P.K. Ampiah1, P. Hendrick1, F. Moffatt1
1University of Nottingham, Division of Physiotherapy and Rehabilitation, Nottingham, United Kingdom

Background: Low back pain (LBP) is a common musculoskeletal disorder globally and the number one cause of years lived with disability; affecting populations from both low- and middle-income, and high-income countries. Global point prevalence of LBP was estimated at 9.4%, with prevalence increasing with age. Prevalence is substantially higher in low- and middle-income countries notably in Africa (39%). The biopsychosocial modes of managing patients with LBP has been predominantly applied and evaluated in high-income countries.
A recent review established the paucity of high-quality physiotherapist-led studies applying a biopsychosocial approach in low- and middle-income countries. Furthermore, evidence suggests that management of patients with LBP in low- and middle-income countries such as Ghana is biomedically focused. It is therefore important to assess the feasibility of implementing a biopsychosocial approach in resource-limited low- and middle-income countries such as Ghana.

Purpose: Aim
To investigate the feasibility of implementing a biopsychosocial management approach (exercise and patient education) for the management of patients with chronic low back pain (CLBP) in a Ghanaian context.
To establish:
  • The feasibility of training physiotherapists to deliver a biopsychosocial approach. 
  • Whether it is feasible to recruit and retain participants. 
  • Whether it is feasible to capture data.

Methods: This study followed the Medical Research Councils framework for developing and evaluating complex interventions.
Context: Komfo Anokye Teaching Hospital, Ghana
Design: Mixed-methods, sequential, feasibility, pretest-posttest quasi-experimental study. Physiotherapists (n = 2) were recruited and trained to deliver the biopsychosocial intervention, followed by recruitment of patients (n = 30) with CLBP into the study. Outcome measures were conducted at baseline, post-intervention, and 3-months. Patient demographics and secondary outcome measures were also collected. Descriptive statistics summarized the outcomes data and assessed feasibility against a priori feasibility criteria. Finally, qualitative interviews (physiotherapists: n = 2; patients: n = 6) were conducted to explore participants’ experiences and acceptance; analysis followed a thematic approach.

Results: Most feasibility criteria was met whereby participant consent rate was 100%; recruitment rate was 5 participants per week; 90% of participants were retained post-intervention; data completion rate post-intervention was 89% for baseline data, 99.2% for pre-intervention outcome measures, 99.8% for post-intervention outcome measures; no adverse events were recorded; and treatment fidelity was 83%. Regarding treatment compliance, 80.56% adhered to their treatment schedule, whilst only 16% adhered to the home program which did not meet feasibility criteria. Post intervention results showed improvement in pain intensity, function, pain catastrophising, kinesiophobia, self-efficacy, and quality of life. Preliminary analysis of the qualitative results suggests themes including autonomy, beliefs and expectations, and personnel and professional characteristics as positive facilitators for the feasibility of implementing and testing this intervention in a Ghanaian context.  

Conclusion(s): The results of this study demonstrate that it is feasible to implement a biopsychosocial physiotherapy management approach for patients with CLBP in Ghana.

Implications: Results will inform future clinical trials in a Ghanaian context.

Funding, acknowledgements: The author is a PhD student supported by the Commonwealth Scholarship Commission. All views expressed are that of the author.

Keywords: Chronic low back pain, Biopsychosocial, Physiotherapy

Topic: Pain & pain management

Did this work require ethics approval? Yes
Institution: University of Nottingham
Committee: Faculty of Medicine and Health Sciences, Research Ethics Committee
Ethics number: 384-1909

All authors, affiliations and abstracts have been published as submitted.

Back to the listing