Relevance: Globally, chronic conditions are becoming the leading causes of morbidity and mortality with chronic low back pain (CLBP) being the primary reason for continuing disability in most societies (Vos et al., 2015). Psychosocial factors are known to facilitate the maintenance of chronicity (Pincus et al., 2015) and are the strongest predictors of CLBP disability (Igwesi-Chidobe et al., 2015a). In the rural Nigerian context, CLBP is predominantly managed within a pharmacologically-based biomedical model without any acknowledgement of the impact of psychosocial factors (Igwesi-Chidobe et al., 2015b). Rural Nigeria has a much greater burden of CLBP (72%) compared with urban areas (39%) but lack physiotherapy services (Birabi et al., 2012). Using the Intervention Mapping approach, a self-management programme ('ukwu oma' (good back)) aimed at targeting the psychosocial and physical factors was developed for the management of CLBP in rural Nigeria. Purpose(s): To assess the feasibility and acceptability of 'ukwu oma' (good back) programme for the management of CLBP in rural Nigeria. Methods/analysis: A pragmatic non-randomised controlled feasibility study with nested qualitative feedback interviews was conducted. Village wide announcements was utilised to recruit rural community dwelling adults with CLBP. Eligible participants were screened and purposively assigned to either receive 'ukwu oma', once weekly for 6 weeks at a rural primary health care centre or usual care (waiting list). The 'ukwu oma' programme was underpinned by the Leventhal's self-regulatory model of illness cognitions (Leventhal et al., 1980). It was delivered by a trained Physiotherapist using Cognitive Behavioural Therapy/Motivational interviewing principles to challenge maladaptive illness perceptions about CLBP and facilitate behaviour change in adopting exercises. The programme combined group exercise sessions with group/individual discussion sessions. All participants were assessed pre and post intervention in the 7th week. Feasibility of intervention was assessed in terms of recruitment, treatment uptake, completion of assessment; clinical outcome measures were assessed in self-reported disability: RMDQ, performance-based disability: BPS, and self-reported illness perceptions: BIPQ; acceptability was assessed qualitatively with an interview that explored participants' experiences of the programme and reasons for adherence/non-adherence to recommended exercises. Data was analysed quantitatively with means and standard deviations in SPSS and qualitatively with content analysis in NVivo. Result(s): All eligible participants were willing to participate in the study. Recruitment rate was 80%, treatment uptake was 83% and loss to follow up was 8%. Twenty participants (12: intervention, 8:control) completed the study. Clinical outcome measures demonstrated greater benefits for the intervention group compared with control: RMDQ: -9.8(SD4.8) versus 1.5(SD3.9); BPS: -0.8(SD1.3) versus 0.3(SD2.8); BIPQ: -21.6(SD15.2) versus 3.8(SD7.5). Participants also reported satisfaction with the programme and their comments suggested improvements in symptoms as the strongest determinant of both programme attendance and exercise adherence. Discussion and conclusions: This intervention appears promising and now warrants testing in a randomised controlled trial after incorporating suggested areas for intervention improvement, such as including videos of exercises, using larger rooms at the primary health care facility, and more community involvement. Impact and implications: This programme may be useful for physiotherapists in primary health care in resource constrained settings such as rural Nigeria.
Igwesi-Chidobe, C., Kitchen, S., Godfrey, E., & Sorinola, I. (2016). Feasibility of a physiotherapist-led community-based self-management programme for reducing non-specific chronic low back pain disability in rural Nigeria. Physiotherapy, 102, e61. https://doi.org/10.1016/j.physio.2016.10.384