Back & Neck
programme

MANAGEMENT PROTOCOL

“When low-back pain becomes chronic and disability more ingrained, an intensive interdisciplinary treatment approach is required because these patients have complex needs and requirements, and because of the deleterious effects of physical deconditioning … thus, this stage of treatment is much more complex and demanding of healthcare professionals working independently. Consequently the strengths of multiple providers and co-ordinated systems to address the complex issues confronting patients disabled by chronic low-back pain are greatly needed.” Gatchell and Bruga

Evaluation

The contents and duration of the programme depend on the severity of pain, the severity of deconditioning, psychological profile and social needs. These are assessed with validated questionnaires and measurements – not only to define patients’ needs, but also to monitor progress and document outcomes.

The DBC treatment concept is translated into practice by a combination of assessment, treatment and outcome-monitoring protocols. These protocols are all evidence-based.

Treatment reports

Treatment and evaluation reports on progress are generated at baseline, three weeks (or after six treatments) and six weeks (or after 12 treatments) follow-up and intermittently in the maintenance period. Patients are discharged with a choice of home-based, gym-based or DBC-based exercise and pain management programmes.

Functional rehabilitation therapy

The key difference between back-specific and non-specific exercises is that the loading and, subsequently, the effect can be targeted in an isolated and safe way to the lumbar spine.

DBC-trained therapists guide the physical reconditioning programmes. The treatment is primarily based on exercises in iso-inertial rehabilitation devices where correct loading and range limiters ensure exercises are performed in a painless and safe range of motion, targeting the lumbar spine paravertebral muscles.

Treatment includes controlled movements in lumbar and thoracic flexion, extension, rotation and lateral flexion.

The treatment begins with individualised loads. The load is gradually increased until, at the end of the programme, patients are instructed to continue an individualised secondary-prevention programme. This is carried out with or without guidance depending on the patient’s needs.

The aim is to achieve segmental motion of the lumbar spine in a controlled manner.

Cognitive and behavioural support

The patient receives handouts that explain the back problem in layman’s terms. Members of the rehab team also reinforce the benign nature and good prognosis of low-back pain. This, combined with objective measurements of the patient’s progress, result in diminished fear of pain and increased self-efficacy beliefs. DBC provides treatment- and cost-effective solutions to patients, practitioners and funders alike, improving quality of life and maintaining quality of care.

DBC Selection Criteria

Strict inclusion criteria have been developed by DBC internationally and include but are not limited to the following Diagnostic Subgroups:

LUMBAR Inflammatory (Rheumatoid) Post-Traumatic Post-Operative Nerve Root Compression Spinal Stenosis type Pelvic and LBP Spondylolisthesis Spondylolysis Non- Specific Back	CERVICAL Inflammatory Post-Traumatic spinal injury Whiplash associated disorder, WAD Post-Operative Narrowing of Spinal canal Nerve Root Compression Non- Specific Cervical Pain
Outcome: Diagnosis and reconditioning programme model