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

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

Abstract

Background: 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. 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.

Methods: GLA: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.

Results: Educational 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.

Conclusion: From 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.

Keywords: Back pain; Exercise therapy; Intervention development; Patient education; Primary health care.

Conflict of interest statement

Ethics approval and consent to participate

The Regional Committees on Health Research Ethics for Southern Denmark decided that the study did not need ethical approval (file number S-20172000-93). Authorisation for the data collection has been obtained from the Danish Data Protection Agency (DPA) as part of the University of Southern Denmark’s institutional authorisation (DPA no. 2015-57-0008 SDU no. 17/30591).

Consent for publication

The manuscript does not include any individual person’s data. The individual depicted in the images provided her written informed consent for the publication of these identifiable images

Competing interests

The authors declare to have no competing interests. PK’s position at the University of Southern Denmark is financially supported by the University College Lillebaelt, Odense, Denmark.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Program model. Overview of the GLA:D Back intervention, the proposed patient achievements and outcomes through the GLA:D Back program and their theoretical links
Fig. 2
Fig. 2
The balance model. Illustration from the patient education explaining that pain is a result of your demands (physical, emotional and social) exceeding your capacity (physical, emotional, and cognitive)
Fig. 3
Fig. 3
Key messages in GLA:D® Back. An overview of key messages from the GLA:D Back pain education material. (GLA:D® is a registered Trademark of the University of Southern Denmark: The name can only be used for an intervention if all criteria described by the University of Southern Denmark are met).
Fig. 4
Fig. 4
Exercise example. An example of exercises for the lateral buttocks at four different levels. The individual depicted in the images provided her written informed consent for the publication of this identifiable image. (GLA:D® is a registered Trademark of the University of Southern Denmark: The name can only be used for an intervention if all criteria described by the University of Southern Denmark are met).

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