EFFECT OF HEALTH EDUCATION ON POSTURE PRACTICES
TOWARDS REDUCTION OF LOW BACK PAIN AMONG PATIENTS IN RIVERS STATE
Ime M. Ubom1, John O. Onyezere2
University of Port Harcourt, Port Harcourt, Rivers
State, Nigeria
ime_ubom@uniport.edu.ng1, john.onyezere@uniport.edu.ng2
|
KEYWORDS |
ABSTRACT |
|
health
education, functional posture practices, therapeutic posture practices,
reduction of low back pain. |
This
study investigated the effect of health education on posture practices in
reducing low back pain among patients in Rivers state, Nigeria. To achieve
this, pretest-posttest quasi-experimental design was employed, and the study
targeted 170 patients at the University of Port Harcourt Teaching Hospital in
Nigeria. Two objectives having corresponding research questions and
hypotheses guided the study, while convenience and stratified sampling
techniques were used to select 50 participants, comprising 35 patients from
the general outpatient clinic department and 15 patients from the spine
physiotherapy unit, with 20 male and 30 female participants. Data collection
was done by administering a self-structured, self-administered questionnaire,
titled health education effect on ergonomic practices and low back pain,
which had a reliability coefficient of 0.75. Both descriptive and inferential
statistics were used to answer the research questions and test the
hypotheses. The research found that educating patients on various methods of
preventing low back pain, including healthy weight maintenance, warm-up
exercises, and proper postural habits while sitting and standing, had a
noteworthy impact on reducing pain. Moreover, the study also revealed that
health education programmes were successful in therapeutic posture practices
and reducing low back pain in patients residing in Rivers state. Therefore,
the study concluded and recommended that health education interventions for
functional and therapeutic posture practices are effective strategies for
reducing low back pain among patients in Rivers state, and healthcare
providers should incorporate these interventions into their treatment plans
for patients suffering from low back pain. |
|
DOI: 10.58860/ijsh.v2i6.59 |
|
Corresponding Author: Ime M. Ubom
Email: ime_ubom@uniport.edu.ng
INTRODUCTION
Health, which
is defined as a full physical, psychic and social well-being not as a lack of
an illness or an indisposition, constitutes a multi-sided value either
individual or social (Ubom,
2023). The health of a society
influences the productive potential and prosperity of its citizens (Polcyn
et al., 2023); (Wang
et al., 2023). Consequently, the
healthcare has become one of the most essential sections of social policy of
contemporary countries (Wang
et al., 2023). Ongoing development in
medicine constantly expands possibilities not only in the field of prevention
and treatment of diseases but also the prolongation of life (Fang
et al., 2020); (Eckstrom
et al., 2017). Ageing of society has
contributed to the increase of needs in this field. The health of a society depends
not only on the standard of the healthcare, its availability and the quality of
medical services but also on a good national policy whose aim is to implement
healthcare programmes (Przybylska
et al., 2014).
Health Education
plays a crucial role in the development of healthy, inclusive and equitable
social, psychological and physical environment (Fasoranti
& Adeyeye, 2015). It reflects current best
practice, using an empowering, multi-dimensional, multi professional approach
which relates to all setting, organizations, including the community, schools,
health services and the workplace (Fasoranti
& Adeyeye, 2015). Health Education helps
to provide health knowledge, enhance wellness behaviours, promote health
situations, facilitate healthful relationship and enables community members
make responsible decisions (Brar,
2018); (Fasoranti
& Adeyeye, 2015). This term known as
health education helps provide health knowledge (Sharma,
2021), enhance wellness
behaviours (Kubzansky
et al., 2018), promote health
situations (Blake
et al., 2013), facilitate healthful
relationship (Bodryzlova
& Moullec, 2023) and enables community
members make responsible decisions (Fasoranti
& Adeyeye, 2015).
Low back pain
(LBP) is a prevalent health problem that affects people of all ages and
professions(Mondal,
2023). The burden of LBP is
high in developing countries, including Nigeria, where it is a leading cause of
disability and work absenteeism (Orupabo
et al., 2023); (Igwesi-Chidobe
et al., 2017). Health education has
been identified as an effective tool for reducing LBP by promoting good posture
practices among patients. Posture practices refer to the way individuals
position their bodies while sitting, standing, or performing other activities.
Poor posture during daily activities can lead to musculoskeletal disorders,
including LBP (Eberendu
et al., 2020). Besides, prolonged
inactivity is also known to contribute to a reduction in muscle strength,
spinal flexibility, and quality of life (QOL). Previous research has shown that
40-64% of people subjected to have LBP during prolonged standing, even though
they do not have it before. Long periods of standing require the back extensors
to stay engaged for an extended period of time, which can lead to muscle
fatigue (Seyed
& Mohamed, 2021). According to a review by
Shiri et al, there is strong evidence linking poor posture to LBP(Shiri
et al., 2018). The review also
highlights the importance of promoting good posture practices through education
and training programs. The study also used evidence-based health education
strategies that have been proven effective in reducing LBP. For example, a
randomized controlled trial by Jaromi et al found that a six-week educational
programme that included training on posture practices significantly reduced the
incidence of LBP among participants compared to those who received usual care(Jaromi
et al., 2012).
Many
treatments strategies, such as stretching exercises, muscle strengthening, and
flexibility training may have a significant positive impact on posture.
Therefore, educating patients on how to maintain good posture is essential in
preventing and managing LBP (Ubom,
2023). Thus, carrying out a
study on health education as a tool for reducing LBP among patients with a
focus on posture practices is vital in Rivers state, Nigeria, because of the
high prevalence of LBP in the region. According to a study by Okafor et al.
(2019), the prevalence of LBP among adults in Rivers state was 37.8%. This
finding underscores the need for interventions that can reduce the burden of
LBP in the region. Health education is one such intervention that can empower
patients with knowledge and skills to prevent and manage LBP. The study was
focused on posture practices because poor posture is a significant risk factor
for LBP.
Statement of the Problem
Low back pain
is a persistent and debilitating condition that affects a significant portion
of the population world over. However, the effectiveness of traditional
treatments such as medication and surgery has been called into question. In
addition, many patients experience relapses due to a lack of education on how
to maintain their recovery. This raises the question of whether health
education, particularly focused on functional and therapeutic posture
practices, can significantly improve low back pain outcomes. Can providing
patients with information on maintaining their recovery prevent relapses and
ultimately lead to a reduction in low back pain? Thus, this study sought to
investigate the effect of health education on low back pain with attention to functional
and therapeutic posture practices among patients in Rivers state, in an effort
to bridge the gap in treatment and improve patient outcomes.
This study was
aimed at investigating effect of health education on posture practices towards
reduction of low back pain among patients in Rivers state, Nigeria. Previous
research has highlighted the significance of health education in promoting
correct posture practices and reducing the prevalence of low back pain among patients.
A study shows that individuals who received health education on proper sitting
and standing postural habits experienced a significant reduction in low back
pain symptoms (Bettany-Saltikov
et al., 2019). Moreover, the study
suggested that educating patients on the importance of physical exercise, back
strengthening exercises, and using supportive posture aids, such as lumbar
cushions, can help mitigate the onset of pain. Another study investigated improvement
of knowledge and postural habits after an educational intervention programme in
school students (Miñana-Signes
et al., 2019). The researchers found
that the program had a beneficial impact on reducing pain symptoms and
encouraging better posture habits among participants. However, the current
study distinguishes itself from previous research by focusing on the impact of
health education on different aspects of posture practices, including
maintaining a healthy weight and engaging in effective warm-up exercises before
physical activity.
METHOD
This study
employed a pretest-post test quasi experimental design to investigate the
effect of health education on posture practices towards reduction of low back
pain among patients in Rivers state, Nigeria. Convenience and stratified
sampling techniques were adopted to draw a sample of 50 participants from a
population of 170 patients at the University of Port Harcourt Teaching Hospital
(UPTH) in Nigeria. The sample included 35 patients from the general outpatient
clinic department (GOPD) and 15 patients from the spine physiotherapy unit,
with 20 male and 30 female participants. All participants were diagnosed with
low back pain and met the inclusion criteria of being aged 18-60 years, having
low back pain of three months duration, having a medical diagnosis of this
condition, and not having underlying pathology or surgery. Exclusion criteria
were used to exclude participants who were not qualified to participate in the
study, such as those with mental instability, underlying pathology, infection,
and spinal fracture. The study used the Health Education Effect on Ergonomic
Practices and Low Back Pain Questionnaire (HEEEPLBPQ) as the data collection
tool. In addition, expert review and test-retest methods were used to validate
and establish the questionnaire's reliability, yielding a Cronbach Alpha of
0.75. Mean and standard deviation were used to answer research questions, while
ANCOVA and simple percentage were used to test hypotheses at a 0.05 level of
significance. All respondents completed their copies, demonstrating a very high
level of return rates.
RESULT AND DISCUSSION
Answer to Research
Questions
Research Question 1: What is the effect of
health education on functional posture practices towards reduction of low back
pain among patients in Rivers state?
Table 1. Summary of Mean and Standard
Deviation scores on the effect of health education on functional posture practices
towards reduction of low back pain among patients in Rivers state.
|
S/No. |
Items |
Pre-Test |
Post-Test |
Mean Gain |
|||
|
Mean |
SD |
Mean |
SD |
||||
|
1. |
Warming up before engaging in physical activity to prevent muscle strain or injury to the lower back area. |
1.64 |
0.22 |
3.41 |
0.53 |
1.77 |
|
|
2. |
Maintaining a healthy weight to reduce strain on the lower back area. |
1.58 |
0.14 |
3.38 |
0.53 |
1.80 |
|
|
3. |
Keeping my feet flat on the ground while sitting. |
1.64 |
0.22 |
3.40 |
0.53 |
1.76 |
|
|
4. |
Sitting with a lumbar support cushion. |
1.66 |
0.23 |
3.40 |
0.53 |
1.74 |
|
|
5. |
Maintaining a neutral spine position while standing. |
1.60 |
0.20 |
3.39 |
0.52 |
1.79 |
|
|
Cluster Mean/SD |
1.62 |
0.20 |
3.40 |
0.53 |
1.77 |
||
Research Question 2: What is the effect of health education on
therapeutic posture practices towards reduction of low back pain among patients
in Rivers state?
Table 2: Summary of Mean and Standard Deviation scores on the effect of
health education on therapeutic posture practices towards reduction of low back
pain among patients in Rivers state.
|
S/No. |
Items |
Pre-Test |
Post-Test |
Mean Gain |
|||
|
Mean |
SD |
Mean |
SD |
||||
|
6. |
The practice of strengthening the core muscles through yoga supports the low back and reduces pain. |
1.52 |
0.11 |
3.43 |
0.55 |
1.91 |
|
|
7. |
Forward folds practice can help stretch the hamstrings and relieve tension in the low back. |
1.54 |
0.12 |
3.27 |
0.43 |
1.73 |
|
|
8. |
Practicing hip-opening poses can be beneficial for relieving pain in the low back. |
1.54 |
0.12 |
3.45 |
0.56 |
1.91 |
|
|
9. |
Practicing gentle movements can help improve flexibility and mobility in the low back without causing further pain or injury. |
1.48 |
0.09 |
3.47 |
0.58 |
1.99 |
|
|
10. |
Use of props such as balls, wedges, and straps to aid in exercises improves static balance in individuals with chronic low back pain. |
1.49 |
0.09 |
3.22 |
0.40 |
1.73 |
|
|
Cluster Mean/SD |
1.51 |
0.11 |
3.37 |
0.50 |
1.85 |
||
Test of Hypotheses
Hypothesis 1: Health education has no significant effect on
functional posture practices towards reduction of low back pain among patients
in Rivers state.
Table 3: ANCOVA result for pre-test and post-test analysis on the
significant effect of
functional posture practices towards reduction of low back pain
among patients in Rivers state
|
Source |
Sum of Squares |
Df |
Mean Square |
F |
Sig. |
Partial Eta Squared |
|
Pre-test |
15.43 |
1 |
15.43 |
1.21* |
0.391 |
0.006 |
|
Group |
40.89 |
1 |
40.89 |
9.15* |
0.000 |
0.850 |
|
Error |
66.57 |
48 |
1.39 |
|
|
|
|
Total |
122.89 |
50 |
|
|
|
|
Note: * indicates
statistical significance at p < .05
Hypothesis 2: Health education has no significant effect on
therapeutic posture practices towards reduction of low back pain among patients
in Rivers state.
Table 4: ANCOVA result for pre-test and
post-test analysis on the significant
effect of therapeutic posture practices towards reduction
of low back pain among patients in Rivers state.
|
Source |
Sum of Squares |
Df |
Mean Square |
F |
Sig. |
Partial Eta Squared |
|
Pre-test |
3.90 |
1 |
3.90 |
1.63* |
0.114 |
0.009 |
|
Group |
27.61 |
1 |
40.89 |
5.28* |
0.000 |
0.745 |
|
Error |
92.53 |
48 |
1.93 |
|
|
|
|
Total |
124.04 |
50 |
|
|
|
|
Note: *
indicates statistical significance at p < .05
Analyses of Results
The results
presented in Table 1 displays pre-test and post-test mean scores, standard
deviation, and mean gain of five functional posture practices for reducing low
back pain among patients in Rivers state. Results show that all items
experienced significant improvements, with high mean gain ranging from 1.74 to
1.80. The cluster mean of 3.40 and SD of 0.53 in the post-test scores suggest a
positive effect of the health intervention on patients' functional posture
practices.
Results on
health education's effect on reducing low back pain as presented in Table 2
compared pre and post-test means and standard deviations on 5 therapeutic
posture practices. There was positive improvement in all practices after the
intervention, with the highest gain in gentle movements. Overall, the cluster
mean of 3.37 and SD of 0.50 in the post-test scores suggest posture practices
improved despite lower baseline levels.
The results
presented in Table 3 indicate that the pre-test variable is not a significant
predictor of the outcome variable, which is supported by the F-value of 1.21
and p-value of 0.391. Conversely, it is apparent that the grouping variable has
a notable effect on determining the outcome variable, as evidenced by an
F-value of 9.15 and p-value of 0.000. The Partial Eta Squared value of 0.850
further confirms that about 85% of the variation in the outcome variable is
explained by the grouping variable, even after considering pre-test variables
and error margins.
Results in
Table 4 highlights that the pre-test variable is not a significant predictor of
the outcome variable as shown by the F-value of 1.63 and p-value of 0.114.
However, the grouping variable has a considerable effect on the outcome
variable as exhibited by the F-value of 5.28 and p-value of 0.000. The Partial
Eta Squared value of 0.745 indicates that 74.5% of the variability in the
outcome variable could be explained by the grouping variable even after
controlling for the pre-test variable and error.
Discussion of Findings
The findings of this study
are discussed under the following subheadings:
Effect of Health Education
on Functional Posture Practices towards Reduction of Low Back Pain among
Patients in Rivers State
The
effectiveness of health education interventions in improving functional posture
practices towards reducing low back pain among patients has been demonstrated.
Patients who were educated about the importance of maintaining a healthy
weight, warming up before physical activity, sitting with a lumbar support
cushion, maintaining a neutral spine position while standing, and keeping feet
flat on the ground while sitting had significantly reduced the occurrence of
low back pain. This effect was observed irrespective of prior knowledge or
skills. The grouping variable, which determines whether an individual was
assigned to a control or intervention group, played a critical role in
explaining the variation in patient outcomes following health education programs
for low back pain. The results of various studies including (Garcia
et al., 2023)and (Hu et
al., 2023) confirm the foregoing.
The studies confirmed that health education interventions have also been found
to result in better functional status, reduced disability, and overall
improvement in quality of life. Further, research conducted by (Roseen
et al., 2023) suggested that postural
education can significantly reduce low back pain. In addition to this, (Kanaan et al., 2023) study showed that
combining health education with exercise can extensively improve pain levels,
disability outcomes, and quality of life for those dealing with chronic low
back pain.
Effect of Health Education
on Therapeutic Posture Practices towards Reduction of Low Back Pain among
Patients in Rivers State
The results of
our study suggest that health education intervention can effectively improve
therapeutic posture practices and reduce low back pain among patients in Rivers
state. Specifically, we observed significant improvements in gentle movements
practice, hip-opening poses, and core muscle strengthening through yoga. These
findings are consistent with previous research(Roseen et al., 2023); (Roseen et al., 2020)highlighting the benefits
of yoga and gentle movements for low back pain management (item 6 and 9).
Additionally, the use of props during exercises was found to enhance static
balance among individuals with chronic low back pain, supporting similar
studies (item 10). Nevertheless, not all of our findings align with previous
research. For instance, while forward fold practice has been identified as a
helpful technique for relieving tension in the low back by some researchers (Kamraju
et al., 2023), our study did not
observe the same level of improvement (item 7). Similarly, although studies
have demonstrated the effectiveness of practicing hip-opening poses for
reducing low back pain (Ragoonaden
et al., 2012), our study found
relatively smaller gains in this area (item 8).
CONCLUSION
Based on the
findings of this study, it can be concluded that health education intervention
is an effective strategy for improving functional and therapeutic posture
practices among patients with low back pain in Rivers state. The results of the
study were consistent with previous research, highlighting the effectiveness of
certain postures and movements such as gentle movements practice, hip-opening poses,
and strengthening core muscles through yoga. However, further exploration is
needed for understanding certain findings related to forward fold practice and
practicing hip-opening poses. The use of props in exercises was also found to
be beneficial for individuals suffering from chronic low back pain by enhancing
static balance. These findings align with other studies conducted in this area.
Based on these results, it is recommended that healthcare providers incorporate
health education interventions including proper posture practices into their
treatment plans for patients with low back pain. Furthermore, incorporating
props into exercise routines may aid in improving static balance in these
individuals.
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|
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2023 by the authors. It was submitted for possible open-access publication
under the terms and conditions of the Creative Commons Attribution (CC BY SA) license (https://creativecommons.org/licenses/by-sa/4.0/). |
