Effect of Back School Program on Functional Ability in Activities of Daily Living and Frequency of Postural Awareness in Patients with Chronic Low Back Pain

Abstract

Objectives: To compare functional ability in activities of daily living (ADL) and frequency of postural awareness between chronic low back pain patients who participated and did not participate in back school program.

Methods: This study was an experimental study. The subjects were 56 chronic low back pain patients who received treatment at the Department of Physical Medicine and Rehabilitation, BMA General Hospital from August 2009 to March 2010. Control group (28 cases) received standard treatment including pelvic traction, deep heat, trunk exercise recommendation and back pain brochure. Study group (28 cases) received the same standard treatment with an additional participation in a back school program. The back school program took 120 minutes and included knowledge of anatomy, mechanism of disease, pathology, biomechanics of back movement, posture correction in ADL, and trunk muscular training. Three assessments were done: first day, day of discharge from clinic, and 2 months after discharge. Outcomes included the scores of functional ability in ADL base on the Owestry Low Back Pain Disability questionnaires (version 1.0) Thai version and the scores from the questionnaire of postural awareness frequency, which was developed by the researchers. The scores from both questionnaires were converted to percentage. Lower ADL scores represented greater functional ability while the higher scores of postural awareness represented greater postural awareness.

Results: Mean age of the study group was 52.5 ฑ 12.7 years while mean age of the control group was 52.5 ฑ 16.7 years. The scores of functional ability and the scores of the frequency of postural awareness in the study group tended to be better than in the control group but did not reach statistical significance (p-value = 0.106 and 0.060, respectively). The scores of functional ability were 33.2 ฑ 15.3, 21.8 ฑ 14.7, and 13.7 ฑ 9.5 on the first day, on the day of discharge and at 2 months after discharge in the study group compared to 34.1 ฑ 14.4, 21.1 ฑ 14.5, and 21.2 ฑ 14.8, respectively in the control group. The scores of the frequency of postural awareness were 45.8 ฑ 17.7, 66.2 ฑ 17.9, and 69.3 ฑ 17.5 on the first day, on the day of discharge and at 2 months after discharge in the study group compared to 48.6 ฑ 17.1, 59.4 ฑ 21.6, and 59.7 ฑ 21.4, respectively in the control group.

Conclusion: Back school program tended to improve the functional ability in ADL and enhance the frequency of postural awareness in chronic low back pain patients better than the standard program.

Keywords: low back pain, back school program, ability of daily living