1.0 Introduction
The author is an independent consultant occupational physician covering a wide range of industry in the West Midlands and Wales and he is aware of the major cost of sickness absence on industry and the NHS, due to chronic back pain. He is also aware of the government's recent drive to reduce the numbers of people in the UK on long term incapacity benefit, especially with chronic back pain.
The author has seen many severe cases of chronic mechanical back pain or 'failed backs' that do not seem to have received optimal treatment under the current system.
The evidence shows that at least 90% of acute mechanical low back pain (LBP) episodes will recover well within six weeks and they will be able to return to their usual work1. Unfortunately many people continue to suffer severely with chronic back pain, despite receiving maximum analgesia from their doctors, excellent surgery from spinal surgeons and also many sessions of physiotherapy or manual therapy from osteopaths and chiropractors. There is strong evidence that the longer an employee is off work with low back pain, the lower are their chances of ever returning to work. After 1-2 years absence it is unlikely that they will return to any form of work in the foreseeable future, irrespective of any further treatment2.
The Springback™ treatment also incorporates the use of a device; called the Power-Assisted Mobilisation (PAM) tool, which seems to assist an experienced therapist in more effectively mobilising the whole spine, while allowing the natural healing process to take place, according to its inventor, Robert Taylor. Usually there is a dramatic restoration of spinal mobility and a subsequent relief of chronic and disabling back or neck pain. The author first saw this machine or 'tool' demonstrated in 1997/8 at an airbase by a physiotherapist, who found it greatly helped the many chronic back cases and also the fast jet pilots with their back pain, due to prolonged sitting in cramped cockpits.
2.0 Methods
2.1 Population to be studied and the criteria for inclusion
At this stage, the author wanted to investigate approximately 70 cases seen at the Springback clinic (between the 13 June 2008 and the 12 August 2008), and he found that 58 (83%) agreed to take part. The last 70 cases were chosen to avoid any risk of errors in selection.
2.2 Controls
Not required at this preliminary stage for a case study.
2.3 Design
Retrospective case study using an anonymous patient identifying code.
2.4 Group code and chronicity
A group code would be used to designate cases into groups 1-5, as used in a similar Oswestry study:
Group 1: chronic mechanical backache, without evidence of degenerative changes
Group 2: prolapsed intervertebral disc and sciatica
Group 3: degenerative spinal disorder (Based on patient records and investigations)
Group 4: spondylolysis and/or listhesis (Based on patient records and investigations)
Group 5: post surgical patients with chronic pain
The author planned to look at chronicity in years, as with the Oswestry study, i.e. whether the patients were working, not working or retired, or not working due to their back problem and he also asked them about the effects on their lifestyle; what areas were painful and their views on the likely causes. See 3.3 and 3.4.
2.5 Other measurements
See 3.6 below; they were asked what areas had been affected; lower back, leg pain, neck pain etc. Also, if there was any history of accidents, either at home or work, sports injury, any diagnosis of arthritis or osteoporosis; see 3.7. The author asked about the types of medication and physical treatment they had received; such as surgery, physiotherapy, manipulation, acupuncture and how effective it had been; see 3.8.
2.6 Measurement of response
The author asked how they heard about the Springback clinic; when did they start treatment; were they told all about the treatment; had it been beneficial and how many treatments had they had. Some of these patients had been coming to Springback for a number of years from all over the UK and from abroad, for regular top up treatments.
2.7 Agreements
All patients were notified of the case study and told that the results would be strictly anonymous and they were also asked how they were functioning on a daily basis at present, with the help of the questio