Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Department of Chiropractic, Durban University of Technology, Durban, South Africa, 2016. / BACKGROUND: Low back pain (LBP) is a major health problem and a leading cause of disability worldwide, accounting for numerous medical and chiropractic consultations. Risk factors for developing as well as perpetuating LBP have been recognised, including psychosocial factors and to a lesser extent organic diseases. There is good evidence for the role of biological, psychological, and social factors in the aetiology and prognosis of back pain. The biopsychosocial model developed by Waddell (1987) has become a dominant consideration in determining the aetiology and prognosis of back pain, and has led to the development and testing of many back pain care interventions. This includes a focus on identifying and treating ‘yellow flags’ which are psychosocial factors that may result in LBP becoming chronic, and incorporating the treatment of these ‘yellow flags’ as a component of LBP care. AIM: The aim of this study was to determine a psychometric profile of patients attending the Durban University of Technology (DUT) Chiropractic Day Clinic (CDC) with non-specific LBP using the Keele STarT Back Screening Tool (SBST) and Bournemouth Questionnaire (BQ). METHODOLOGY: Once ethical clearance was obtained to conduct the research study at the DUT CDC, all patients over the age of eighteen presenting to the DUT CDC with non-specific LBP as new patients, or as former or current patients presenting with non-specific LBP as a new complaint, were directly approached by the researcher. The prospective participants were asked a series of screening questions in order to ensure that they qualified for the study. A total of 132 participants completed an informed consent, a pre-validated questionnaire, the SBST and the BQ. The questionnaires took approximately ten to fifteen minutes to complete; participants were given the choice to complete them either before or after their appointment so as not to interrupt the treatment time. All informed consents and completed questionnaires were collected by the researcher and stored in separate sealed ballot boxes. All questionnaires were kept confidential and only seen by the researcher and supervisor. A code was allocated to each questionnaire before data was captured on a spreadsheet for data analysis. The IBM SPSS version 22 was used for data analysis by a biostatistician. RESULTS: A total of 132 questionnaires were utilised for statistical analysis. Based on the SBST, 47.7% (n = 63) of the total population (N = 132), had a low risk of developing chronic LBP, 28.8% (n = 38) had a medium risk of developing chronic LBP, and 23.5 % (n = 31) had a high risk of developing chronic LBP. The BQ indicated that 63.6% (n = 84) of the total population (N = 132) scored 35 or less and thus had a low risk of developing chronic LBP, while 36.4% (n = 48) scored above 35 and thus had a medium to high risk of developing chronic LBP. A very strong association was found between the SBST and BQ risk groups (p = <0.001). A total of 87.1% (n = 27) of the participants who had a high risk of chronicity according to the SBST (N = 31) also had a high risk of chronicity according to the BQ. The female gender, being a current smoker and partaking in little or no physical activity were found to be statistically significant risk factors for chronic LBP. CONCLUSION: The results in this study suggest that patients presenting to the DUT CDC supports the notion that chronic LBP is a multifactorial condition with significant psychosocial implications and should be approached as such. / M

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2017. / Background: The increasing cost and prevalence of chronic low back pain (LBP), has resulted in more resources being devoted to its treatment and management than ever before, despite only approximately 10% of acute cases progressing to chronicity. Determining prognostic factors for the short-term improvement of acute and chronic patients with LBP has become a research focus area to try and identify baseline factors that may affect a patients’ improvement with conservative treatment. Internationally studies have been conducted in developed countries however similar studies are lacking in developing settings like South Africa. It is unclear if the prognostic factors identified would be similar across populations. Thus, this study aimed to determine if pain, disability (social and physical), anxiety, depression, work fear-avoidance and locus of control, were associated with short-term prognosis, as determined by self-reported improvement using a Patients Global Impression of Change (PGIC) scale, in acute and chronic LBP patients attending the Durban University of Technology Chiropractic Day Clinic (DUT CDC). Method: Consecutive patients seeking treatment at the DUT CDC with a new episode of non-specific LBP, who met the study criteria, were approached for participation in the study. On agreeing to participate they were given the Bournemouth Questionnaire (BQ), a demographic questionnaire and a letter of information and consent (LOIC) at the initial consultation by student chiropractors. Those participants that were still attending treatment at the 4th/5th and tenth visit were required to complete the BQ and the PGIC. Results: A hundred participants were enrolled in the study, 65% had acute LBP and 52% were male. Only 20% of the initial group were still attending treatment at the 4th/5th follow-up. Baseline comparisons of those with acute and chronic pain revealed no significant difference in gender or age. Acute patients at the initial visit had higher levels of disability (social and physical), anxiety, depression and fear-avoidance beliefs than the chronic pain participants. At the 4th/5th treatment, the acute pain patients showed a significant decrease in pain (p=0.002) and disability (p=0.032), with all other measures decreasing from baseline measures. Similarly, chronic pain participants had a significant decrease in pain (p=0.038) but a significant increase in depression (p=0.015) scores, with all other prognostic factors being rated higher than at the initial consultation. The majority of participants (85%) in this study reported a clinical improvement in their LBP. In the acute pain sufferers, all but one participant reported improvement, thus identification of prognostic factors or this group was not possible. In the chronic pain participants, no factors were identified as prognostic for improvement, regardless of the low numbers still attending at the 4th/5th visit. Conclusions: Trends suggested that chronic pain sufferers were less likely to report decreases in the prognostic factors (except for pain), when compared to the acute pain participants. In the chronic LBP participants, no factors were associated with improved prognosis. The predictive value in determining which patients were less likely to improve was limited in the current study due to a small sample size. / M