Treatment of Low Back Pain: Extended follow up of an Original Trial comparing a Multidisciplinary Group-based Rehabilitation Program with Oral Drug Treatment alone up to 36 months (original) (raw)
Related papers
Treatment of Chronic Low-Back Pain
Clinical Orthopaedics and Related Research, 1984
Study Design. A stratified randomized single-blinded clinical trial. Objective. To compare the efficacies of 2 active therapies for chronic low back pain (CLBP). Summary of Background Data. Both a multidisciplinary biopsychosocial rehabilitation program and an intensive individual therapist-assisted back muscle strengthening exercise program used in Denmark have been reported to be effective for the treatment of CLBP. Methods. A total of 286 patients with CLBP were randomized to either a group-based 12-week program comprising 73 hours of therapist exposure (approximately 12 h/patient): 35 hours of hard physical exercise, 22 hours of light exercise/occupational therapy, and 16 hours of education (group A) or a 12-week program comprising 1 hour of personal training twice a week, i.e., therapist exposure 24 h/patient (group B). At baseline and at 3, 6, 12, and 24 months, patients filled out questionnaires on pain (visual analogue scale [VAS]-pain average, which was the primary outcome measure), Roland-Morris disability questionnaire, global perceived outcome, and 36-Item Short-Form General Health Survey. Data were analyzed using the intention-to-treat principle. Results. Of the 286 patients, 14 patients did not start treatment. Of the remaining patients, 25 (9%) dropped out of therapy. The 2 groups were comparable regarding baseline characteristic. After treatment, significant improvements were observed with regard to pain, disability, and most of the quality of life dimensions. These effects were sustained over the 24-month follow-up period. There were some statistically significant differences between the 2 groups relating to secondary end points, Roland-Morris disability questionnaire, and in the MOS 36-Item Short-Form Health Survey the "physical functioning" dimension and the "physical component summary." Conclusion. Both groups showed long-term improvements in pain and disability scores, with only minor statistically significant differences between the 2 groups. The minor outcome difference in favor of the group-based multidisciplinary rehabilitation program is hardly of clinical interest for individual patients.
European Journal of Pain, 1997
Based on existing models for pain chronicity and effective &atment strategies for patients with chronic low back pain, a multidisciplinary rehabilitation programme for an outpatient group setting was developed. The main treatment components address the patient's physical functional capacity (functional restoring), cognitive and affective processes (pain management strategies), and behavioural and ergonomical aspects (back school elements).
PAIN®, 2014
We sought to systematically analyze the influence of dose of pain rehabilitation programs (PRPs) for patients with chronic low back pain (CLBP) on disability, work participation, and quality of life (QoL). Literature searches were performed in PubMed, Cochrane Library, Cinahl, and Embase up to October 2012, using MeSH terms, other relevant terms and free-text words. Randomized controlled trials in English, Dutch, and German, analyzing the effect of PRPs, were included. One of the analyzed interventions had to be a PRP. Outcomes should be reported regarding disability, work participation, or QoL. To analyze dose, the number of contact hours should be reported. Two reviewers independently selected titles, abstracts, and full-text articles on the basis of inclusion and exclusion criteria. Data were extracted and risk of bias was assessed. Effect sizes (ES) were calculated for each intervention, and influence of dose variables was analyzed by a mixed model analysis. Eighteen studies were identified, reporting a wide variety of dose variables and contents of PRPs. Analyses showed that evaluation moment, number of disciplines, type of intervention, duration of intervention in weeks, percentage of women, and age influenced the outcomes of PRPs. The independent effect of dose variables could not be distinguished from content because these variables were strongly associated. Because dose variables were never studied separately or reported independently, we were not able to disentangle the relationship between dose, content, and effects of PRPs on disability, work participation, and QoL. Ó
European Spine Journal, 1995
Several new studies have indicated that an active approach to patients with chronic disabling low back pain (LBP) seems effective. Some of these studies emphasize the importance of dealing with the patient's total situation in comprehensive multidisciplinary programs -the bio-psycho-social model. However, these programs are expensive. The aim of this study was to evaluate the rehabilitation outcome from three different active programs in terms of: (1) return-to-work rate, (2) days of sick leave, (3) health-care contacts, (4) pain and disability scores, and (5) staying physically active. The subjects included 132 patients randomized to the study, of whom 123 started one of the treatment programs. They had all had at least 6 months of chronic LBR The patients were randomized into one of three programs: group 1 -a full-time, intensive 3-week multidisciplinary program, including active physical and ergonomic training and psychological pain management, followed by 1 day weekly for the subsequent 3 weeks; group 2 -active physical training, twice a week for 6 weeks, for a total of 24h; group 3 -psychological pain management combined with active physical training, twice a week for 6 weeks, also for a total of 24h. The results presented here are based on data collected 4 months following treatment, which shows an 86% response rate. The initial examination and the follow-up evaluation were performed by a blinded observer. The results show that 4 months after treatment, the intensive multidisciplinary program is superior to the less intensive programs in terms of return-to-work rate, health-care contacts, pain and disability scores, and staying physically active. In conclusion, it seems that although the multidisciplinary program is initially expensive compared to the less intensive programs, the savings in sick pay, early retirement pensions, and health care contacts make it economically worthwhile. Long-term follow-up will show whether this effect continues.
Journal of Clinical Medicine
Low-back pain is a major health problem exacerbated by the fact that most treatments are not suitable for self-management in everyday life. Particularly, interdisciplinary programs consist of intensive therapy lasting several weeks. Additionally, therapy components are rarely coordinated regarding reinforcing effects, which would improve complaints in persons with higher pain. This study assesses the effectiveness of a self-management program, firstly for persons suffering from higher pain and secondly compared to regular routines. Study objectives were treated in a single-blind multicenter controlled trial. A total of n = 439 volunteers (age 18–65 years) were randomly assigned to a twelve-week multidisciplinary sensorimotor training (3-weeks-center- and 9-weeks-homebased) or control group. The primary outcome pain (Chronic-Pain-Grade) as well as mental health were assessed by questionnaires at baseline and follow-up (3/6/12/24 weeks, M2-M5). For statistical analysis, multiple linea...
Journal of primary health care, 2011
The health and economic costs associated with chronic low back pain (CLBP) have increased substantially over the past few decades. Despite extensive research, a consistently valid, reliable and effective diagnostic and treatment regime for CLBP is yet to be determined. This paper presents an established interdisciplinary rehabilitation model for CLBP initially developed by the Canadian Back Institute. An audit describes the symptomatic, functional and vocational outcomes achieved for patients who attended the programme over three years throughout a national network of primary health care facilities in New Zealand. Over a three-year period, 899 patients with CLBP completed their rehabilitation programme at one of eight affiliated clinics. Of the 899 patients discharged, 780 (86.8%) reported that their back pain had gone or reduced at the end of their rehabilitation. There was a statistically significant, and clinically relevant, improvement in both average pain and subjective functio...