group improved from 54.44 to 17 and the control group improved from 52.57 to 13.40 for the VAS and from 23.72 to 8 for the experimental group and from 20.7 to 11.00 for the control group for the ODI respectively. The results from the experimental group were compared to results from similar studies to obtain an indication of results achieved versus those achieved in developed countries. In conclusion, the VAS and ODI results achieved by the South African subjects were equal to or better than those achieved by patients in developed countries.http://www.ajol.info/journal_index.php?jid=153&ab=ajpher

The incidence of chronic low back pain on employment status in working adults in South Africa

Low back pain has become one of the most influential musculoskeletal disorders of modern society. Exercise has been shown to be very effective in the treatment of chronic low back pain. The goal of the study was to test the effect of two exercise intervention programmes (conservative or progressive-aggressive programmes) for 12 weeks on low back muscle strength as well as psychological factors in participants with chronic low back pain. In total 32 participants were recruited for the study and randomly assigned to two exercise groups. However, due to medical and work related reasons a number of subjects dropped out. At the end there were 10 subjects in the conservative exercise group and 11 in the progressive-aggressive group. Statistically significant differences at the 5% level of significance were found at the post-test measurements between the two groups. The results from the present study indicate that both types of programmes have shown to be very effective in the treatment of chronic low back pain, but that an aggressive-progressive exercise programme may be slightly more effective than a more conservative exercises programme.http://reference.sabinet.co.za/sa_epublication/ergosahb201

The effect of chronic low back pain on daily living and fear-avoidance beliefs in working adults

Low back pain (LBP) has become one of the most influential musculoskeletal diseases of modern society. Exercise has been shown to be very effective in the treatment of chronic low back pain (CLBP). The goal of the study was to test the effect of two exercise intervention programmes (conservative and progressive-aggressive programmes) for 12 weeks on CLBP and their impact on the activities of daily living, and fear avoidance beliefs about physical activities and workrelated activities. In total 22 participants were recruited for the study and randomly assigned to one of two exercise groups: 11 participants in the conservative exercise group and 11 in the progressive-aggressive group). The Oswestry Disability Index (ODI), the Functional Rating Index (FRI), and the Visual Analogue Scale (VAS) for pain measurement was completed by the participants pre- and post-test. There were no statistically significant differences at the 5% level between the conservative and progressive-aggressive programmes. In conclusion, the results from the present study indicate that both types of programmes have shown to be very effective in the improvement of daily living and fear avoidance beliefs. On the basis of the magnitude of improvement, an aggressive-progressive exercise programme may be a little more effective than a more conservative exercise programme.http://www.ajol.info/journal_index.php?jid=153&ab=ajpherd2017-03-31am201

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

Background Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. Methods We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). Findings In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683–0·717]). Interpretation In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. Funding British Journal of Surgery Society