Promoting the Home-Based Back Care with

Abstract Description

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Authors (including presenting author) :

Tsang TW(1), Yu CH(1), Tsui LK(1), Fong IC(1), Fung YH(1)

Affiliation :

(1) Physiotherapy Department, Caritas Medical Centre

Introduction :

Low Back Pain(LBP) is one of the major conditions treated in out-patient department(OPD) of Physiotherapy(PT) Department in Caritas Medical Centre(CMC) (14.3% in the period of 4Q2015-3Q2016#). Degenerative LBP causing recurrent attendance to PT department is a common phenomenon. The usual treatment period of LBP patient is 10.4 sessions according to our statistics in the period of 4Q2015-3Q2016#. Encouraging patient empowerment and promoting the home based management of LBP are more effective in treating patients with chronic LBP. A structured program of Back Rehabilitation Class is introduced in January 2018 in order to (1) enhance the understanding of the pathology of chronic LBP; (2) teach self-help techniques in managing chronic LBP; and (3) design personalized set of exercise for individual patient as home exercise program.

Objectives :

Through this program, we hope to promote the home-based back care of LBP in order to facilitate patients to re-engage to the community, reduce the number of treatment sessions, and reduce the chance of repeated attendance to PT OPD service.

Methodology :

The chronic LBP cases are recruited into Back Rehabilitation Class after one screening session (mainly degenerative type). Each class is capable to serve 6-8 patients at the same time. The average period of treatment is reduced from 10.4 sessions to 4 sessions. Home based exercise, cause of LBP, and ergonomic advice are explained in detail to reduce the chance of repeated attendance to hospital. Each back exercise is given an Easy Remember “Kung-Fu” name. Patients feel more interesting, familiar and initiative with such “Kung Fu” name, e.g. Whole set of exercise called “腰背十一式 排憂解痛”, Lumbar rotation exercise called “神龍擺尾”, and Sciatic nerve stretching called “一飛沖天”. Long contact time (1 hour) is provided in order to provide interactive and comprehensive information about LBP, and promote proper exercise training. Back Rehabilitation Class is with fun and full of useful information. The Class promotes support among patients and increases the morale for continuing exercise. The Class help the patients to develop the sense of self management, promote self-initiative treatment rather than passive treatment in individual session.

Result & Outcome :

Improvement was shown in the following parameters after completion of Back Rehabilitation Class: (1) Number of patients[completed the program and returned the Roland Morris Disability Questionnaires(RMDQ) after 3 months]: 21; (2) Mean age of patients: 57.52; (3) Year of onset of LBP: 2.84; (4) Length of Stay: Reduced from 10.4 sessions to 4 sessions; (5) Overall Improvement for LBP: 50.48% (P=0.000) and Numeric Global Rate of Change scale(NGRCS) on the LBP: 5.048 (P=0.000); (6) Pain level in Numeric Pain Rating Scale(NPRS): Reduced from 4.00 to 2.57 (P=0.001); (7) Patient satisfaction on the Back Rehabilitation Class: 89.71%; (8) RMDQ Score: reduced from 7.29 to 4.86 and maintained 5.38 after 3 months (P=0.029); (9) The re-attendance rate to HA PT OPD (up till 20-12-2018) is 0%. When resources are available, class size and number of sessions can be expanded. This structured program may be further considered as a fast track program aimed at shortening the waiting time of physiotherapy service (the waiting time in 90% percentile for LBP new case was 31 weeks in the period of 4Q2015-3Q2016#) and providing service for larger number of patients at the same time. Remarks: # Data retrieved from Clinical Management System(CMS) during the period of Fourth Quarter 2015 – Third Quarter 2016