“Back in Action” – a streamlined patient-centered approach to teach and practice movement strategies for patients with low back pain

Abstract

Background:  Patients with low back pain often need to adjust movement strategies and require feedback on their performance. The implementation of a systematic but individualized approach was designed to provide a streamlined approach for therapists to identify appropriate targets for patients with low back pain.

Purpose: To present an efficient method (Back-in-Action) to teach and practice movement strategies for patients with low back pain.

Design: Administrative Two Patient Case Study

Methods: The top three most limiting activities reported on the Modified Oswestry Disability Index were selected to develop an individualized exercise training circuit and a movement education home exercise program for two patients with chronic back pain (Patient A: female, age 54 and Patient B: female, age 64). Pain education materials were provided to each patient. A modified Functional Independent Measure scoring system provided standardization of feedback as a reflection of each patient progress.

Results: After a two month trial program, therapists reported moderate to strong patient compliance and were highly satisfied with patient performance. By discharge, both patients decreased in disability levels according to MODI scores (Patient A: Pre: 46%, Post: 10%; Patient B: Pre: 62%, Post: 31%).

Conclusions: The “Back in Action” program incorporates patient-centered individualized activity circuit training by prioritizing responses from outcome measures and records standardized measures of the extent of feedback along with functional outcome measures as a reflection of improvement. The system is efficient, tailored to individual needs, and allows patients to practice movement strategies with feedback. Further investigation of the reliability of the feedback scoring system and overall outcomes is warranted.

Clinical Relevance: The program described in this paper is likely to be useful to readers who are seeking options to provide efficient but thorough methods to manage one of the top disabilities contributing a major burden to the health care system. The paper also provides justification for use of outcome measures to drive exercise prioritization, and suggests options for methods to meet patient satisfaction, and financial reimbursement.