Effects of Patient Education Manual in Patient With Chronic Low Back Pain
Condition: Back Disorder
MeSH terms: Back Pain; Low Back Pain
Study type: Interventional

Summary: 
      It was a randomized clinical trial conducted to determine the effects of patient education
      manual on pain, range of motion and function in patient with chronic low back pain at Salamat
      hospital Satellite Town Gujranwala in patients with 6-month chronic low back pain who were
      willing to follow patient education manual. Patients were assessed for pain, disability due
      to backpain and lumbar ranges, at baseline, 2nd, 4th and 6th week of intervention. The SPSS
      20.0 version was used to analyse data. Tests of normality were executed that whether data was
      normative or non-parametric, based on which outcomes were compared either using independent
      samples t test or Mann-Whitney test.
    

Detailed description: 
      The goal of current study was to figure out how patient education manual can impact the
      outcomes, such as decreasing pain and disability and increasing range of lumbar spine, in
      patients having low back pain. The patient education manual model has been under research in
      recent time all over the world. There have been mixed results. Mostly there is moderate to
      high quality evidence in support of patient education that it can help improving the efficacy
      of physical therapy treatment. However, the previous literature lacks in uniformity of
      outcome measures used in the studies and spinal ranges have not been studied in majority
      studies.

      This study was conducted by developing a patient education manual given to patients along
      with routine physical therapy. The study findings showed that the patients with combination
      of patient education manual and routine physical therapy improved their disability level
      significantly more than the patients in control group receiving routine physical therapy
      alone. However, there was no significant difference in improvement of pain itself and spinal
      ranges of lumbar region except lumbar flexion which was improved significantly among patient
      education manual group. When the analysis was performed for within group pre and post
      interventional difference in both groups separately, it was seen that patient improved in
      both groups significantly at all stages of measurements such as 2nd, 3rd and 6th week, p
      value less than 0.05.

      Looking closer, it was seen that pain was improving similarly in both groups, p value more
      than 0.05. However, it was slightly better in Group A, having combination of patient
      education manual and routine physical therapy, with a slight mean difference i.e. -.33333 at
      2nd and 4th week and -.41667 at 6th week post intervention. In past studies pain has been
      reported to be significantly better with patient education groups.

      The disability was measured by Oswestry Disability Index for back pain. It was seen that
      patients having patient education manual significantly improved at all assessment stages i.e.
      at 2nd, 4th and 6th week, p value less than 0.05. This was the only outcome in this study
      showing a significantly better effect of patient education manual with straight and clear
      findings. The mean difference was of 4.25000 at 2nd week, while peak mean difference of
      8.83333 points was seen at 4th week which declined to 4.83333 at 6th week but it was still
      significantly better as compared to routine physical therapy group. It also indicated the
      gradually fading off difference in long term assessment. In previous studies functional has
      always been found to improve with patient education. This might due to nature of this outcome
      which is based on patients' experience and perception, which means due to patient education
      or information material, it is possible that it has uplifted moral of patients and
      ultimately, they feel better in all aspects of function. Whatsoever the reason, disability
      can be greatly improved by use of patient education method in patient with low back pain.

      The spinal ranges was the special outcome measure in current study that has been addressed
      the least in previous literature. It was seen that except lumbar flexion, all ranges were
      improving without any significant difference, even the improvement in lumbar flexion became
      same at 6th week assessment. Moreover, there was no consistency in mean difference of ranges,
      some ranges improved slightly better at one stage of assessment while the same ranges were
      slightly less improved at other stage, but overall there was no significant difference.

      A study had discussed effect of patient education on ranges in terms of its long-term impact
      and recurrence of hypomobility in spinal region. The study has multiple outcome measures such
      as pain, disability, ranges and quality of life. The study suggested that all in short term
      patient education played a significantly better role in improving pain, function and life
      quality but ranges were no different. Furthermore, all ranges were not measured due to their
      consistently being similar.

      It can be said that all outcomes in which were clinician-based has no difference of
      improvement in patient education manual group or that of control group while the outcome
      which were based on patient's perception were improved more among patient education manual
      group. This pattern can be seen in satisfaction with manual therapy. Although, satisfaction
      was not associated with treatment group as shown by non-significant p value of chi square
      more than 0.05, but it can be seen that patients with patient education manual reported
      themselves to be 'very satisfied' category while in control group the majority patients
      reported themselves in 'satisfied' category. This showed that all patients were satisfied
      with care provided for treatment of backpain but providing a patient education manual can
      further boost their satisfaction which is then reflected in their function.

      In short, the outcomes such as function were improved with combination of patient education
      manual and routine physical therapy while the pain and ranges were no different with or
      without patient education manual. There needs further studies with more sample size and long
      term assessment in order see long term impact of patient education manual.
    

Intervention name(s): Physical therapy with Patient education; Physical Therapy without patient Education
Intervention type(s): Other; Other
Intervention description(s): patient manual was translated and validated in Urdu which was provided to patients so that they can follow it at home; Group B was only treated with proper physical therapy treatment protocol according to patient presenting condition
Other intervention name(s): patient education manual
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Back Pain Exercise Therapy; Patient Education Manual