Delivering a Back School Programme with a Cognitive Behavioural Modification: A Randomised Pilot Trial on Patients with Chronic Nonspecific Low Back Pain and Functional Disability

Abstract

Introduction: Chronic non-specific low back pain is a major health burden worldwide including Singapore. As literature shows inconclusive evidence on the benefit of various forms of exercises for chronic low back pain patients, we intended to investigate the efficacy of a four-week posture correction and movement re-education programme delivered through cognitive behavioural modification. Methods: A blinded randomised controlled pilot trial was conducted with the participants randomised into two different group exercise classes. The control group performed generic mat exercises. The experimental group performed functional back exercises and had training in activities like lifting, sitting, mopping to learn correct postures and body mechanics with proper ergonomics and activity pacing through cognitive behavioural modification. The following outcome measures were scored in this study: verbal numerical pain (VNP) scale, Roland Morris disability questionnaire (RMDQ), patient-specific functional scale (PSFS), and global perceived effect (GPE) score. Results: At baseline (n=15), the data was normally distributed between the control and the experimental groups, with the exception of BMI in the control group and VNP in the experimental group. In the experimental group, all outcome measures showed statistically significant difference between pre- and post-intervention scores, VNP (p=0.01), RMDQ (p=0.01), PSFS (p=0.01) and GPE (p=0.00). In the control group, a statistically significant difference between pre- and post-intervention was noted in the PSFS score (p=0.04). Conclusion: This pilot study demonstrated that an exercise class incorporating correction of postures and body mechanics in daily activities with a cognitive behavioural modification reduces pain and disability better than generic mat exercise class in patients with chronic non-specific low back pain.