A GROUP-SUPERVISED NEUROMUSCULAR TRAINING PROGRAM FOR THE TREATMENT OF LOW BACK PAIN IN CANADIANMILITARY PERSONNEL - A RANDOMIZED CONTROLLED TRIAL

F. Dupuis^1,2, K. Perreault^1,2, L. J.Hébert¹, M. Perron¹, J.-S. Roy^1,2

¹Université Laval, Quebec, Canada, ²Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Québec, Canada

Background: Low back pain (LBP) is the most prevalent musculoskeletal (MSK) disorder and source of disability among military personnel in the Canadian Armed Forces (CAF). Although the available evidence supports exercise-based rehabilitation programs for the management of people with LBP, access to rehabilitation services has been hindered due to recent CAF resources limitations. A supervised-group program (SGP) for people with LBP has been developed to address this issue. However, the clinical effectiveness of SGP has not yet been evaluated.

Purpose: The main objective of this project was to compare the effectiveness of SGP to that of usual physiotherapy care (UPC) on functional limitations and pain for the treatment of LBP in CAF soldiers.

Methods: This single blind randomized clinical trial included CAF soldiers suffering from LBP randomly assigned in a 1:1 ratio to either SGP or UPC. The two 12-week programs were supervised by physiotherapists. UPC included education, manual therapy as well as individual strengthening, neuromuscular, and stretching exercises. The SGP included education as well as strength and neuromuscular trainings; each soldier performed their own exercises in a group setting of 4 to 8 participants, and the level of supervision was adapted to soldier’s needs. The primary outcome was functional limitations measured with the pain interference subscale of the Brief Pain Inventory (BPI) (/10, 0=no limitation, 10=total incapacity). Secondary outcome was pain intensity as measured with the BPI pain severity scale (/10, 0=no pain, 10=worst imaginable pain). All outcomes were assessed at baseline, and at 6 and 12 weeks after baseline. Two-way repeated-measures ANOVAs were used to compare interventions.

Results: Thirty-six soldiers (SGP n=18, UPC n=18) with LBP were included in this study and all completed their 12-week follow-up. Baseline characteristics were similar between groups (age, weight, height and pain duration,p˃.05). As for functional limitations, there was no difference between the two groups at 6- and 12-weeks follow-up (Time x Group, p<.87). Both groups showed significant improvement over time (Time effect p=.009), reaching a clinically important difference (mean difference baseline-6weeks: SGP = 1.5pts, UPC =1pts; mean difference baseline-12weeks: SGP= 2 pts, UPC = 1.6 pts). Similar results were obtained for pain severity: no difference between the two groups was observed (Time x Group, p = .446), but both groups showed clinically and statistically significant improvement over time (mean difference baseline-6weeks: SGP=1.5pts, UPC = 1.1pts; mean difference baseline-12 weeks: SGP=3.2pts, UPC = 1.2pts, Time effect p=.003).

Conclusions: Theseresults suggest that SGP is as effective as UPC in reducing functional limitations and pain in soldiers with LBP.

Implications: The validation of SGP effectiveness provides a novel approach to manage LBP disorders among military personnel, which could improve timely access to rehabilitation care and reduce associated costs.

Funding acknowledgements: This project is funded by a Catalyst Grant from the Canadian Institutes of Health Research (CIHR; Grant Number: 429273).

Keywords:
Low back pain
Rehabilitation
Group-based program

Topics:
Musculoskeletal: spine
Disability & rehabilitation
Primary health care

Did this work require ethics approval? Yes

Institution: CIUSSS-CN

Committee: The sectorial rehabilitation and social integration research ethics of the CIUSSS-CN

Ethics number: #2021–2039