Keywords: Chronic, Lowe Back Pain, Wellness, Physical Exercise

Setting:

Setting
This quality improvement project was implemented at Leabaib Wellness Center, a primary care–based wellness facility within the Primary Health Care Corporation in Qatar. The program ran in consecutive Plan–Do–Study–Act (PDSA) cycles from May 2022 to December 2025, using the center’s gym and swimming pool to deliver structured exercises for adults with Chronic Low Back Pain (CLBP).

Target group:

The project targeted adults with CLBP who had completed standard management and were referred for an exercise-based program. Eligible participants were medically fit for moderate exercise and able to complete the Oswestry Low Back Pain Disability Questionnaire (OLBPDQ).

Description of the innovative practice or project:

The innovation was the routine integration of a 12-week, supervised exercise pathway into CLBP care, comparing two pragmatic options: (1) mixed gym-based exercises plus swimming, and (2) swimming-only therapy. Each participant attended about three sessions weekly, following standardized protocols. Disability was assessed using OLBPDQ at baseline and at 12 weeks.

Evaluation:

Across 2022–2025, 173 adults with CLBP completed the 12‑week program and both OLBPDQ assessments (102 in mixed exercise; 71 in swimming only). Baseline scores reflected moderate disability; after 12 weeks, both groups showed clinically meaningful reductions. In the first cycle, scores decreased by ≈52% in the mixed-exercise group and ≈32% in the swimming-only group, with similar patterns in later cycles.

Next Steps:

The practice will continue as routine wellness care and is being prepared for scale-up to other PHCC wellness centers. Future cycles will extend evaluation to health-system outcomes such as clinic visits, sick leave, and costs.

Lessons learned:

Successful collaboration between family medicine, physiotherapy, and wellness teams; a simple, validated outcome tool; clear exercise protocols; and exercise access. Others are advised to start with small PDSA cycles, use one patient-friendly disability measure, ensure trained supervision, and offer combined land-based and swimming exercises where feasible.