Implementing an Educational Intervention Regarding Exercise Prescription for Chronic Low Back Pain in a Primary Care Clinic

Abstract

Low back pain (LBP) is a common complaint for which patients present to a provider and is one of the leading causes of absenteeism from work. The duration of pain experienced determines the classification or type: acute (<4 weeks), subacute (4-12 weeks), chronic (12+ weeks). The framework that structured this quality improvement project is part of the Institute for Healthcare Improvement’s (IHI) Model for Improvement: the Plan-Do-Study-Act (PDSA) model, and the theory that informed the intervention was the theory of planned behavior by Ajzen (1991). Acute and subacute LBP are most commonly self-limiting. While those with CLBP showed improvement in both pain and functionality with exercise compared to no exercise. The purpose of the project was to identify provider knowledge and perceived barriers to exercise prescription to treat chronic low back pain (CLBP) at one family practice clinic. Stakeholders involved were the primary care providers, as they were most affected by the intervention. This quality improvement project was completed in two phases. Phase 1 - was a qualitative needs assessment used to tailor the intervention to participants. Phase 2 - was an educational intervention with a pretest/posttest approach. A 15-minute educational PowerPoint presentation focused on evidence-based treatment, specifically exercise, for CLBP was given to participants during a monthly staff meeting. A pretest was administered before the presentation, with a posttest completed weeks to months after. The questions were divided into four categories, which are types of exercise, provider knowledge, barriers to exercise prescription, and self-reported confidence to prescribe exercise. Due to a high baseline level of knowledge, likelihood to prescribe, and confidence, there were no changes in responses to six questions. However, pre/post responses changed in six of the 12 questions. Overall, responses showed an increase in knowledge of exercises, and confidence in exercise prescription. The primary limitation was the length of time between pretest and posttest. Providers need to increase personal knowledge to increase confidence in prescribing exercise. Lack of educational opportunities was cited as a leading factor in the under-prescription of exercise.