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Effectiveness of multipurpose health-worker-led exercise therapy on pain reduction among patients with chronic nonspecific low backache in primary health-care setting: a randomized control trial
Das H, Jayaseelan V, Manikandanesan S, Sharma D, Rehman T
Journal of Family Medicine and Primary Care 2019 Jan;8(1):199-202
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: The trial aimed to study the effectiveness of multipurpose health-worker-led exercise therapy on women patients of 30 to 50 years of age with chronic nonspecific low backache (LBA) in a primary health center. MATERIALS AND METHODS: The multipurpose health worker had undergone 2 days training for exercises to relief chronic nonspecific LBA in the Department of Orthopaedic, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry. Patients were allocated to either intervention arm (who received exercise therapy) or control arm (who received pharmacological therapy of analgesics). Patients with less than 3 months of pain, acute onset of pain, localized pain, or straight leg raising test positive were excluded. The pain score on three different positions (motion, sitting, and standing) was assessed on visual analogue scale before starting the exercise therapy or the pharmacological therapy and after 1 month of the exercise therapy or pharmacological therapy. STATISTICAL ANALYSIS: Data were analyzed using SPSS Software. Wilcoxon sign-rank test is used to compare the scores before and after intervention depending upon normality of distribution. Difference in difference analysis is used to compare the scores between the two groups. RESULTS: Multipurpose health-worker-led exercise therapy is found to be equally effective as compared to pharmacological therapy. Significant difference in reduction of pain score was not obtained between control and intervention arm (p value 0.343, 0.819, and 0.335 in motion, standing, and sitting position). However, significant reduction in pain score in all the three positions was obtained in intervention (p value < 0.001, < 0.001, < 0.001 in motion, standing, and sitting, respectively). Therefore, it can be suggested that multipurpose health-worker-led exercise therapy may be implemented in a primary health-care setting which will help to reduce the analgesics load on the health center and prevent the adverse effect profile of the drugs on patients.

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