COMPARISON OF FOUR PHYSIOTHERAPY REGIMENS IN THE TREATMENT OF CHRONIC MECHANICAL LOW BACK PAIN

Abstract

Chronic mechanical Low Back Pain (LBP) remains a leading cause of disability and quality of life depreciating factor, the treatment of which continues to pose challenges to both clinicians and researchers. Several treatment approaches have been used in its treatment and physiotherapy is an important component of conservative management of chronic mechanical LBP. No consensus exists on the most effective physiotherapy regimen in treating chronic mechanical LBP hence this study compared the efficacy of eight weeks of four regimens of physiotherapy in the treatment of chronic mechanical LBP. In this pre-test - post-test quasi experimental study, only 53 (21 males and 32 females) of 73 individuals diagnosed with chronic mechanical LBP and recruited consecutively from the Physiotherapy Department, University College Hospital, Ibadan completed the study. They were assigned into four study groups with 13, 14, 14 and 12 participants in groups A, B, C and D respectively using the simple random sampling technique. Participants in group A received a combination of Back Muscles Endurance Exercise (BMEE), McKenzie Spinal Therapy (MST) and Back Care Education (BCE), participants in group B received BMEE and BCE, participants in group C received MST and BCE while participants in group D received BCE only. Treatment was carried out thrice weekly for eight consecutive weeks. The treatment outcomes, pain intensity, disability, lumbar flexibility and self esteem were measured at baseline and at the end of 4th and 8th weeks of study, using Numeric Pain Scale, Roland Morris Disability Questionnaire, Modified Schober Technique and Adanijo and Oyefeso Self Esteem Questionnaire respectively. Data were analysed using descriptive and inferential statistics of one way and repeated measures analysis of variance, least significant difference post hoc and paired t-test. The mean age of participants was 45.3 ± 8.1years. The groups did not differ significantly in age or physical characteristics, and in treatment outcomes at baseline. The groups differed significantly (p<0.05) at the end of week 8 with respect to pain intensity and disability. Post hoc analysis showed that pain intensity reduction in groups C (Mean Difference = -5.9) and A (Mean Difference = - 4.6) was significantly different from that of other groups, while group B had significantly higher reduction (Mean Difference = -5.4) in disability than other groups. Group C had the most reduction in pain intensity (82.9%), group B the most in disability (86.3%) but group A had high reductions in both pain intensity (82%) and disability (82.3%). There was no significant difference in lumbar flexibility increase in all the groups. Within group comparison showed that groups A, B and C had significant reduction (p<0.05) in pain intensity and disability and group D improved significantly (p<0.05) in pain intensity and self esteem. All the treatment regimens produced significant improvement in two LBP treatment outcomes except BCE group that produced improvement in only one outcome. Any of the regimens for groups A, B, or C is therefore recommended in the treatment of chronic mechanical LBP.