Collaboration of Patients undergoing Chronic Low Back Pain Rehabilitation by Community Participation, Songkhla Province, Thailand

Abstract

The purpose of this qualitative study was to explore a model for patients who were undergoing chronic low back pain rehabilitation in the community. Purposive sampling was performed by deriving the micro level of framework for Innovative Care for Chronic Conditions, which provides information, preparation, and motivation. The researchers recruited 20 individuals with chronic low back pain, along with their family members, 15 health care personnel, and 15 community members as stakeholders who took care of patients with chronic low back pain in the community. A semi-structured questionnaire and field observation were utilized using an in-depth interviewing technique. Data analysis was performed by using a content analysis method.

            Findings of the model for patients with chronic low back pain rehabilitation were separated into 3 parts: provision of information, preparation, and motivation as follows: 

            First is the provision of chronic low back pain rehabilitation information to patients, relatives, and community leaders. The information should have three main components of providing basic knowledge on self-care, an exercise program to improve muscle strength, flexibility, and endurance which could enhance spinal stability, ergonomic postures for low back pain prevention, and the rights of healthcare service access. Information regarding chronic low back pain rehabilitation for health care teams should also have integrated knowledge of caring for patients and their families.

            Second is preparation for patients, relatives, and community leaders. The findings reveal that the preparation phase should include a training course on ergonomic posture practice during work and daily activities, as well as exercising to improve muscle strength, flexibility and endurance. In addition, community partners should provide financial support for these community activities. The health care team should support the use of materials or innovative tools which could be easily created by patients, relatives and community members. In addition, health care organizations and the health care network in the community should support and motivate chronic low back pain rehabilitation activities through a community health policy. The development of the service system and the preparation of the health care team should include a systematic collection of community health databases, and treatment should be integrated to effectively meet the needs of the patient.

            Third is motivating and encouraging patients, family members, health care teams and community leaders. This is the most important part. Awards, certificates, and compensation are secondary factors. All of these factors need to be integrated from all sectors to achieve cooperation for solving chronic low back pain problems, which can lead to an efficient and sustainable health care service system. In conclusion, this study explored the model of patients with chronic low back pain rehabilitation. Based on the micro level of the framework for Innovative Care for Chronic Condition, interactions among providing information, preparation, and motivation were revealed by three sectors: patients and relatives, the health care team, and community partners. Awareness and attention should be given to patients and relatives in terms of empowering them to provide health care and manage chronic low back pain by themselves. Integrative collaboration of all community sectors should be performed to achieve cooperation and develop an effective sustainable health care service model for patients with chronic low back pain rehabilitation in the community.