Development and preliminary evaluation of a self-management programme for people with non-specific chronic low back pain in rural Nigeria

• Main Author: Igwesi-Chidobe, Chinonso Nwamaka
• Other Authors: Godfrey, Emma Louise ; Sorinola, Isaac Olubunmi
• Published: King's College London (University of London) 2017
• Subjects: 617.5
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.713125

Background: There is currently no access to effective treatment of low back pain (LBP) in rural Nigeria despite its significant burden in this context. This increases disability, deepens poverty, and reinforces rural-urban inequality. Evidence from developed countries suggests that psychosocial factors are associated with chronic low back pain (CLBP) disability, but no research has examined these factors in rural Nigeria. This PhD aims to explore the biopsychosocial factors associated with CLBP disability in rural Nigeria, and then develop and test the feasibility of an intervention to address them. Methods: Six studies were conducted as part of this PhD. Two qualitative studies to explore the experiences of people living with CLBP (Study 1), and the management of CLBP (Study 2) in rural Nigeria. The cross-cultural adaptation and psychometric testing of measures to assess any suggested biopsychosocial factors (Study 3). A cross-sectional survey to investigate the biopsychosocial factors associated with CLBP disability in rural Nigeria (Study 4). A systematic review to assess the intervention components to improve acceptability of exercises and physical activity behaviour in people with chronic non-communicable diseases in Africa (Study 5). The development of an exercise-based self-management programme (SMP) to target biopsychosocial factors associated with CLBP disability in rural Nigeria, and then conduct a feasibility study of this programme (Study 6). Results: Study 1 found maladaptive beliefs and coping strategies, emotional distress and disability among individuals with CLBP. Study 2 showed that CLBP was predominantly managed within a biomedical model. Study 3 found that the adapted measures were reliable and valid for use in rural Nigeria. Study 4 showed that psychosocial factors explained 63% and 49% of the variance in self-reported and performance-based CLBP disability respectively. Study 5 suggested that behavioural rehearsal/practice, habit formation, and restructuring the physical and social environment improved the acceptability of exercises, and physical activity behaviour. Study 6 found that the SMP was feasible and acceptable to participants, and had potential in terms of clinical (biopsychosocial) outcomes. Conclusions: This PhD has enabled the identification of the biopsychosocial factors associated with CLBP disability in rural Nigeria, and the development of a novel intervention that shows promise in addressing them.