Abstract
Background: Pain is one of the main causes of poor quality of life in patients with Parkinson's disease. According to research, the percentage of Parkinson's patients with back pain is 37.1% and the VAS (Visual Analog Scale) pain score is 5.65. The Quality Control Circle method can be used to analyze possible causes of low back pain in patients with Parkinson's in a multi-directional manner to achieve an integrated treatment outcome.
Approach: We aimed to use the Quality Control Circle (QCC) method to improve low back pain in patients with Parkinson's disease, with an expectation of a 1.37 point decrease in VAS as reaching a clinically important difference. 6 patients with Parkinson's disease who had low back pain were referred from the Parkinson and Movement Disorder Holistic Treatment Center of the National Taiwan University Hospital Hsin Chu Branch.
The Cause & Effect Analysis Diagram was used to analyze the influencing factors of the theme, and the four components of chronic postural problems, slow movement, low patient motivation and nutritional imbalance were used for the analysis of the important factors.
The four dimensions were analyzed into more specific factors and surveyed by patients through questionnaires, and the three highest scored items (tilted posture, poor balance, and limited exercise) were selected by the patients as the three key factors for improvement of this QCC.
Based on the brainstorming of the three key factors, 10 programs were developed and evaluated by the circle members. Depending on the scores, four countermeasures were selected as the central concept of this QCC (core training, balance training, group exercise class and exercise series) .
Countermeasure 1: Utilize core training to improve poor posture caused by tilting posture.
Countermeasure 2: Use balance training to improve slow movement caused by poor balance.
Countermeasure 3: Use group exercise class training to improve the slowness of movement caused by little exercise.
Countermeasure 4: Improve the slowness of movement caused by less movement by utilizing the exercise series program.
Improvement activities were designed for the above four main strategies, and the implementation, evaluation and review of the effectiveness of each strategy were carried out smoothly.
Results: After the circle members implemented core training, balance training, group exercise classes, and exercise series program, the VAS of low back pain was reduced from 5.6 to 3.3, a decrease of 2.3 points exceeding the target set, and the patient's tilted posture, poor balance, and lack of exercise also improved significantly. This integrated strategy led to good results, therefore relevant strategies are now included in the patient's regular treatment process.
Implications: The QCC method was able to analyze factors to reduce the low back pain of patients with Parkinson's disease, and through the implementation of the targeted strategies, low back pain decreased in patients with Parkinson's disease, and at the same time improved the patient's tilted posture, poor balance, and lack of exercise, which resulted in significant implementation results.