TP9.1.5Optimizing Patient Outcomes and Improving Organization Efficiency through Enhanced Management of Low Back Ache and Sciatica

Aim This study was undertaken to tackle the rising incidence of Low Back Ache and Sciatica in a primary care government setup, which had contributed to a disabled and diminished workforce. The aim being improving patient outcomes by implementing changes in the current management protocol (measured against the standard NICE guidelines by an initial clinical audit) Method Two Plan-Do-Study-Act (PDSA) cycles were implemented post an initial clinical audit among 59 patients of the institution. Data was collected using self-made questionnaires and then analyzed. Re-audits were done to measure the outcome against a set standard. Results 20-30% (n = 12-18) of patients were aware of their risk category, understood various treatment modalities and use of orthotics in the initial clinical audit. 56% (n = 33), 73% (n = 43), 88% (n = 51) of the patients were absent from work or had diminished work output, were offered imaging and were put on medication respectively. 10% of the patients were offered psychological counselling. Post implementation of changes from the first PDSA cycle, the set target of 90% was achieved in most of the categories. Further, 24% (n = 14) of patients reported that they were still apprehensive about their condition. A second PDSA cycle was undertaken and post implementation of changes, the set standard of 10% or less patients being apprehensive was noted. Conclusions Increased awareness among patients through means of regular educational sessions, psychological counselling, updated management protocols have led to healthier patients, less absence from duty and improved work output thereby increasing the organizational efficiency as a whole.

Adverse events associated with COVID-19 vaccination among health care professionals of Himachal Pradesh- a Rapid Survey.

Background: The rolling out of the COVID -19 vaccination programme was accompanied by several doubts including the safety and occurrence of adverse effects after the vaccination. Methodology: A cross sectional study was conducted amongst the health care professionals working in the state of Himachal Pradesh to assess the frequency and types of side effects associated with the administration of Covid-19 vaccines using a semi structured questionnaire floated through a Google form. Result: Of the 187 responses received, after the 1st dose, 37.5% participants reported malaise, 31% myalgia, 36.4% low-grade fever, while 18.5% high-grade fever. Mild reactions at the injection site were reported by 37.5%, headache was reported by 3%, low back ache, drowsiness, giddiness and diarrhea were reported by about 3%. No reactions were reported by 18.5% of the participants. After the second dose, 51.8% did not report any adverse event, 17.1% reported malaise,15.2% reported low grade fever, 3% reported high grade fever, 20.1% reported mild reactions at the site of injection while 4.2% reported drowsiness, breathlessness on exertion, nausea, low back ache and diarrhea. Conclusion: The frequency of adverse events with COVID -19 vaccines is not higher than those observed with other commonly used vaccines.

RELATIONSHIP BETWEEN SACRALIZATION AND LOW BACK PAIN IN RURAL POPULATION

Sacralization is an embryo congenital defect in which the fifth lumbar vertebra is fused to the sacrum in various degrees. The prevalence of sacralization is 7.5 percent. Sacralization can be unilateral or bilateral. This disorder arises due to irregularities in the lumbosacral spine segmentation during development. Transverse process of the L5 on one side or both sides is wider than usual and fuses into the sacrum or ilium or both in the sacralization of the fifth lumbar vertebra. Low back pain is the most common symptom in most of the population throughout their lifetime. As low back pain is a leading cause of disability, interfering with quality of life and job outcomes our goal is to assess the association between sacralisation and low back pain. Purpose: To study the relationship between sacralization and low back pain. Because the role of sacralization throughout causing LBP is still controversial. This is the observational study which includes 55 participants who have low back ache. The participants are between the ages 60 to 70 years. The intensity of pain was assessed through NPRS. To assess the relationship between Sacralization and low back pain, all the participants were sent for Xray and the presence of Sacralization was assessed by X-ray. We found that there was a significant relationship between sacralization and low back pain. The patients with sacralization show the high intensity of low back pain. We concluded that Sacralization affects the lumbosacral spine in different ways and result in pain in lower back. And there is significant association of sacralization with low back ache.

Synergistic effects of Vitamin D and magnesium in non-specific low back ache (nLBA) – A prospective comparative study

Low back ache constitute a group of symptoms with no clear etiopathogenesis and pose a major difficulty for a health care professional to diagnose and treat the disease per se. Low back ache has become permanent disability for certain individuals and interferes with normal functioning of day-to-day life activities. This study was undertaken to establish the correlation and functional outcome between combination of Vitamin D & magnesium supplementation and Vitamin D supplementation for patients with non-specific low back ache. An observational comparative study was performed with 117 patients of non-specific low back ache from June 2019 to May 2020. Out of 117 patients, a total of 60 patients (Group A) were treated with a combination of Vitamin D supplementation along with magnesium tablets for 3 consecutive months and remaining 57 patients (Group B) were treated with Vitamin D supplementation for 3 consecutive months. Both the groups were followed up for 6 months for pain relief assessed by VAS score and functional improvement in quality of life assessed by Oswestry Low Back Pain Disability Questionnaire. A significant difference was noted in the Group A compared to Group B which demonstrates an additive effect on the combination used in them. When analysing the change in parameters compared to the pre-interventions state both the groups showed significant improvements. However, upon analysis of the correlation between the parameters with regard to the change among the groups, we noted that Group A showed significant correlation with respect to the Calcium and Vit-D level improvement out of the intervention upon the observed results. Treatment of non-specific low back ache with vitamin-D and magnesium shows synergistic effects with significant improvement in the functional outcomes and the pre-intervention metabolic parameters.

A CASE STUDY: ANUVASANA BASTI WITH KETAKYADI TAILAM IN LOW BACKACHE

Low back ache is the pain in the lumbo-sacral region triggered by combination of factors like muscle strain, overuse, injury or trauma to muscles, ligaments and disc that support the spine. A diagnosed case of Low back ache came with complaints of pain over low back region, stiffness and limitation in the movements of lumbo-sacral joint since 2 years. There was no history of trauma or fall and other systemic illness. A positive family history was noted. In Ayurveda, it can be correlated with Asthigata vata and deranged Vata dosha is the main cause for pain. The primordial treatment for Vata dushti is Basti, especially Anuvasana vasti. Ketakyadi taila is very effective in Asthigata vata. So Anuvasana Basti with Ketakyadi tailam is administered continuous 9 days. The clinical symptoms like low back pain and stiffness got relieved markedly on 5th day itself. After the entire treatment the condition of the patient improved remarkably.

STUDY OF GRIDHRASI AS SCIATICA AND ROLE OF SCIATICA NERVE (GRIDHRASI)

Gridhrasi is such an entity enumerated into eighty types of Nanatmaja Vataj Vyadhies. It is characterized by its distinct pain emerging from buttock and goes towards the heel of afflicted area. On the basis of symptom complex it can be broadly correlated with disease Sciatica in modern science. Ayurveda is a simple practical science of life and its principles are universally applicable to each individual for day to day life. Ayurveda speaks of every elements and facts of human life. Each and every human being desires to live happy and comfortable life but it is not possible owing to multiple factors related with changing lifestyle, environmental factors etc. As the advancement of busy professional and social life improper sitting posture in offices, factories, continuous and over exertion, jerk movements during travelling and sports. All these factors create undue pressure to the spinal cord and play a chief role in producing low back ache and Sciatica.

DIVERSIFIED HISTOPATHOLOGICAL INTERPRETATION OF SPINAL CORD LESIONS IN A TERTIARY CARE CENTRE IN LAST TWO YEARS: AN ENIGMATIC OBSERVATION

Spinal lesions may present in any age group and may be incidental or commonly present as back ache. Metastatic deposits are the commonest encountered entities, but primary lesions may also be found. Often they may be a part of systemic disease. Appropriate history, imaging studies and tissue diagnosis is essential to arrive at denitive diagnosis. This series focus on 7 varied diseases of spinal cord that may pose a diagnostic challenge for the pathologist and clinicians.

A CLINICAL COMPARATIVE STUDY TO EVALUATE THE EFFECTIVENESS OF RASNA SWADAMSTRADI KSHEERAPAKA WITH SUKUMARAM KASHAYAM IN SPASMODIC DYSMENORRHOEA

Many women are familiar with the experience of spasmodic dysmenorrhoea, one of the commonest gynaecological conditions that affects the quality of life of many in their reproductive years. This condition manifested as painful menstruation, is the most frequently encountered gynaecological complaint and it can be included under Udavartha yonivyapat, caused by Apana vata vaigunya described in Ayurvedic classics. As the condition has significant effect on quality of life, personal health, and working hours and there are several limitations and adverse effects in modern medicine, its Ayurvedic management is of great importance. Randomized clinical study was conducted in Govt. Ayurveda College Hospital for Women and Children, Poojappura to evaluate the effectiveness of Rasna swadamstraadi ksheerapaaka in spasmodic dysmenorrhoea and to compare its result with that of Sukumaram kashayam. Total 30 patients between the age group 15-35 yrs were taken in to the study who had complaints of severe or moderate lower abdominal pain and associated complaints such as low back ache, nausea, vomiting, diarrhoea, and allocated them into two groups. Study group were treated with Rasna swadamstraadi ksheerapaaka and control group with Sukumaram kashayam. Administration of drug started10 days before menstruation and continued till 4th day of menstruation for 3 consecutive cycles for study group and control group. Follow up without medicine was done for next 3 consecutive cycles for both the groups. Results were analyzed and compared statistically. The research drug Rasna swadamstraadi ksheerapaaka had shown effectiveness in controlling pain in spasmodic dysmenorrhoea and associated symptoms like low back ache and nausea, but in the case of vomiting, and diarrhoea it showed less sustained action in follow up period. The control drug Sukumaram kashayam had also shown effectiveness in controlling pain in spasmodic dysmenorrhoea and associated complaints nausea and low back ache. But in the case of vomiting, and diarrhoea this medicine also showed less sustained action in follow up period. On conclusion the study revealed that the research drug Rasna swadamstraadi ksheerapaaka and control drug Sukumaram kashayam are equally effective in treating spasmodic dysmenorrhoea, without any side effects.

Outcome of transforaminal nerve root block using posterolateral approach in patients with low back ache due to PIVD in a tertiary care centre of North India

Background: Back ache has become a common phenomenon in our society, reason being our sedentary and unhealthy lifestyle. Transforaminal administration of steroid and analgesia is an important modality in the conservative management of prolapsed lumbar disc. The aim of this study is to assess functional outcome of transforaminal epidural analgesic injection in cases of chronic back pain due to prolapsed intervertebral disc.Methods: 152 patients who fulfilled the inclusion and exclusion criterias were given the block and were compared pre and post injection using ODI score.Results: Most patients in study were in fourth or fifth decade and had complained of pain for more than a year. L4-L5 was found to be the most common level involved. Post injection 129 patients out of 152 reported minimal pain and most of the patients reported improvement in pain post block.Conclusions: We concluded that tranforaminal block is an effective method of achieving pain relief in most patients for some duration and can help in delaying and in some cases avoiding the need for surgery.