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Physical Therapy Modalities Used By Physical Therapists In The Management Of Chronic Low Back Pain In Khyber Pakhtunkhwa

Research Article                                          Vol:1, Issue:2

Aatik Arsh, Dansih Ali Khan, Haider Darain

Abstract

Chronic Low back pain (CLBP) in most cases results in disability with restricted function and reduced efficiency. Physical therapy modalities can help in lessening the adverse outcomes of CLBP, nevertheless here is no agreement on the selection of modalities. The aim of this study was to scrutinize physical therapy modalities that are presently being utilized in the Treatment of CLBP by physical therapists in Khyber Pakhtunkhwa (KPK). A previously validated questionnaire was distributed among physical therapists practicing in KPK using Google doc system/email services and self-approach. In 1st segment of the questionnaire, questions related to age, sex and experience as physical therapists were asked. In 2nd segment, questions related to, number of CLBP patients managed and modalities used for the management of these patients. In 3rd segment of the questionnaire, questions were asked about quantity of articles studied in the last year and whether they critically appraised those articles or not. About 130 questionnaires were distributed among physical therapists working in KPK and 105 questionnaires were returned. The response rate was 80.76 %. Out of the total 105 respondents, 98 that is 75.38% met the inclusion criteria whereas remaining 7 were considered non valid. Results of current study established that physical therapists in KPK province frequently treat CLBP patients using general back exercises and spinal mobilization. 92.9% physical therapists in KPK uses general exercise regimen 84.7% use spinal mobilization, 70.4% use training of specific muscles and local stabilizers, 66.3% use stretching exercises while 65.3% use spinal manipulation and 64.3% use neural tissue mobilization for managing CLBP patients. According to results of current study Physical therapists in KPK, when managing CLBP patients, does not select modality on the base of up to date evidence. 49% physical therapists did not studied any article related to orthopedic manual therapy in one year. 21.4% physical therapist studied 1-5 articles in last year while 29.6% physical therapist studied greater than 5 articles. The major issue was that only 19.4% physical therapists appraise journal articles. Physical therapists in KPK, when managing CLBP patients, do not select modality on the base of up to date evidence.

Keywords: Chronic Low back pain, modality, Khyber Pakhtunkhwa, Management.

SAJMED.2016; 1(2):35-40                                                                      PDF Download

Introduction

ow back pain (LBP) is a most prevalent musculoskeletal condition in which there is pain and/or discomfort in low back area (1). About 84 percent people complaint of LBP at least once in their life span (2). Point prevalence of LBP is about 15%to 30%, one month prevalence is about 20%to 45% while life time prevalence is approximately 59%to 84%1. In Pakistan, prevalence of mechanical back pain is about 40% in urban areas while in rural population its prevalence is 31% (3). Approximately 40% of Pakistani population suffers from pain in their back. Out of these 40%, 34% were male while 46% were female. Approximately 39% Pakistani population believed that their LBP is due to strenuous work while 28% report their LBP due to general physical weakness. 9% people relate their LBP to bad posture (4). The effective management of CLBP consist of physical therapy management, management using medications, surgery as well as cognitive and unconventional treatment methods (5). It is suggested that multidisciplinary approach is essential in the treatment of CLBP2. For CLBP, Physical therapy management is one of the most familiar and effective type of conservative treatment (6). Physical therapy management for CLBP consists of different types of interventions. These interventions include exercise therapy, mobilization techniques, manipulation techniques, use of physical agents and education (7). In Physical therapy modalities, manual therapy such as mobilization and manipulation techniques and exercise therapy are commonly used for the management of CLBP (8). Treatment of CLBP needs to be searched and analyzed in depth because of its harmful consequences on patient life and its huge socioeconomic losses. It is very important and crucial that the treatment of CLBP must tag on the tendency of the proof and evidence. Because it is believed that Evidence always demonstrates only efficient and helpful treatment approach (9). Because our country Pakistan is still a developing country and considerable number of people living in Pakistan are concerned with some type of physical/manual occupation, that’s why most of the Pakistani population is at high risk for developing CLBP. Physical therapy modalities can help in lessening the adverse outcomes of CLBP. No research study have been conducted in Pakistan/Khyber Pakhtunkhwa (KPK) to appraise the physical therapy modalities utilized in the treatment of CLBP. The aim of this research study was to scrutinize physical therapy modalities that are presently being utilized in the Treatment of CLBP by physical therapists in KPK.

Materials And Methods

A Quantitative descriptive cross sectional study was carried out using previously validated questionnaire. Questionnaire was taken from the study carried out by Vaneshveri Naido. Questionnaire comprised of following subdivisions. In 1st segment of the uestionnaire, questions related to age, sex and experience as physical therapists were asked. In 2nd segment of the questionnaire, questions related to, number of CLBP patients managed and modalities used for the management of these patients presenting with pain in low back area. In 3rd segment of the questionnaire, questions were asked about quantity of articles studied in the last year and whether they critically appraised those articles or not. The participants in research were Physical therapists working in any Government and private hospitals of KPK, or working in private clinics in KPK. Consecutive sampling was used for this research study. Before data collection, Approval was taken from director/principal IPMR KMU. Data was collected from those physical therapists who fulfill eligibility criteria of the study. To mostof the eligible physical therapists, purpose and method of study was explained. Most of the Questionnaires were distributed among physical therapists practicing in KPK using Google doc system or email services. Online questionnaire was emailed and response of eligible physical therapists to questionnaire was noted. Some of the Questionnaires were also distributed among eligible physical therapists by giving hard copies of the Questionnaires. Physical therapists filled questionnaire by themselves. If any participant was not willing to answer any question present in the questionnaire, they were given the option to leave that question without attempting. After collecting data, it was entered into SPSS. The data obtained from physical therapy students was analyzed using SPSS version 16.0.
Results

About 130 questionnaires were distributed among physical therapists working in KPK and 105 questionnaires were returned. The response rate was 80.76 %. Out of the total one hundred and five (105) respondents, ninety eight (98) were considered valid whereas remaining seven (7) were considered non valid. These seven (7) were those participants who failed to attempt whole  uestionnaire of the study or who were non-working physical therapists. Among these ninety eight (98) physical therapists 73.5% were males while 26.5% were females. 37.8% of respondents were having age from 20 to 30 years and 39.8% were having age from 30 to 40 years. 31.6% physical therapists included in the study were experienced from 3 to 5 years, 23.5% from 6- 10 years, 21.4% greater than 10 years, 14.3% 1 year and only 9.2% less than 1 year. The biggest percentage (39.8%) of respondents in the current study was having age from 30 to 40 years while 37.8% were having age from 20 to 30 years. Most of the physical therapists (31.6%) included in the study were experienced from 3 to 5 years. That’s why results of the current study were mainly gained from recently graduated physical therapists. In addition to this, a large percentage of physical therapists included in the study were having experience more than 5 years (23.5% from 6-10 years, 21.4% greater than 10 years). Results show that physical therapists in KPK province frequently treat CLBP patients using general back exercises and spinal mobilization. 92.9% physical therapists in KPK uses general exercise regime and 84.7% use spinal mobilization for managing CLBP. 70.4% use training of specific muscles and local stabilizers, 66.3% use stretching exercises while 65.3% spinal manipulation and 64.3% use neural tissue mobilization for managing CLBP patients. 49% physical therapists did not studied any article related to orthopedic manual therapy in one year. 21.4% physical therapist studied 1-5 articles in last year while 29.6% physical therapist studied greater than 5 article. The major issue was that only 19.4% physical therapists appraise journal articles. Existing evidence presents supervision in choosing treatment procedures to those physical therapists who are engaged in managing CLBP patients. This helps them in finding guiding principles for managing CLBP patients18. The majority of physical therapists in current study (49%) did not studied any article related to orthopedic manual therapy while very less number of (21.4%) physical therapist studied 1-5 articles in one year, which shows that perhaps most physical therapists in KPK are unaware of the fact that guiding principles are present about managing CLBP patients. Consequently, if physical therapists are deficient in this skillfulness, it may be very hard to identify as well as put evidence into practice.
Discussion

Results of current study established that physical therapists in KPK province frequently treat CLBP patients using general back exercises and spinal mobilization. 92.9% physical therapists in KPK uses general exercise regime and 84.7% use spinal mobilization for managing CLBP. 70.4% use training of specific muscles and local stabilizers, 66.3% use stretching exercises while 65.3% spinal manipulation and 64.3% use neural tissue mobilization for managing CLBP patients. According to current study, the most frequent modality used by physical therapists in Khyber Pakhtunkhwa for managing CLBP patients is general exercise plan. Previous studies exposed that exercises proposed by physical therapists are very beneficial in managing CLBP patients (14), which give explanation why physical therapists in KPK frequently use general exercises for managing CLBP patients. A research study carried out by Chiradejnant et al. established that spinal mobilization not only help in reducing pain symptoms but also recover function as well as mobility of the
backbone (12). Because patients always supposed to get at least little relief from pain whenever they passed through a treatment
procedure, that’s why physical therapists always prefer those procedures which have direct positive results (13). This can be a possible motive because of which physical therapists in KPK frequently use spinal mobilization for managing CLBP patients. From the study carried out by Vaneshveri Naidoo it was established that physical therapists in Kwazulu-Natal province most frequently treat patients with CLBP using general back exercises and spinal mobilization. 31.1% patients with CLBP were treated using general back exercises, 27.1% were treated using techniques of spinal mobilization, 17.9% using myofascial release and 12% were treated with training of specific muscles and local stabilizers.
As compared to exercises and mobilization, training of local stabilizer muscles is applied by very less number of physical therapists in KPK. Previous studies exposed that working out on local stabilizer muscles not only consumes a lot of time but also necessitate enough expertise and knowledge of the physical therapist (16). Similarly, education is also applied by very less number of physical therapists in KPK. Heymans et al. exposed that educating patients consumes a lot of time and need enough awareness about CLBP (17). This can be a possible cause why physical therapists in Khyber Pakhtunkhwa did not use education for managing CLBP patients.