None listed
Conditions
Brief summary
Acute low back pain (LBP) is a common presentation to the emergency department (ED). It is also a major health condition associated with high rates of absenteeism from work and more frequent use of health services. As per the international back pain guidelines, primary contact practitioner aim is to classify back pain and rule out serious pathology. The mechanical low back pain group (back pain from a musculoskeletal cause) makes up 90% of presentations to ED. Currently in ED standard treatment comprises of subjective and objective assessment (RMO/ED registrar, or Physiotherapist):,radiological investigations as appropriate for the individual. Management will include patient education and assurance, symptom relief by analgesia (NSAIDS, paracetamol & opioids if necessary), as well as recommendation to stay as active as possible including return to work. Depending on their response to the analgesia patients are discharged with gentle exercises & Physiotherapy follow-up. Despite these forms of care twenty five percent (RBWH ED statistics) of low back pain patients are admitted to the short stay unit for overnight analgesia due to difficulties coping with the pain. They are then discharged after 1-2 days. Apart from adding to the cost , this also blocks a bed for other emergency patients. Effective treatment of acute LBP is important because it prevents patients from developing chronic LBP which needs more costly and complex investigations and treatment. Presently treatment for patients presenting to ED with back pain lacks an individualised approach with respect to alleviating mechanical low back pain. We propose this may be improved with the use of a McKenzie approach to management of back pain in the ED setting. The McKenzie method of mechanical diagnosis & therapy is an active exercise approach involving repeated movements, sustained positions and therapeutic forces, it has an educational component with the purpose of minimising pain, disability, and improving spinal mobility. Currently data suggesting effectiveness of this method in an ED setup is lacking. Therefore the purpose of this study is to compare if more benefits are gained with a ‘McKenzie exercise’ approach compared to a ‘stability/mobility’ exercise approach for patients who are treated by a Physiotherapist for low back pain in ED. We anticipate the findings of the study will be informative to the best approach to management of these patients in ED.
Interventions
McKenzie approach for treatment of acute low back pain.
The McKenzie method of mechanical diagnosis & therapy is an active exercise approach involving repeated movements, sustained positions and therapeutic forces, it has an educational component with the purpose of minimising pain, disability, and improving spinal mobility. This method involves the assessment of symptomatic and mechanical responses to repeated movements and sustained positions. The responses are used to classify them into subgr
McKenzie approach for treatment of acute low back pain. The McKenzie method of mechanical diagnosis & therapy is an active exercise approach involving repeated movements, sustained positions and therapeutic forces, it has an educational component with the purpose of minimising pain, disability, and improving spinal mobility. This method involves the assessment of symptomatic and mechanical responses to repeated movements and sustained positions. The responses are used to classify them into subgroups or syndromes (Posture, Dysfunction and Derangement) which help in guiding the treatment principles. Physiotherapist (assessor) will perform a physical assessment of lumbar range of motion & palpation, he/she will also look for any directional bias the symptoms have. Depending on whether the patient responds to flexion or extension movement, exercises will be prescribed to the patient on the day of presentation in the emergency department. This process of assessment and treatment takes around 90minutes. The patient will also receive analgesia(NSAIDS, paracetamol & opioids if necessary. The patient will asked to perform the same set of exercises 20minutes 4/day for 2weeks at home.(exercise sheets will be provided for assistance) The patient will be provided with an daily exercise checklist which he would return by a reply paid envelope to the principle investigator. Patient education provided will help improve exercise adherence.
Sponsors
Mahender Samtani
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
20 Years to 50 Years
Healthy volunteers
No
Inclusion criteria
Inclusion criteria Low back pain (LBP) – atraumatic onset. Age – 20-50 years Gender – Male and/or Female. Low back pain of Musculoskeletal origin (which will be confirmed by a subjective & objective assessment, imaging will be performed if indicated)
Exclusion criteria
History of substance abuse eg: IV drug user (IVDU), ETOH Spinal fractures. Pregnant women Neurological compromise (as shown by loss of strength, sensations and reflexes). Red flags eg: loss of weight, fever, history of cancer. Multiple medical co-morbidities (chronic obstructive pulmonary disease, ischemic heart disease, chronic kidney disease, uncontrolled diabetes and hypertension). Patients brought in by police who are under influence of illicit drugs and alcohol. Patients bought in by police who will remain in custody. Patients with known cognitive and intellectual disability (decided on the basis of information collected by the triage nurse). Patients having an acute concurrent systemic illness. Patients with congenital spinal structural deformity. Patients unable to provide consent and comply with the home exercise program.
Outcome results
None listed