Back Care Instructions in Physical Therapy: A Trend Analysis of Individualized Back Care Programs

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Abstract
Background and Purpose. The treatment of people with low back pain often includes giving a variety of instructions about back care. The objective of our study was to explore the content and sequence of these instructions. Subjects. Our database contained information on 1,151 therapy sessions for 132 patients who were treated by 21 therapists. Methods. Hierarchical linear modeling was used to establish trends in instructions during the course of treatment. Instructions were measured by means of a registration form. Results. Pain management instructions were given at the start of treatment and then decreased in later sessions. Instructions about taking care of the back in daily activities followed the same course. Exercise instructions were introduced after the start of treatment and were spread evenly across the visits. The number of recommendations about general fitness decreased during treatment. Conclusion and Discussion. The majority of back care instructions were spread evenly across therapy visits. Relatively little variation in instructions among patients was seen, which may indicate a lack of individualization of the back care programs.