Developing and Testing the Feasibility of an Interprofessional Rehabilitation Program for People with Chronic Low Back Pain in Ethiopia

Abstract

Chronic low back pain (CLBP) accounts for the highest number of years lived with disabilities of any health condition, globally. The growing disability burden is largely driven by increases in low- and middle-income countries, including Ethiopia. An increasing body of evidence from high-income countries supports the effectiveness of interprofessional rehabilitation programs, integrating physical, psychological, and vocational components, for people with CLBP. In contrast, CLBP care in Ethiopia remains predominantly biomedical, fragmented, and misaligned with international best practices. To bridge this gap, this research aimed to systematically develop a context-specific interprofessional rehabilitation program for people with CLBP in Ethiopia and test the feasibility of a future trial to evaluate its implementation and effectiveness. To address the above research aim, a multi-methods approach was employed, comprising four interconnected studies conducted in two phases, with each study informing the next. Phase one focused on program development and included three studies: a scoping review to synthesize evidence, a Modified Delphi study to build consensus among experts on the targeted outcomes and key characteristics of the program, and an interpretive description qualitative study to explore barriers and facilitators. Phase two involved a pilot randomized control trial (RCT) with an embedded process evaluation to evaluate the feasibility of implementing the program and carrying out a future full-scale trial. The interprofessional rehabilitation program for people with CLBP developed in this research was evidence-informed and tailored to the Ethiopian health system through a steering group of experts and input from people with CLBP. The final interprofessional rehabilitation program integrates physical activity and exercises, education, psychotherapy, and ergonomics interventions delivered by an interprofessional team. The program is an outpatient intervention grounded in the biopsychosocial model, comprising 12 group sessions and 24 individual sessions delivered over four weeks (2 hours/day, 4 visits/week). The pilot RCT demonstrated feasibility of the interprofessional rehabilitation program in Ethiopia, and feasibility estimates support a future full-scale trial. This research lays a foundation for a future large-scale trial evaluating the effectiveness and implementation of an interprofessional rehabilitation program for CLBP in Ethiopia and offers a methodological roadmap for developing and evaluating complex interventions in low-resource settings.