1. Alternative Interventions to Treat Chronic Back Pain for Return to Work ASOT 2014 VISION IN ACTION CONFERENCE Casey Smith, OTS January 24 th, 2014

2. Topic Development Leading cause of disability in Americans under 45 years old. Fieldwork experience Personal experience Interest in Alternative (non-Pharmacological) treatments

3. Objectives Main causes for chronic back pain Literature Search What does the evidence say? Practicality of interventions Fieldwork experience Implications for Future Practitioners Questions?

4. Chronic Low Back Pain Chronic pain is any pain lasting longer than 6 months Causes Implications for OT How it is measured?

5. Literature Search Search Engines:  Academic Search Premier: EBSCOhost, PubMed, AJOT, JRRD Key Search Terms:  Chronic pain, chronic back pain, return to work, work hardening, work rehabilitation, work related injury, yoga, yoga and pain management, aquatic therapy, PENS, electrical nerve stimulation, and core strengthening

6. What does the Evidence Say? Clinically Effective  Aquatic therapy  Multimodal Work Hardening with Cognitive behavioral approach  Yoga  Balneotherapy  PENS  Core strengthening Clinically Significant  Surface Perceptive Tool vs. Back School program

7. Practicality of Interventions Replicating some of these studies would be challenging (Balneotherapy, Surface Perceptive tool, Aquatic Therapy). Pain outcomes/measures are subjective Studies carried out in other countries Small sample sizes Length of treatment and duration, and follow up Did not monitor variable of pharmaceuticals How easily could these be implemented?

8. Fieldwork Experience Christian Health Center of Louisville - SNF  Heat, Ice, Ultrasound and TENS, pharmaceuticals Frazier Newburg Road Clinic – Work Hardening Program  Lumbar stabilization exercises, core strengthening, heat, ice, weight lifting, walking, stretching, and work simulation tasks including lifting and carrying weighted objects

9. Future Implications for Practitioners Open to new alternative treatments for back pain Emerging research studies Continued research  Dry needling?  Program development for new facilities  Local programs

10. Questions Email: csmith31@spalding.edu

11. References Baena-Beato, P., Arroyo-Morales, M., Delgado-Fernández, M., Gatto-Cardia, M., & Artero, E. G. (2013). Effects of different frequencies (2-3 Days/Week) of aquatic therapy program in adults with chronic low back pain. A non-randomized comparison trial. Pain Medicine, 14(1), 145-158. doi: 10.1111/pme.12002 Bethge, M., Herbold, D., Trowitzsch, L., Jacobi, C. (2011). Work status and health related quality of life following multimodal work hardening: A cluster randomized trial. Journal of Back and Musculoskeletal Rehabilitation. 24, 161-172. doi: 10.3233/BMR-2011-0290 Denneson, L. M., Corson, K., Dobscha, S.K. (2011). Complementary and alternative medicine use among veterans with chronic noncancer pain. Journal of Rehabilitation Research & Development, 48(9), 1119–1128. doi: 10.1682/JRRD.2010.12.0243 Morone, G., Iosa, M., Paolucci, T., Fusco, A., Alcuri, R., Spadini, E., &... Paolucci, S. (2012). Efficacy of perceptive rehabilitation in the treatment of chronic nonspecific low back pain through a new tool: a randomized clinical study. Clinical Rehabilitation, 26(4), 339-350. doi: 10.1177/0269215511414443 Tefner, I., Németh, A., Lászlófi, A., Kis, T., Gyetvai, G., & Bender, T. (2012). The effect of spa therapy in chronic low back pain: a randomized controlled, single- blind, follow-up study. Rheumatology International, 32(10), 3163-3169. doi:10.1007/s00296-011-2145-y Tilbrook, H. E., Cox, H., Hewitt, C. E., Kang'ombe, A., Ling-Hsiang, C., Jayakody, S., &... Torgerson, D. J. (2011). Yoga for chronic low back pain. Annals Of Internal Medicine, 155(9), 569-W-167. Unsgaard-Tondel, M., Nilsen, T.I.. Magnussen, J., Vasseljen, O. (2012). Is activation of transversus abdominis and obliquus internus abdominis associated with long-term changes in chronic low back pain? A prospective study with 1-year follow-up. British Journal of Sports Medicine. 46, 729-734. doi: 10.1136/bjsm.2011.085506 Weiner, D.K., Rudy, T.E., Glick, R.M., Boston, J.R., Lieber, S.J., Morrow, L.A., Taylor, S. (2003). Efficacy of percutaneous electrical nerve stimulation for the treatment of chronic low back Pain in older adults. Journal of the American Geriatrics Society, 51(5), 599-608. doi: 10.1034/j.1600- 0579.2003.00202.x