Effects of sleeping postures on back pain, quality of life and sleep quality

INTERVENTION: To check the hypothesis related to differences in back pain, quality of life indices and sleep quality indices, three groups were created after an initial analysis of postural behaviors during sleep period. All participants (males and females, students and military) were separated into 3 groups, conveniently chosen according to the self‐related level of back pain and quality of life indices to homogenize the sample. So, each group was linear at baseline with four male and four female in each group: i) Experimental Group (EG); ii) Placebo Group (PG) and; iii) Control Group (CG). i) Experimental Group (EG) Based on Gracovetsky (1987), Haex (2005) and Tetley (2000), individuals in the Experimental Group (EG) were instructed according to the method used in this study, which represents the recommendations of the ideal sleeping posture with the optimal quantity and place of use of pillows (using a pillow in mixed position) considering the pathological problems or the amount of back pain reported (Intervention program). Firstly, the principal investigator gave to the participants initial instructions in a lecture for a small group with 30 minutes of duration. Second, weekly positive reinforcement with 15 minutes of duration plus sending the presented material and informal contact through e‐mail and phone, as preferred by the participant, were given. Thus, participants in EG (Group I – Experimental), altered the initial body posture while sleeping to: a) Lateral decubitus right or left, for participants with neck and dorsal pain, the use of a pillow under the lateral head / neck with height of the distance between the shoulder and the neck of each participant, a pillow between the knees and a pillow between the arms or; b) Supine, for participants with low back pain, with the use of a low pillow (5 cm) below the head / neck and a pillow or high roller (15cm height) below the knees. These positions have been indicated depending the pain area in order to keep a good balance and alignment of the spine and distribute the body's weight over the entire surface of the mattress (Haex, 2005; Desouzart, Matos, Melo, & Filgueiras, 2016; Verhaert, et al., 2012; Gracovetsky, 1987). These indications will be held every day for the duration of this study (3 month), which provided a continuous reinforcement of the method through informal contact via email and mobile phone for any questions and issues. ii) Placebo Group (PG) To prove the reliability of the method, an intervention was performed with a second experimental group (Placebo Group – PG) that received and perform the technique of progressive muscle relaxation Jacobson (Jacobson, 1938; Toledo & Bara Filho, 2007). Later designated Group II ‐ Placebo. Jacobson's relaxation technique, also known as progressive relaxation therapy, is a type of therapy that focuses on tightening and relaxing specific muscle groups in sequence. Again, the principal investigator conducted an initial lectures during 30 minutes with a small group, and weekly positive reinforcement for 15 minutes (with sending the material presented and informal contact through e‐mail and phone, as preferred by the participant) CONDITION: Non specific chronic back pain Sleep disorders PRIMARY OUTCOME: Observations of sleeping posture behaviour in 24 young adults assessed over three nights using video analysis and iSEE software. INCLUSION CRITERIA: ‐ Clinical diagnosis nonspecific chronic back pain ‐ Young adults aged between 18 and 25 years old ‐ Lived in collective residences (such as the case of university students and the Air Force Military) Progressive relaxation is a technique of fourteen groups of exercises in which 16 muscle groups (Head and face, anterior trunk, posterior, superior and inferior, upper and lower limbs) they are relaxed one after another. Each group is first placed in tension and then relaxed several times, achieving a relaxation ever‐deeper muscle group. The following stress‐relaxation of every muscle group is repeated to achieve relaxation in the muscles in question, equal to the relaxation in parts already relaxed, at least three repetitions in each group. These details were also held every day for the duration of the study for approximately 15 minutes per day immediately before bed throughout the intervention period. This relaxation technique was considered Placebo because the participants were informed that this intervention was shown for the relief of back pain. However, little or nothing is referenced in the literature on the effectiveness of the technique of progressive muscle relaxation approach recommendations for aspects such as back pain or improve quality of life (Toledo & Bara Filho, 2007; Laloni, 1997; Davis, Eshelman, & Mackay, 1996; Junqueira & Ribeiro, 2006). At the end of the 3rd month, all subjects (EG, PG) were re‐filmed during 3 consecutive nights to analyze whether recommended changes were implemented. Participants were also asked to fulfill a questionnaire about the level of pain, quality of life and quality of sleep as well as a functional daily to see if there was any change in behavior or in the environment. SECONDARY OUTCOME: Analysis of intervention ergonomic program in sleep period with questionnaire about severity of back pain, assessed by visual analogue scale (VAS). Analysis of intervention ergonomic program in sleep period with questionnaire about severity of Quality of life, assessed by WHOQOL‐Bref. Analysis of intervention ergonomic program in sleep period with questionnaire about severity of Sleep quality, assessed by Pittsburg Sleep Quality Index (PSQI). Analyze adherence to postural recommendations, assessed over three nights using video and iSEE software.