Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.5935/2595-0118.20220032-en
Brazilian Journal of Pain
Original Article

Exercise-based and pain education program for adults with chronic low back pain in Brazilian Primary Care: feasibility study

Programa de exercícios físicos e educação em dor para adultos com dor lombar crônica na Atenção Primária brasileira: estudo de viabilidade

Ana Ellen do Nascimento Santos; Catharina Saraiva Nobre Cacau; Ana Carla Lima Nunes; Fabianna Resende de Jesus-Moraleida

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Abstract

BACKGROUND AND OBJECTIVES: Low back pain is the leading cause of disability in Brazil. Most of the evidence on interventions for chronic low back pain (CLBP) comes from high income countries. The objective was to investigate the feasibility of conducting a program based in exercise and pain education in Primary Health Care supported by low-cost mobile technology for adults with CLBP (versus waiting list) and to explore the profile of patients who adhered compared to those who did not adhere.

METHODS: This is a feasibility study with adult residents of Fortaleza, Brazil with CLBP. The Intervention Group consisted of strategies such as physical exercises, pain education, phone calls and support messages to participants. The Control Group was based on a waiting list. Primary outcomes included retention and adherence rates, comprehension of the intervention, credibility, and satisfaction with the intervention. Secondary outcomes included clinical and demographic factors such as pain intensity, disability, recovery prognosis, and physical activity, described according to adherence behavior.

RESULTS: Forty-five individuals were allocated to the Intervention Group and 24 to the Control Group. Overall, 57.8% of participants adhered to the intervention. Retention rates were 53.33% and 58.3% for intervention and control, respectively. The other primary feasibility outcomes were satisfactory. Longer time spent sitting and level of schooling differed the profile of those who adhered to the intervention from those who did not. Higher pain intensity and poorer recovery prognosis, measured at baseline, influenced non-adherence to home exercises.

CONCLUSION: The feasibility of the protocol was adequate for the comprehension of the components, however, adherence to the protocol and the follow-up of the participants were low. The profile of individuals adhering to the intervention includes higher schooling and more time spent sitting at baseline. Characteristics such as higher pain intensity and the influence of psychosocial factors influenced non-adherence to home exercises. Brazilian Registry of Clinical Trials (REBEC RBR-5wqr2j).

Keywords

Low back pain, Primary Health Care, Treatment adherence and compliance

Resumo

JUSTIFICATIVA E OBJETIVOS: A dor lombar é a principal causa de incapacidade no Brasil. A maior parte da evidência sobre intervenções para dor lombar crônica (DLC) advém de países desenvolvidos. O objetivo deste estudo foi investigar a viabilidade de conduzir um programa baseado em exercícios e educação em dor na Atenção Primária à Saúde para adultos com DLC (versus lista de espera) e explorar o perfil dos pacientes que aderiram comparado aos que não aderiram à intervenção.

MÉTODOS: Este é um estudo de viabilidade. Foram incluídos adultos com DLC e residentes em Fortaleza, CE, no Brasil. O Grupo Intervenção foi composto por estratégias como exercícios físicos, educação em dor, ligações telefônicas e mensagens de suporte aos participantes. O Grupo Controle consistiu em lista de espera. Os desfechos primários incluíram taxas de retenção e adesão, entendimento da intervenção, credibilidade e satisfação com a intervenção. Os desfechos secundários incluíram fatores clínicos e demográficos, como intensidade de dor, incapacidade, prognóstico de recuperação e atividade física, descritos segundo comportamento de adesão.

RESULTADOS: Quarenta e cinco indivíduos foram alocados para o Grupo Intervenção e 24 para o Grupo Controle. Em geral, 57,8% dos participantes aderiram à intervenção. As taxas de retenção foram 53,33% e 58,3% para intervenção e controle, respectivamente. Os demais desfechos primários de viabilidade foram satisfatórios. Maior tempo sentado e o grau de instrução diferiam o perfil dos aderentes dos não aderentes à intervenção. Maior intensidade de dor e pior prognóstico de recuperação, mensurados na avaliação, influenciaram a não adesão aos exercícios domiciliares.

CONCLUSÃO: A viabilidade do protocolo apresentou-se adequada para entendimento dos componentes. Entretanto, a adesão ao protocolo e o seguimento dos participantes foram baixos. O perfil dos indivíduos aderentes à intervenção incluiu maior instrução e mais tempo sentado na sua avaliação inicial. Características como maior intensidade de dor e influência de fatores psicossociais influenciaram a não adesão aos exercícios domiciliares. Registro Brasileiro de Ensaios Clínicos (REBEC RBR-5wqr2j).

Palavras-chave

Atenção Primária à Saúde, Cooperação e adesão ao tratamento, Dor lombar

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Submitted date:
12/22/2021

Accepted date:
05/09/2022

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