RELATIONSHIP AMONG PSYCHOSOCIAL FACTORS, ADHERENCE TO HOME PROGRAMMES AND RECURRENCE OF SYMPTOMS IN PATIENTS WITH NON-SPECIFIC CHRONIC LOW BACK PAIN

O. Ogwumike^1,2, O. Oyinlola², U. Badaru³

Background: Adherence, an active voluntary involvement of patients in the planning and implementation of the treatment has been identified as an antecedent to successful patient outcomes especially those with musculoskeletal disorders such as low back pain. Patient adherence is important in optimising physiotherapy treatment outcomes and in effect, poor adherence can compromise treatment outcomes and lead to recurrence of symptoms.

Purpose: Most patients with low back pain will have experienced a previous episode, and acute attacks often occur as exacerbations of chronic low back pain and so recurrences are common. This study investigated possible relationships among psychosocial factors and adherence to home programmes and recurrence of symptoms in patients with chronic low back pain.

Methods: Participants being managed for chronic low back pain were purposively recruited from a tertiary and secondary health care facility in Ibadan, Oyo state Nigeria. Psychosocial factors were assessed using: Hospital Anxiety and Depression Scale for Anxiety and Depression, Fear Avoidance Belief Questionnaire for Fear of Pain during physical activity and work and Social Support and Exercise Survey Questionnaire-Family version. In addition, the Patient Self-Report Scale of adherence to home-based physiotherapy was used to assess adherence to home programs. Data were summarized using descriptive statistics of frequencies and percentages and inferential statistics and Pearson Correlation Coefficient to analyze relationship among the variables while level of significance was set at 0.05.

Results: One hundred and twenty-six patients (24 males, 102 females) completed participation in the study, they were aged 58.2 ± 11.4 years. Seventy-five (59.5%) were married while 51 (40.5%) were non-married. Most of them 62 (59.2 %) had tertiary education. Some 58 (46.0%) of them have had low back pain for over four years and 55 (43.7%) have been managed for more than four years for low back pain. 68 (54.0%) reported adherence to home programs, while 58 (46.0%) were non-adherent.  A significant negatively weak correlation (r = -0.22; p=0.02) was observed between adherence and depression while a significant positively weak correlation (r=0.29; p=0.00) was observed between family support and adherence to home programs.

Conclusion(s): It appears that patients with chronic low back pain with depression may find it difficult to adhere to their home programs hence making for recurrence of symptoms while family social support may play a helpful role in encouraging adherence to home programs.

Implications: Involvement of informal caregivers for family social support may be imperative in management of patients with chronic low back pain to enhance adherence to their home programs, limiting recurrence of symptoms, thereby making for improved treatment outcomes.

Funding, acknowledgements: No funding was received for this study

Keywords: Low back pain, Home programs, Adherence

Topic: Musculoskeletal

Did this work require ethics approval? Yes

Institution: University of Ibadan/University College Hospital Ibadan

Committee: University of Ibadan/University College Hospital Ethics Commitee

Ethics number: UI/EC/19/0397