Clinical Governance and Practice Improvement Assignment Sample

• Subject Name : Nursing

Do the Exercise and Acupressure (c) Is Effective (o) in The Chronic Back Pain (i) in The Trauma Patients (p) in Six Months Period (t)? 

Introduction to Clinical Governance and Practice Improvement

Chronic back pain is characterized as pain that lasts for 12 weeks or more, even after initial injury treatment for the actual problem of acute low back pain is obtained. Around 20 percent of people with acute low back pain experience chronic low back pain for a year with recurring symptoms (Allegri et al., 2016). When the pain occurs, however, it does not necessarily mean that there is a medically relevant underlying cause, or one that can be easily diagnosed and treated. Therapy like acupressure and exercise successfully helps to relieve chronic low back pain for certain patients but in many patients, the pressure persists despite medical and surgical treatment. In this assignment, the chronic back pain in trauma patients is discussed with the effectiveness of acupressure and exercise as an intervention to cure the pain.

With the application of evidence based practice comes quality therapeutic outcomes, which can be associated with a significant reduction of visits and cost for health services. Outdated methods, for example, may have included materials equipment or items which are no longer required for certain techniques or procedures. This offers a mechanism in which the patient health and clinical treatment are collectively accountable to physicians and managers. The goal of evidence-based practice and clinical governance together is to promote safety and quality which can be enhanced in addition to other capabilities in practice (Spigelman & Rendalls, (2015).

Back pain in people experiencing trauma is far more common. Weak spine and stomach muscles failed to protect the spine properly. Patients with trauma are much more likely to have severe back injuries than those who make moderate physical activity a normal routine. Studies show that aerobic exercise with high impact will help maintain the integrity of the intervertebral disks. Clear statistics support the use of exercise-driven treatment in people recovering from serious back pain — typically aiding in rehabilitation (Hurlbert et al., 2015). In contrast with other behavioral strategies, exercise on its own and in conjunction, for example, with cognitive therapy, produces good effects. In chronic non-specific low back pain, exercise therapy consisting of specially tailored programs, including strengthening or relaxing, and being administered with supervision can improve functional capacity (Ahuja et al., 2017).

Another method to ease chronic pain is acupressure is medium effect. This includes pressing through different points in the body and stimulating them (by twisting or going through a low-voltage electrical current), which may allow the brain to produce naturally produced pain-relieving chemicals like endorphins, serotonin, and acetylcholine (Murphy et al., 2019). It has been reported that people who conducted relaxing acupressure reported pain and fatigue reduction compared with the normal treatment community as well as those who performed soothing acupressure felt that discomfort had reduced after 6 weeks. Despite rising levels of opioid abuse, acupressure may be an alternative to drugs for safe pain relief. Some of the medications provided are drugs that have side effects, which can raise the risk of violence which addiction in some cases (Song et al., 2015). Although larger trials are required, acupressure can be a useful technique for pain relief, as it is low risk, low cost, and simple to administer. Acupressure various forms can be used to treat patients with different levels of chronic back pain. 

A randomized controlled trial was performed in a study to assess the efficacy of acupressure and exercise. In 129 patients with chronic low back pain, the pain scores and functional status were tracked for six months and the effectiveness of acupressure and exercise were observed. Statistically important differences existed between the two groups where acupressure in terms of impairment, pain scores, and functional status was successful in minimizing low back pain. The benefit lasted six months (Hsieh et al., 2006).

PICOT

Do the exercise and acupressure (C) is effective (O) in the chronic back pain (I) in the trauma patients (P) in six months period (T)?

Trauma patients with chronic low back pain (CLBP) are equating difficult physical exercise with muscle aches and avoidance of exercise, which is believed to cause pain. Nevertheless, individuals with CLBP are considered to be not active as measured by various activity and disability tests, and significant physical deconditioning levels have been reported in this population (Synnott, et al., 2015). The extent of reported pain is considered to be caused by multiple non-physical factors, and is thus not a reliable or objective predictor for exercise recommendations. Additionally, given ongoing pain effects, substantial changes in physical function can be seen in trauma patients with CLBP. Nevertheless, health care professionals are hesitant to encourage activity resumption, and instead raising clinical activity targets in this patient group due to pain reports. It may lead to an unhealthy sedentary condition that raises this population's risk of ill health and premature mortality.

To reverse deconditioning and boost life function, intensive rehabilitation programs for CLBP patients include improved endurance, flexibility, and strength training. Targets for medical care are not focused on reported pain levels and therapeutic strategies are used to make physical and functional improvement through positive reinforcement (Qaseem et al., 2017). In addition to substantial long-lasting changes in physical parameters of trauma patients following these treatments, there is evidence of improved life function and reduced pain levels. Providing these costly workout therapies like acupressure would seem unreasonable if there is no substantial improvement in the back pain (O’Sullivan et al., 2018). Therefore, the trauma patients undergo exercise therapy, irrespective of the conditions, and put efforts to be required to achieve exercise-adherence consequences and to identify factors influencing therapy.

Conclusion on Clinical Governance and Practice Improvement

This study aimed to develop a PICOT question to investigate compliance with exercise and acupressure in chronic back pain trauma patients following involvement in an intensive spine rehabilitation program in six months. It can be determined whether in six months of back-strengthening exercise, aerobic exercise, back stretching, and weight training rise relative to acupressure is helpful in effective pain treatment in trauma patients having intensive chronic back pain.

References for Clinical Governance and Practice Improvement

Ahuja, C. S., Nori, S., Tetreault, L., Wilson, J., Kwon, B., Harrop, J., ... & Fehlings, M. G. (2017). Traumatic spinal cord injury—repair and regeneration. Neurosurgery, 80(3S), S9-S22.

Allegri, M., Montella, S., Salici, F., Valente, A., Marchesini, M., Compagnone, C., ... & Fanelli, G. (2016). Mechanisms of low back pain: A guide for diagnosis and therapy. F1000Research, 5.

Hsieh, L. L. C., Kuo, C. H., Lee, L. H., Yen, A. M. F., Chien, K. L., & Chen, T. H. H. (2006). Treatment of low back pain by acupressure and physical therapy: Randomised controlled trial. Bmj, 332(7543), 696-700.

Hurlbert, R. J., Hadley, M. N., Walters, B. C., Aarabi, B., Dhall, S. S., Gelb, D. E., ... & Theodore, N. (2015). Pharmacological therapy for acute spinal cord injury. Neurosurgery, 76(suppl_1), S71-S83.

Murphy, S. L., Harris, R. E., Keshavarzi, N. R., & Zick, S. M. (2019). Self-administered acupressure for chronic low back pain: A randomized controlled pilot trial. Pain Medicine, 20(12), 2588-2597.

O’Sullivan, P. B., Caneiro, J. P., O’Keeffe, M., Smith, A., Dankaerts, W., Fersum, K., & O’Sullivan, K. (2018). Cognitive functional therapy: An integrated behavioral approach for the targeted management of disabling low back pain. Physical Therapy, 98(5), 408-423.

Qaseem, A., Wilt, T. J., McLean, R. M., & Forciea, M. A. (2017). Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 166(7), 514-530.

Song, H. J., Seo, H. J., Lee, H., Son, H., Choi, S. M., & Lee, S. (2015). Effect of self-acupressure for symptom management: A systematic review. Complementary Therapies in Medicine, 23(1), 68-78.

Spigelman, A. D., & Rendalls, S. (2015). Clinical governance in Australia. Clinical Governance: An International Journal.

Synnott, A., O’Keeffe, M., Bunzli, S., Dankaerts, W., O'Sullivan, P., & O'Sullivan, K. (2015). Physiotherapists may stigmatise or feel unprepared to treat people with low back pain and psychosocial factors that influence recovery: A systematic review. Journal of Physiotherapy, 61(2), 68-76.

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