Evaluate the feasibility and effectiveness of a pilot chronic low back program for Ezidi refugees: a waitlist-controlled study

The group program included 1x weekly 30-minutes education sessions tailored for delivery using methods appropriate to the low level of health literacy of the participants, 2x weekly 1-hour exercise classes and 1 x weekly home exercise. This program was a multi-disciplinary intervention. The education sessions included introduction to the program; information about aerobic, progressive strengthening and motor control exercises; pain; pain and physical activity; pain and pacing; chronic pain and medication; psychology in chronic pain; and nutrition and chronic pain. The education sessions were delivered by a physiotherapist, a dietitian, a pharmacist and a psychologist. The exercise program included 20 minutes of high intensity aerobic, progressive strengthening and motor control exercises. The exercise program included 20 minutes of high intensity aerobic, progressive strengthening and motor control exercises. The aerobic exercises were either treadmill or stationary bike training with the aim of achieving 50% to 85% of the individual’s age-predicted maximal heart rate. The strengthening exercises were with upper and oblique abdominals from the supine position with knees bent, lower abdominal crunches, full abdominal crunches, lifting trunk to neutral from prone position and arms in elevation, straight leg lifts toward ceiling and bridging with the exercise intensity progressed from 2 sets of 10 repetitions (weeks 1–2), 2 sets of 15 repetitions (weeks 3–4) to 3 sets of 10 repetitions (weeks 5–6) and 3 sets of 15 repetitions (weeks 7–8). For the motor control exercises, the participants were trained how to activate their transversus abdominus muscles which was facilitated by visualization techniques, verbal instruction, manual palpation and education using illustrations. Participants were instructed to complete controlled, low-level contractions, rather than maximum strength contractions. Training commenced in a low-load non-functional position (prone lying, four-point kneeling, supine lying with flexed knees). Holding time for exercises was gradually increased. Once the participants were able to perform sustained contractions in low-load postures, the exercises were progressed to functional tasks such as lifting an object, pushing a trolley, cleaning the floor, vacuuming, washing dishes and folding laundry. The exercise classes were supervised by a physiotherapist with groups of 6 participants. The total duration was 8 weeks. Assessing and monitoring was carried out by the physiotherapist at the class, and participants' attendance were recorded with a checklist for each exercise. All participants had 8 weeks of waiting time(control) and all participants participated in the intervention(Intervention).