GLA:D® BACK: GROUP-BASED PATIENT EDUCATION AND EXERCISES TO SUPPORT SELF-MANAGEMENT OF PERSISTENT/RECURRENT BACK PAIN. DEVELOPMENT, THEORIES AND SCIENTIFIC EVIDENCE

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Kjaer P1,2, Kongsted A1,3, Ris I1, Abbot A4, Rasmussen CDN5, Roos EM1, Skou ST1,6, Andersen TE7, Hartvigsen J1,31University of Southern Denmark, Sports Science and Clinical Biomechanics, Odense, Denmark, 2University College Lillebaelt, Applied Health Sciences, Odense, Denmark, 3Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark, 4Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy, Linköbing, Sweden, 5National Research Centre for the Working Environment, Copenhagen, Denmark, 6Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Department of Physiotherapy and Occupational Therapy, Slagelse, Denmark, 7University of Southern Denmark, Department of Psychology, Odense, DenmarkBackground: Clinical guidelines recommend that people with back pain be given information and education about their back pain, advice to remain active and at work, and exercises to improve mobility and physical activity. Guidelines, however, rarely describe how this is best delivered.Purpose: The aim was to present the development process, the theories, and underlying evidence for 'GLA:D® Back' - a group education and exercise program that translates guideline recommendations into a clinician-delivered program for the promotion of self-management in people with persistent/recurrent back pain.Methods: GLA:D® Back was developed using an iterative process, which included the establishment of a rationale and objectives for the program, an explanation of the theory and evidence for the interventions, and the production of program materials. The content of the patient education and exercise programs tested in randomised trials was extracted and a multidisciplinary team of expert researchers and clinicians prioritised common elements that were hypothesised to improve back pain beliefs and management skills for patients with persistent/recurrent LBP. The program was tested on eight people with persistent/recurrent back pain in a university clinic and 152 patients from nine primary care physiotherapy and chiropractic clinics. Following feedback from the clinicians and patients involved, the program was modified and refined.Results: Educational components included pain mechanisms, pain modulation, active coping strategies, imaging, physical activity, and exercise that emphasised a balance between demands on the back and the individual's capacity to respond. These were operationalised in PowerPoint presentations with supporting text to aid clinicians in delivering two one-hour patient education lectures. The exercise program included 16 one-hour sessions over 8 weeks, each comprising a warm-up session and eight types of exercises for general flexibility and strengthening of back extensor muscles, hip abductors and extensors, trunk rotators, rectus and oblique abdominal muscles and leg muscles, and each with four levels of difficulty. The aims of the exercises were to improve overall back fitness and, at the same time, encourage patients to explore variations in movement by incorporating education content into the exercise sessions.Conclusion(s): Research and clinical experts developed a structured program - GLA:D® Back - to support self-management in people with persistent/recurrent back pain using an iterative process with feedback from treating clinicians and patients with back pain.Implications: The implementation of the GLA:D® Back program is currently taking place. We expect that more than 400 physiotherapists and chiropractors will be trained in delivering the program in Denmark by the end of 2018. This will potentially result in more than 3000 patients being enrolled in the GLA:D® Back program within the next year. Based on the feasibility studies, we believe that the program will improve the quality of care for people with back pain, make the clinicians feel more confident and competent and assist the patients to develop skills to self-manage their back pain. The implementation process is being closely monitored and a number of outcomes for both clinicians and patients are being systematically collected. Further to this, the program is being piloted and tested in Canada and Australia.Keywords: Back pain, Patient Education, Exercise TherapyFunding acknowledgements: No funding was received for this studyTopic: Musculoskeletal: spine; Primary health care; Education: clinicalEthics approval required: NoInstitution: University of Southern DenmarkEthics committee: The Regional Committees on Health Research Ethics for Southern DenmarkReason not required: The study was a literature review, consensus discussions and feasibility studies of a type that does not require approval according to Danish legislation (ref.no. S-20172000-93)All authors, affiliations and abstracts have been published as submitted.

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