Abstract
This unblinded, controlled clinical trial was undertaken in order to demonstrate the advantage of education concerning low back pain in the labour intensive workplace and to show that education alone as well as in conjunction with chiropractic manipulative therapy, is a valuable time and cost-effective mechanism for reducing low back pain. This will be achieved by comparing comprehensive industrial back school (CIBS) in combination with chiropractic manipulative therapy (CMT) and CIBS in isolation.
In the execution of the study it was hypothesised that both the treatment protocols would be effective in the treatment of low back pain, but that the combined therapy would be more effective due to the fact that the treatment protocol involving the combined treatment would be assessing and correcting lumbar spine pathomechanics.
The patient base for the study was drawn from the technical services division (labour force) of the Technikon Witwatersrand in Johannesburg, South Africa. Patients were recruited by consulting the managers of the technical services departments at the Technikon Witwatersrand, and a presentation concerning low back pain was given to the labour forces involved in the technical services division, detailing the treatment protocols and the risks and benefits involved. After the presentation anyone suffering from low back pain was invited to participate in the study. Only males were included in the study, rendering the data more valuable relative to the small sample group. Thirty patients whom conformed to the diagnostic criteria and did not have any conditions that contraindicated CIBS or CMT were included in the study. The patients were divided into two groups according to where they worked (Doornfontein or Auckland Park campus). Fifteen (15) people were selected from each campus (both campuses are under the same labour demands). This situation was decided upon as to not allow cross contamination of the groups; it was also logistically more practical.
The Doornfontein group (DFC) received CMT in combination with the CIBS. All fifteen patients attended one CIBS per week for four weeks; and received six CMT treatments over four weeks. The Auckland Park group (AKP) received the CIBS in isolation; also running once a week for four weeks. All patients (both groups) were assessed and data captured at the first week, fourth week and at a follow up visit one month after the final session (eighth week), where all the data was captured again.
The subjective data was collected using the McGill Pain Questionnaire and the Oswestry Low Back Pain Disability Index. Objective data was obtained using the cervical and lumbar range of motion instruments (Goniometers) and a universal inclinometer. Anecdotal data was collected using a questionnaire.
The data was analysed using “Jandell Scientific Sigma Stat and Sigma Plot 2.02”.
The subjective results indicate that both treatment protocols were equally effective in reducing low back pain in men involved in labour intensive work. A statistically significant difference presented in both groups. The results indicated that in order to reduce the period of intense pain more rapidly, a combination of CMT and CIBS would be the treatment of choice. However the long-term benefit of both protocols was equally beneficial. This is believed to be as a result of education changing the way in which people live and work and therefore taking effect over a longer period but having a more lasting effect. The objective results indicate that the protocols were equally as effective in improving the patient’s range of motion. However it was noted that range of motion was seen to reduce over a shorter period of time in the DFC group (combined treatment protocols).
Based on the results of this study, the protocols were equally effective in the long term. This is due to the fact that as patients are educated about caring for their backs in the work place, and during activities of daily living, the amount of times they place their backs in positions resulting in excessive loading is reduced, therefore resulting in a reduction in pain, disability and further pathology.
Dr. M.A. Khoury
Mr. S. Nalla