EFFECTS OF A 10-WEEK PROGRESSIVE GOAL ATTAINMENT PROGRAMME ON SELECTED OUTCOMES IN PATIENTS RECEIVING CONVENTIONAL TREATMENT PROCEDURES FOR MECHANICAL LOW BACK PAIN

Abstract

Mechanical Low Back Pain (MLBP) is a major cause of disability and may be influenced by psychosocial variables such as fear-avoidance beliefs, catastrophic thinking, reduced self-efficacy and perceived disability. Progressive Goal Attainment Programme (PGAP) is an activity-based cognitive behavioural therapy that is often administered by physiotherapists as an adjunct therapy to improve treatment outcomes for individuals with MLBP. Prospective studies on the effects of PGAP on treatment outcomes in individuals with MLBP are not readily available globally while information on its therapeutic effects on psychosocial variables in patients with MLBP in Nigeria is scarce. The effects of a 10-week PGAP adjunct therapy on selected pain and psychosocial characteristics in patients with MLBP were investigated in this study. This quasi-experimental study involved seventy (42 females; 28 males) consecutively selected individuals with newly diagnosed MLBP at the physiotherapy clinic, Federal Medical Centre Abeokuta. Participants were screened for Pain Catastrophising (PC) and kinesiophobia using Pain Catastrophising Scale and Tampa Scale for Kinesiophobia. Participants were alternately assigned into experimental group (EG) and control group (CG). The EG received PGAP and conventional treatment for MLBP while the CG received only conventional treatment. The PGAP included a walking program, activity scheduling and monitoring. Conventional treatment entailed routine medical treatment (Paracetamol and Ibruprofen) and physiotherapy care (soft tissues mobilisation and Mckenzie exercise). Both groups received treatment thrice weekly for 10 weeks. Participants‟ pain intensity (PI), PC, Kinesiophobia, Perceived Disability (PD) and Self-Efficacy were assessed at baseline, end of 5th and 10th week of intervention using Visual Analogue Scale, Pain Catastrophising Scale, Tampa Scale for Kinesiophobia, Revised Oswestry Disability Questionnaire and Self-Efficacy in Rehabilitation Scale, respectively. Participants were re-assessed 12 weeks after intervention. Data were analyzed using t-test, Mann-Whitney U and Freidman‟s ANOVA at p=0.05. The ages of EG (44.97±8.29years; n=35) and CG (47.43±7.54years; n=35) were comparable. At baseline, scores for PI (9.4±0.9; 9.1±0.9); PC (33.6±9.9; 33.0±5.3), kinesiophobia (41.4±7.7; 41.5±3.0); PD (59.1±12.8; 55.5±12.3); self-efficacy (81.4±9.5; 81.2±12.0) for EG and CG were not significantly different. Between-group comparison at the end of 5th week revealed that scores for PC (22.2±11.2; 27.9±8.8), kinesiophobia (37.3±7.5; 42.2±3.2), self-efficacy (94.4±14.5; 80.0±20.1) for EG and CG respectively were significantly different but PI (4.9±1.9; 5.0±2.8) was not significantly different. Between-group comparison at the end of 10th week revealed that the scores for PI (3.6±1.6; 3.1±1.8), PC (23.0±9.42; 23.0±8.4); kinesiophobia (34.4±6.8; 36.9±3.7), self-efficacy (94.4±11.5; 94.1±9.4) for EG and CG were not significantly different. At the end of 5th and 10th weeks, scores for perceived disability for EG (42.6±11.1; 41.1±8.5) were significantly lower than CG (57.8±8.9; 45.3±7.3) respectively. At 12 weeks follow-up, EG had lower scores for PI (3.8±1.6; 5.0±1.6); PC (21.7±9.5; 27.5±5.8), kinesiophobia (29.1±6.3; 35.8±6.6), PD (33.0±7.0; 43.4±7.6) and significantly higher score for self-efficacy (101.2±11.5; 92.3±9.3) than CG. Addition of Progressive Goal Attainment Programme to conventional treatment is effective in achieving sustained reduction in perceived disability among patients with mechanical low back pain. This study serves as evidence for incorporating Progressive Goal Attainment Programme into treatment for patients with mechanical low back pain having psychosocial overlay.