Title

Effect of Additional Lumbosacral Corset on the Outcome of Patients with Non-Specific Acute Low Back Pain at The Aga Khan University Hospital, Nairobi

Date of Award

5-30-2016

Document Type

Dissertation

Degree Name

Master of Medicine (MMed)

First Supervisor/Advisor

Dr. Akil Fazal

Second Supervisor/Advisor

Prof. Hassan Saidi

Third Supervisor/Advisor

Mr. Parmenas K. Oroko

Department

General Surgery (East Africa)

Abstract

Introduction: Low back pain (LBP) is a common problem world over affecting 60-90% of the population in their lifetime. It is a leading reason for hospital admission, healthcare spending, workplace absenteeism and years lived with disability.

Up to 90% of patients suffering from low back pain do not have a serious pathology warranting imaging or further intervention besides symptom relief. These are categorized as having non- specific low back pain. This has a good prognosis running a short course of 3 to 6 weeks.

The management of non-specific acute LBP entails analgesia and non-pharmacologic interventions (back school and physical therapy). Many modalities of physical therapy are often employed for non-specific acute LBP. The use of lumbosacral corset as a physical therapy for non-specific acute LBP has not been clearly supported with scientific evidence. However, it is commonly prescribed for this category of patients. It is important to assess the effect of this modality on the outcome of patients with non- specific acute LBP.

Objective: To assess the outcome (change in back specific disability) of patients with non-specific acute low back pain treated with a lumbosacral corset in addition to a standard analgesic protocol compared to those on a standard analgesic protocol alone over a 3- week duration at the Aga Khan University Hospital, Nairobi, Kenya.

Methods: A two-arm single blinded randomized controlled trial was carried out involving 82 consecutively sampled patients. Patients were randomized to analgesic protocol alone or analgesic protocol and a lumbosacral corset and followed up weekly for three weeks. Back specific disability was assessed using the Oswestry Disability Index (ODI). The primary outcome was the mean change in the ODI score between the two arms. We analyzed the data by use of repeated masures ANOVA.

Results: Seventy-nine patients were analysed. The baseline characteristics were similar. There was a significant effect of time on the ODI (F=(1.38, 106.56)=207.89, P=.000). There was a statistically significant difference in ODI score between the two arms favouring the intervention arm ( F (1, 27)=4.23, p=.043). The difference in pain score and days off duty was not statistically significant. The number of days off duty was comparable between the two arms. Compliance to use of lumbosacral corset was good with mean of 1 day off the corset. The maximal change in both ODI and pain score occurred between the first and second reviews indicating maximum clinical improvement with the first week.

Conclusion: Compared to use of analgesia alone, the use of additional lumbosacral corset among patients with non-specific acute LBP resulted in a significant improvement in their back specific disability

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