Effectiveness of an 8 week Physiotherapy intervention program for Rural Women having Lumber Disc Herniation with cauda Equina Syndrome in Jashore, Bangladesh.

Background – Cauda equina syndrome (CES) is a complication associated with lumbar disc herniation (LDH). Women in rural lower-middle income countries (LMIC) pose a greater risk of impairments to bladder and bowel control, sensory and motor functions, and may experience increased pain intensity due to a lack of accessibility to rehabilitation services. Physiotherapy management, the McKenzie technique and Kegels have previously demonstrated a positive impact on pain intensity, bowel and bladder control, and functioning in patients with LDH and CES. This study aims to explore the effectiveness of an eight-week Physiotherapy intervention in women with LDH and CES living in rural Bangladesh and their experiences of receiving rehabilitation.

Methods – The study will be a mixed method using one arm pre and post-test design and in-depth interview with a convenience sampling will be carried out to evaluate the effectiveness of a Physiotherapy intervention program in women from rural villages surrounding Jashore, Bangladesh over an eight-week period. Data will be collected from the participants through pre-post-test outcome measures: Pain intensity using the Visual analogue Scale, neurological function through the American Spinal Injury Association (ASIA) assessment, bladder function using an ultrasonographic evaluation of post-void residual volume, pelvic floor function including strength and endurance using a dynamometer. Functioning will be measured through the Oswestry low back disability Index as a secondary outcome. Data will be analyzed using a paired t-test and regression analysis. Focus group interviews will also be conducted with a sub-sample of participants to explore their experiences of the intervention and receiving rehabilitation. This data will be analyzed using an inductive thematic reflexive approach. A concurrent triangulation approach will be adopted with quantitative and qualitative data being integrated at the point of interpretation and presented in a joint-display table.

Discussion – This study aims to provide short-term rehabilitation and promote long-term self-management techniques to marginalized women with the highest risk of disability to enhance their physical and functional ability, social life and engagement in activities of daily living. We will reach a community that may otherwise have not sought treatment due to a lack of time and resources.