GLA:D\xae Back group-based patient education integrated with exercises to support self-management of back pain\xa0- development, theories and scientific evidence\xa0-

Per Kjaer,Inge Ris,Tonny Elmose Andersen,Jan Hartvigsen,Allan Abbott,Alice Kongsted,Søren T Skou,Ewa M Roos,Charlotte Diana Nørregaard Rasmussen

doi:10.1186/s12891-018-2334-x

Abstract

BackgroundClinical 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. The aim of this paper is to present the development, 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.MethodsGLA:D Back, which included a rationale and objectives for the program, theory and evidence for the interventions, and program materials, was developed using an iterative process. The content of patient education and exercise programs tested in randomised trials was extracted and a multidisciplinary team of expert researchers and clinicians prioritised common elements hypothesised to improve back pain beliefs and management skills. The program was tested on eight people with persistent 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 working version of the program was created.ResultsEducational components included pain mechanisms, pain modulation, active coping strategies, imaging, physical activity, and exercise that emphasised a balance between the sum of demands and the individual’s capacity. 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 supervised one-hour sessions over 8 weeks, each comprising a warm-up section and eight types of exercises for general flexibility and strengthening of six different muscle groups at 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.ConclusionFrom current best evidence about prognostic factors in back pain and effective treatments for back pain, research and clinical experts developed a ready-to-use structured program - GLA:D® Back - to support self-management for people with persistent/recurrent back pain.

Highlights

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
We present the development, theories, and underlying scientific evidence for the GLA:D Back program, which consists of a standardised clinician-delivered care program for back pain comprising group education and supervised exercises aimed at supporting self-management in people seeking care due to persistent and/or recurrent back pain
Rationale for GLA:D Back The burden of back pain Back pain is the most common reason for people in Denmark visiting general practitioners (GPs) [15] and it is responsible for more years lived with disability worldwide than any other condition [16, 17]

Summary

Introduction

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. Evidence-based clinical practice guidelines universally recommend patient education, advice to remain active and at work, and exercises as frontline interventions to help people with persistent and/or recurrent episodes of back pain to self-manage [1]. An example of a successful implementation of clinical guideline recommendations is the GLA:D (Good Life with osteoArthritis in Denmark) for the knee and hip [4]. This program consists of a two-day course that trains clinicians in delivering GLA:D, a standardised evidence-based program for knee and hip pain. The GLA:D approach appears to be an effective, feasible and fast method to implement recommendations from clinical guidelines in clinical practice, and a similar approach might be useful to implement recommendations from clinical guidelines for back pain

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