a)    Abstract:

 Purpose

Data on the management of chronic low back pain (CLBP) by physiotherapists in Africa is scarce. No studies have been done in South Africa/Kwazulu-Natal (KZN) investigating the physiotherapy interventions used in the management of patients with CLBP. Thus the aim of this study was to investigate the treatment modalities which are currently being used in the management of chronic low back pain by physiotherapists in KZN.

The objectives of the study were to establish: the commonly used physiotherapy modalities; reasons; and the evidence-base used for their choice.

 Relevance

The management of acute and chronic low back pain (CLBP) warrants separate consideration as these conditions may respond differently to the same interventions. CLBP presents as a persistent, disabling condition and has a profound effect on quality of life. It has a less favourable prognosis and results in considerable socioeconomic costs, as a result of repeated treatments, long term work absenteeism and social support. The management of CLBP includes a variety of interventions, for example, pharmacological treatment, physiotherapy treatment, surgery, cognitive and behavioural therapy and alternative therapies. At present there is an increasing trend towards evidence-based care and the literature has revealed that the physiotherapy field is no exception to this, especially with regards to the management of CLBP. According to the literature a multi-dimensional approach based on the bio-psycho-social model is required in the management of CLBP.  

Subjects

All practicing physiotherapists in Kwazulu-Natal registered with the Health Professions Council of South Africa (685), involved in the management of patients with CLBP were included in the study.

Methods

A cross-sectional survey was used to investigate the management of CLBP by physiotherapists in Kwazulu-Natal (KZN). Six hundred and eighty-five self-administered questionnaires were posted to all registered physiotherapists in KZN.

Analysis

Frequencies and percentages were used to analyse the data . Tables and graphs were used to illustrate the data where applicable

Results

Of 213 returned questionnaires, 141 (20.6%) met the inclusion criteria as they managed patients with CLBP. General exercises (30%); spinal mobilisation (28%); myofascial release (18%), education (12%) and training of local stabilisers (12%) were the commonly used treatment modalities. Key reasons for the selection of the treatment modalities were undergraduate education received; own clinical experience and the attendance of postgraduate courses/physiotherapy conferences.

Conclusion

The commonly used modalities in the management of CLBP were general exercises; spinal mobilisation; myofascial release; education and training of the local stabiliser muscles.

The reasons cited for the choice of modality selected included undergraduate education received, the attendance of postgraduate courses/physiotherapy conferences and clinical experience. From the reasons specified, the use of written current available literature through reading of journal articles was sparsely utilized.

Implications

From the reasons specified for the choice of treatment modality selected, the extent of evidence-based practice is unclear and needs an in-depth investigation. The literature advocates multidisciplinary treatment, behavioural treatment (all types: operant, cognitive and respondent) and exercise therapy in the management of CLBP.