Implementation of a biopsychosocial physiotherapy management approach for patients with non-specific chronic low back pain in Ghana: a study protocol for a mixed-methods, sequential, feasibility, pretest-posttest quasi-experimental study

Abstract

Background

Low back pain (LBP) is a common musculoskeletal disorder affecting populations from both low- and middle-income, and high-income countries. Global prevalence of LBP is estimated at 9.4% with prevalence rates substantially higher in low- and middle-income countries notably in Africa (39%). The recommended biopsychosocial model of managing patients with LBP, has been predominantly applied and evaluated in high-income countries, therefore, it is essential to ascertain the feasibility of implementing this approach in low- and middle-income countries including Ghana.

Aim

To investigate the feasibility of implementing a biopsychosocial physiotherapy management approach (exercise and patient education) for the management of patients with chronic LBP in Ghana.

Methods

Context: Komfo Anokye Teaching Hospital, Ghana.

Design

Mixed-methods, sequential, feasibility, pretest-posttest quasi-experimental study. Physiotherapists will be recruited and trained to deliver the biopsychosocial intervention, followed by recruitment of patients with CLBP. Assessment of outcome measures will be conducted at baseline, post-intervention, and 3-months, focusing on feasibility outcomes including recruitment rate, retention rate, and acceptability of the intervention. Patient demographics and secondary outcomes measures will also be collected. Descriptive statistics will be used to summarize the outcomes data and assess feasibility against a priori feasibility criteria. Finally, qualitative interviews will be conducted to explore participants’ experiences and acceptance through thematic analysis.

Discussion

This study will investigate the feasibility of implementing a biopsychosocial physiotherapy management approach for patients with CLBP in Ghana. The outcomes will assess the feasibility of the intervention, the appropriateness of outcome measures and inform a future clinical trial.

Keywords:

• Biopsychosocial
• physiotherapy
• patient education
• exercise
• chronic low back pain

Disclosure statement

There are no competing interests.

Authors contributions

PKA is the principal investigator and drafted the manuscript. PH and FM are the supervisory team who participated in the review and approval of the intervention protocol. All authors were involved in the revision and editing of the manuscript. The final manuscript was read and approved by all authors.

Materials and data availability

All data and materials regarding this research will be made available upon request to the corresponding author.

Additional information

Funding

The corresponding author is a PhD student at the University of Nottingham in the United Kingdom, and an independent researcher. This protocol forms part of his PhD which is supported by the Commonwealth Scholarship Commission. All views expressed in this protocol are that of the author and not the Commonwealth Scholarship Commission.

Notes on contributors

Paapa Kwesi Ampiah

Paapa Kwesi Ampiah is a PhD Student at the University of Nottingham, UK, pursuing a PhD in Physiotherapy. He earned his undergraduate degree (BSc) in physiotherapy from University of Ghana, Department of Physiotherapy, and post graduate degree (MSc) in Physiotherapy from the University of Nottingham, Division of Physiotherapy and Rehabilitation. Prior to his MSc degree, Paapa practiced as a physiotherapist in Ghana at Komfo Anokye Teaching Hospital (KATH) where he rose to become the lead physiotherapist for orthopedics and a coordinator of clubfoot clinics. He actively contributed to the development of treatment guidelines for managing musculoskeletal conditions in KATH. Paapa’s MSc specialty was Advancing Neuromusculoskeletal Practice, where he engaged with contemporary musculoskeletal practice and quality improvement initiatives. Subsequently he was made Head of Physiotherapy at the Weija Gbawe Municipal Hospital in Ghana; there, he played an active role in ensuring the successful establishment of the physiotherapy service and engaged well with patients and staff to ensure the instilment of evidence-based practice. Paapa subsequently gained an award to pursue a PhD in Physiotherapy focused on investigating the feasibility of implementing a biopsychosocial physiotherapy management approach in Ghana. His research interests include neuro and musculoskeletal care, orthopedics, and quality improvement studies.

Paul Hendrick

Paul Hendrick is a lecturer in the Division of Physiotherapy and Rehabilitation Sciences, University of Nottingham, UK whose current responsibilities include PG Course Director MSc Programs, Module lead of the Masters Dissertation Module, PG Pain Module and 3rd year Spinal Rehabilitation modules with teaching responsibilities across the UG and PG programs and supervision of PhD students. Paul has worked in a range of clinical fields including musculoskeletal, sports rehabilitation and chronic pain management. Paul undertook his graduate Diploma in Manipulative Therapy and Masters at the University of Otago in New Zealand where he taught on the undergraduate and postgraduate Physiotherapy programs and completed his PhD on the role of physical activity in recovery from low back pain. Paul's teaching and research interests include pain rehabilitation, physical activity and self-management through behavior change in chronic pain. He is also interested in patient education and how clinical reasoning develops through teaching and experience. He has researched and published extensively in these fields with over 40 peer reviewed publications and successful supervision of Masters and PhD students in these areas. Paul continues to work clinically in musculoskeletal rehabilitation

Fiona Moffatt

Fiona Moffatt is lecturer in the Division of Physiotherapy and Rehabilitation Sciences and currently the Director of Research in the School of Health Sciences, University of Nottingham, UK. Fiona obtained a B.Sc. (Hons.) in Physiotherapy from the University of Manchester. She subsequently completed an M.Sc. in Physiology at University College London. Fiona's clinical expertise is the management of the acutely ill adult and patients with cardio-respiratory dysfunction. She is the co-author of a textbook and chapters in this field. Fiona has also worked as an extended scope practitioner within a Critical Care Outreach Team. The PhD explored how contemporary UK policy discourse constructs the rights and responsibilities of healthcare professionals in terms of productive healthcare, how this is made manifest in practice, and the implications for professional autonomy/identity. Fiona's research interests include: physical activity; respiratory dysfunction and neck pain; critical care rehabilitation; sociology of the healthcare professions; healthcare organizational sociology; and implementation science. Methodologically, Fiona has a special interest in qualitative research (in particular ethnography).