Lay-tutors in a back school programme
Lorig et al. has explored the use of patients, who
had experienced effective pain relief through self-
management of their own condition, as role models
(6, 7). These studies showed that role models invited
to educational programmes as active partners might
encourage and motivate participants in BSPs. Other
lay-led programmes, such as the Arthritis Self-Mana-
gement Programme (ASMP) for patients with chronic
disease (8), support this observation. Therefore, we
designed a programme that included lay-persons as
tutors for patients with low back pain. To our know-
ledge, no studies have evaluated the long-term effects
of using lay-tutors as active partners in a BSP, compa-
ring them with similar programmes led by healthcare
professionals (5).
The aim of the present randomized controlled
clinical trial (RCT) was to evaluate the effect of ad-
ding a lay-tutor to the educational sessions of a BSP
for patients with subacute low back pain (SLBPP). It
was hypothesized that patients whose education was
facilitated by lay-tutors would be more motivated to
stay active despite pain and to perform activities of
daily living, thereby showing better improvement in
functional capacity, pain and health-related outcomes
than patients taught solely by healthcare professionals.
METHODS
Table I. Procedures during a 10-week intervention programme
including 10 sessions of education and 20 sessions of exercise
Session
number Teacher Topic
1 Welcome and introduction
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Design
This RCT was conducted in collaboration with the rehabilitation
unit “SANO”, local physiotherapy clinics, the Section of Social
Medicine and Rehabilitation and the university rheumatology
clinic, in order to determine effective educational and exercise
programmes. Fig. 1 shows the patient flow through recruitment,
intervention and follow-up.
699
16
17
18
19
20
Lay-tutor and 1
Physiotherapist
Lay-tutor and 1
Physiotherapist
Physiotherapist
Physiotherapist
Lay-tutor
Physiotherapist
Physiotherapist
Physiotherapist
Lay-tutor
Physiotherapist
Time,
min
Motivation
Physical tests
Exercise programme
How to identify individual goals?
Exercise programme
Exercise programme
How to understand diagnosis?
Exercise programme: focus on specific
muscle groups
Physiotherapist Exercise programme: focus on specific
muscle groups
Physiotherapist Activities of daily living
Lay-tutor
Barriers, how to manage?
Physiotherapist Exercise programme: focus on different
muscle groups and movement patterns
Physiotherapist Exercise programme: focus on different
muscle groups
Physiotherapist Activities of daily living
Lay-tutor
Barriers, from where and from whom
can I get help if needed?
Physiotherapist Exercise programme and how to sit
properly
Physiotherapist Exercise programme
Physiotherapist Pain mechanisms
Lay-tutor
What do I do when it hurts?
Physiotherapist Exercise programme and how to relax
Physiotherapist Exercise programme
Lay-tutor
How to cope with pain?
Physiotherapist Exercise programme and how to cope
Physiotherapist Exercise programme
Physiotherapist Exercise habits
Lay-tutor
Exercise habits
Physiotherapist Home exercise programme
Physiotherapist Exercise programme
Physiotherapist Medication
Lay-tutor
Experiences and follow-up
Physiotherapist Exercise programme
Physiotherapist Exercise programme
Physiotherapist Exercise programme
Lay-tutor and 1 Finishing up and questionnaire
Physiotherapist
Physiotherapist Physical tests
30
30
60
60
60
60
60
60
15+45
60
20
40
15+45
60
20
40
15+45
60
30
30
15+45
60
60
15+45
60
20
40
15+45
60
20
40
60
60
60
60
60
Back school programme
Experimental set-up. The BSP was based on self-management
strategies, with the goal of motivating the participants to
stay active and to change their health-related behaviour. The
programme consisted of 2 sessions each week for a 10-week
period, a total of 20 sessions (Table I). Once a week, the patients
participated in a 2-h session with 1 h of education and 1 h of
physical exercises. The other weekly session included only 1
h of physical exercises.
Educational part of the programme. This part consisted of
providing information related to the condition of the patients. It
included disease-specific information on anatomy, pain physio-
logy and ergonomics. General information included how to cope
with back pain in everyday life and provided examples of how
to change bad habits and develop pain-coping strategies. The
patients were encouraged to set personal goals as an important
component in promoting self-management.
In the intervention group, the lay-tutor was responsible
for general information (40 min) and the physiotherapist for
disease-specific information (20 min). In the control group, 2
physiotherapists covered the entire lesson.
Physical exercise part of the programme. Each exercise session
included aerobic training and exercise, focusing on strength,
stability, coordination, balance, flexibility and relaxation. The
sessions were group-based, but were adjusted to accommodate
the individual patient. During each session, the participants were
encouraged to take responsibility for their own progression
through the programme, while the physiotherapists gave exer-
cise instruction, feedback, and acted as motivators. At the end
of the programme, all patients had an individualized physical
exercise plan to follow.
Prior to the study, a detailed manual was developed for both
the educational and the physical exercise components in order
to standardize the BSP. All lay-tutors and physiotherapists
participated in a 2-day introductory course led by clinical
experts in the field of low back rehabilitation. In addition, the
physiotherapists attended a 1-day course focused on the exercise
lessons. A Danish version of the manual is available on request
from the corresponding author.
Intervention. The intervention represented the participation of
the lay-tutor in the educational part of the BSP. The lay-tutors
J Rehabil Med 51, 2019