OBJECTIVE: To investigate the feasibility and effectiveness of individual work support for employed patients with low back pain.
DESIGN: Pilot randomized controlled trial of a 16-week vocational intervention with six-month follow-up.
SETTING: Community/outpatient.
PARTICIPANTS: Fifty-one employed participants concerned about their ability to work due to low back pain. Outcome data was obtained for 38 participants at six-month follow-up.
INTERVENTIONS: The intervention group received up to eight individually targeted vocational sessions in conjunction with group rehabilitation for low back pain. The control group received group rehabilitation.
OUTCOME MEASURES: The feasibility of the intervention was assessed by the recruitment rate, drop-out and loss to follow-up of the participants and the content and delivery of the intervention as recorded by the researcher. The primary outcome measure was perceived work ability.
RESULTS: Seventy-three participants were referred to the study over six months. Eighty-seven individual work support sessions were delivered. Thirty-one participants (61% of those retained in the study) attended more than half of the group rehabilitation sessions. The intervention was influenced by the uptake of group rehabilitation, the willingness of the participants to involve their workplace and of their workplace to involve the research therapist. The effect of the intervention on work ability was equivocal.
CONCLUSIONS: Although it was possible to recruit participants and to deliver the intervention, considerable methodological problems were identified. However, even if these were addressed, the impact of such interventions is likely to be limited unless there is an integrated approach between healthcare, employers and employees. Further research is required to evaluate work-focused interventions with this client group.
OBJECTIVE: To evaluate the effect on disability, kinesiophobia, pain, and the quality of life of a long-lasting multidisciplinary program based on cognitive-behavioral therapy and targeted against fear-avoidance beliefs in patients with chronic low back pain.
METHODS: None
STUDY DESIGN: parallel-group, randomized, superiority controlled study. Ninety patients were randomly assigned to a multidisciplinary program consisting of cognitive-behavior therapy and exercise training (experimental group, 45 patients) or exercise training alone (control group, 45 patients). Before treatment (T1), 5 weeks later (instructive phase, T2), and 12 (posttreatment analysis, T3) and 24 months after the end of the instructive phase (1-year follow-up, T4), all of the patients completed a booklet containing the Roland-Morris Disability Questionnaire Scale (primary outcome), the Tampa Scale for Kinesiophobia, a pain numerical rating scale, and the Short-Form Health Survey. A linear mixed model for repeated measures was used to analyze each outcome measure, and the reliable change index/clinically significant change method was used to assess the clinical significance of the changes.
RESULTS: The linear mixed model analysis showed a remarkable group, time, and interaction effect for group * time in all of the primary and secondary outcomes (P always <0.001). The majority of the patients in the experimental group achieved a reliable and clinically significant improvement, whereas the majority of those in the control group experienced no change.
CONCLUSIONS: The long-lasting multidisciplinary program was superior to the exercise program in reducing disability, fear-avoidance beliefs and pain, and enhancing the quality of life of patients with chronic low back pain. The effects were clinically tangible and lasted for at least 1 year after the intervention ended.
This study examined the comparative efficacy of three interventions: a spouse-assisted coping skills training protocol for patients undergoing a multidisciplinary pain management programme (SA-MPMP), conventional patient-oriented multidisciplinary pain management programme (P-MPMP) and standard medical care (SMC). Thirty-six chronic low back pain (CLBP) patients and their spouses were randomly assigned to one of the three conditions. The SA-MPMP condition consisted of seven, weekly, 2-h, group sessions of training in dyadic pain coping and couple skills, delivered by a clinical psychologist with support of a multidisciplinary team of specialists, to patients together with their spouses. P-MPMP consisted of the SA-MPMP training delivered to the patient only (i.e., no spouse participation and assistance). The SMC condition entailed continuation of routine treatment, entailing medical care only. Data analysis revealed that, at the 12-month follow-up time point, patients receiving SA-MPMP had significant improvements in kinesiophobia and rumination about pain compared to those receiving P-MPMP and SMC. In patients suffering from CLBP, an intervention that combines spouse-assisted coping skills training with a multidisciplinary pain management programme can improve fear of movement and rumination about low back pain.
OBJETIVO: Evaluar la eficacia de un enfoque rehabilitador perceptiva, basado en un nuevo dispositivo, en relación con el dolor y la discapacidad en pacientes con dolor lumbar no específico crónico.
DISEÑO: Simple ciego, aleatorizado y controlado.
ESCENARIO: Un hospital académico ambulatoria.
Pacientes: Setenta y cinco pacientes con dolor lumbar crónico.
Intervenciones: Los pacientes fueron distribuidos aleatoriamente en tres grupos. Veinticinco pacientes recibieron 10 sesiones en un mes, basado en ejercicios perceptivos específicos que se realizaron en un dispositivo desarrollado adecuadamente. Veinticinco pacientes entraron en un programa de Escuela de Espalda. Veinticinco pacientes comprendían un grupo de control que recibió la misma asistencia médica y farmacológica como los otros grupos.
Principales medidas de resultado: El dolor se evaluó mediante la escala analógica visual y McGill Pain Questionnaire. La discapacidad se evaluó mediante el índice de discapacidad de Oswestry y Waddell índice de discapacidad. Todas las mediciones se registraron antes del tratamiento, al final del estudio, y a los 12 y 24 semanas.
RESULTADOS: el alivio general del dolor se registró en todos los grupos, que se obtuvo más rápidamente en el grupo de tratamiento perceptiva; No se observaron diferencias significativas en las puntuaciones de dolor al final del tratamiento (p <0,001 para la escala analógica visual y P = 0,001 para Cuestionario) frente a los otros grupos. Las puntuaciones de discapacidad en el grupo perceptiva no difirieron significativamente de los que están en el otro grupo, mientras que estos resultados difieren significativamente entre Back School y los grupos de control en los seguimientos (P <0,01 para ambas escalas).
CONCLUSIÓN: Perceptive rehabilitación tiene efectos positivos inmediatos sobre el dolor. Volver Escuela reduce discapacidad en el seguimiento.
OBJETIVOS: Una escuela de espalda es una parte obligatoria del programa de rehabilitación multimodal para pacientes con dolor lumbar crónico en Alemania. Sin embargo, ningún programa escolar normalizado y evaluado de nuevo ha estado disponible para su uso rutinario. En este estudio, se presenta la evaluación de una nueva escuela de espalda que fue desarrollado en base a las teorías de la conducta de salud, pruebas de tratamiento, las guías de práctica y criterios de calidad para la educación del paciente.
MÉTODOS: ensayo controlado aleatorio de pacientes con dolor de espalda baja (n = 360) en la clínica de rehabilitación ortopédica paciente hospitalizado en Alemania. Pacientes intervención recibieron la nueva escuela de espalda, mientras que el control de los pacientes de una escuela de espalda tradicional (atención habitual). Conocimiento Enfermedad (resultado primario) y los resultados conductuales y de salud secundarios fueron evaluados en la admisión, descarga, y 6 y 12 meses de seguimiento.
RESULTADOS: Los resultados mostraron un efecto del tratamiento medio significativa entre los grupos en el conocimiento de los pacientes sobre el dolor de espalda al alta (η² = 0,081), después de 6 (η² = 0,056) y 12 meses (η² = 0,026). Además, se observaron pequeñas y medianas efectos entre las conductas de autocuidado secundarias, como la actividad física, ejercicios de espalda, espalda hábitos posturales y sobrellevar el dolor, después de 6 y 12 meses.
DISCUSIÓN: La eficacia superior de la escuela de espalda sobre la base de un enfoque biopsicosocial se demostró con respecto a la enfermedad y el conocimiento de autogestión comportamientos hasta 1 año. De este modo, el programa puede ser recomendada para su difusión dentro de la rehabilitación médica.
OBJECTIVE: To compare the efficacy of surgery with disc prosthesis versus non-surgical treatment for patients with chronic low back pain.
DESIGN: A prospective randomised multicentre study.
SETTING: Five university hospitals in Norway.
PARTICIPANTS: 173 patients with a history of low back pain for at least one year, Oswestry disability index of at least 30 points, and degenerative changes in one or two lower lumbar spine levels (86 patients randomised to surgery). Patients were treated from April 2004 to September 2007.
INTERVENTIONS: Surgery with disc prosthesis or outpatient multidisciplinary rehabilitation for 12-15 days.
MAIN OUTCOME MEASURES: The primary outcome measure was the score on the Oswestry disability index after two years. Secondary outcome measures were low back pain, satisfaction with life (SF-36 and EuroQol EQ-5D), Hopkins symptom check list (HSCL-25), fear avoidance beliefs (FABQ), self efficacy beliefs for pain, work status, and patients' satisfaction and drug use. A blinded independent observer evaluated scores on the back performance scale and Prolo scale at two year follow-up.
RESULTS: The study was powered to detect a difference of 10 points on the Oswestry disability index between the groups at two years. At two years there was a mean difference of -8.4 points (95% confidence interval -13.2 to -3.6) in favour of surgery. In the analysis of prespecified secondary outcomes, there were significant differences in favour of surgery for low back pain (mean difference -12.2, -21.3 to -3.1), patients' satisfaction (63% (n = 46) v 39% (n = 26)), SF-36 physical component score (mean difference 5.8, 2.5 to 9.1), self efficacy for pain (mean difference 1.0, 0.2 to 1.9), and the Prolo scale (mean difference 0.9, 0.1 to 1.6). There were no significant differences in return to work, SF-36 mental component score, EQ-5D, fear avoidance beliefs, Hopkins symptom check list, drug use, and the back performance scale. One serious complication of leg amputation occurred during surgical revision of a polyethylene dislodgement. The drop-out rate was 20% (34) and the crossover rate was 6% (5).
CONCLUSIONS: Surgical intervention with disc prosthesis for chronic low back pain resulted in a significantly greater improvement in the Oswestry score compared with rehabilitation, but this improvement did not clearly exceed the prespecified minimally important clinical difference between groups of 10 points, and the data are consistent with a wide range of differences between the groups, including values well below 10 points. The potential risks of surgery and the substantial amount of improvement experienced by a sizeable proportion of the rehabilitation group also have to be incorporated into overall decision making. Trial registration NCT 00394732.
STUDY DESIGN: Randomized parallel group comparative trial with a 1-year follow-up period.
OBJECTIVE: To compare in a population of patients with chronic low back pain, the effectiveness of a functional restoration program (FRP), including intensive physical training and a multidisciplinary approach, with an outpatient active physiotherapy program at 1-year follow-up.
SUMMARY OF BACKGROUND DATA: Controlled studies conducted in the United States and in Northern Europe showed a benefit of FRPs, especially on return to work. Randomized studies have compared these programs with standard care. A previously reported study presented the effectiveness at 6 months of both functional restoration and active physiotherapy, with a significantly greater reduction of sick-leave days for functional restoration.
METHODS: A total of 132 patients with low back pain were randomized to either FRP (68 patients) or active individual therapy (64 patients). One patient did not complete the FRP; 19 patients were lost to follow-up (4 in the FRP group and 15 in the active individual treatment group). The number of sick-leave days in 2 years before the program was similar in both groups (180 ± 135.1 days in active individual treatment vs. 185 ± 149.8 days in FRP, P = 0.847).
RESULTS: In both groups, at 1-year follow-up, intensity of pain, flexibility, trunk muscle endurance, Dallas daily activities and work and leisure scores, and number of sick-leave days were significantly improved compared with baseline. The number of sick-leave days was significantly lower in the FRP group.
CONCLUSION: Both programs are efficient in reducing disability and sick-leave days. The FRP is significantly more effective in reducing sick-leave days. Further analysis is required to determine if this overweighs the difference in costs of both programs.
OBJECTIVE: This randomized clinical trial examined the efficacies of a group-based multidisciplinary rehabilitation program and oral drug treatment versus oral drug treatment alone in Iran.
METHODS: A total of 197 patients with chronic low back pain were randomized to either intervention group (n=97) receiving a group-based, 5-session multidisciplinary rehabilitation program plus oral medication or to control group (n=100) receiving just oral medication. At baseline and at 3 and 6-month follow-ups, patients filled out questionnaires on health-related quality of life (36-item Short-form General Health Survey) and disability Questionnaires (Quebec Disability Scale and Ronald-Morris Disability). Repeated measure analysis of variance was used to compare 2 groups during time.
RESULTS: The 2 groups were comparable regarding all baseline characteristics (P>0.05). There were significant differences within each group by time in terms of all subscales of 36-item Short-form (P<0.01) except for mental health (P=0.7). Furthermore, there were significant differences between groups in terms of all domains of SF-36 scale except for general health (P=0.06), social function (P=0.08) and role emotional (P=0.7). Furthermore, according to the scores of Ronald-Morris Disability Questionnaire and Quebec Disability Scale, the disability of patients in the intervention group was improved over time significantly (P=0.01 and P<0.0001, respectively).
DISCUSSION: The findings revealed that the group-based multidisciplinary program could improve most domains of quality of life in chronic low back pain patients in the 6-month period. However, there were no significant differences between two groups in sub scales such as general health, social function and role emotional.
Varios principios de tratamiento para la reducción de la crónica incapacidad del dolor de espalda asociados se han postulado. Para examinar si una combinación de un entrenamiento físico y operante-conductual graduado de actividades con el entrenamiento de resolución de problemas es costo-efectiva en comparación con ya sea solo un año después del tratamiento, un análisis económico junto con un ensayo controlado aleatorizado se llevó a cabo. En total, 172 pacientes con infección crónica incapacitante no dolor lumbar inespecífico que se refiere a tratamiento de rehabilitación, fueron asignados al azar a 10 semanas de entrenamiento aeróbico y de fortalecimiento muscular de los extensores de la espalda (tratamiento físico activo; APT), 10 semanas de la asunción gradual de los pacientes las actividades relevantes en función el operante-conductuales principios y la formación de resolución de problemas (graduado de actividades además de la capacitación para resolver problemas; GAP), o APT junto con GAP (tratamiento combinado; TC). Los costos totales, los actuales de la salud directa y no sanitarias, los costos y los costos indirectos debido a la falta de trabajo remunerado se calcularon mediante el uso de los diarios de costes y las listas de tratamiento de asistencia. El Cuestionario de discapacidad de Roland se utilizó para calcular el costo-efectividad para reducir la discapacidad y la ganancia en el año de vida ajustado por calidad (AVAC) mediante el EuroQol-5D. APT, seguida por TC mostró, aunque no significativa, el aumento de los costes totales que la brecha. La reducción de la discapacidad y la ganancia en AVAC no difirió significativamente entre la TC y las modalidades de tratamiento individuales. En base a los coeficientes de eficiencia de costos incrementales (ICER) y la rentabilidad de las curvas de aceptabilidad TC no es rentable en absoluto. Sin embargo, GAP es costo-efectivo con respecto a la reducción de la discapacidad y el aumento en AVAC, y en menor grado APT es más rentable que la TC en la reducción de la discapacidad.
To investigate the feasibility and effectiveness of individual work support for employed patients with low back pain.
DESIGN:
Pilot randomized controlled trial of a 16-week vocational intervention with six-month follow-up.
SETTING:
Community/outpatient.
PARTICIPANTS:
Fifty-one employed participants concerned about their ability to work due to low back pain. Outcome data was obtained for 38 participants at six-month follow-up.
INTERVENTIONS:
The intervention group received up to eight individually targeted vocational sessions in conjunction with group rehabilitation for low back pain. The control group received group rehabilitation.
OUTCOME MEASURES:
The feasibility of the intervention was assessed by the recruitment rate, drop-out and loss to follow-up of the participants and the content and delivery of the intervention as recorded by the researcher. The primary outcome measure was perceived work ability.
RESULTS:
Seventy-three participants were referred to the study over six months. Eighty-seven individual work support sessions were delivered. Thirty-one participants (61% of those retained in the study) attended more than half of the group rehabilitation sessions. The intervention was influenced by the uptake of group rehabilitation, the willingness of the participants to involve their workplace and of their workplace to involve the research therapist. The effect of the intervention on work ability was equivocal.
CONCLUSIONS:
Although it was possible to recruit participants and to deliver the intervention, considerable methodological problems were identified. However, even if these were addressed, the impact of such interventions is likely to be limited unless there is an integrated approach between healthcare, employers and employees. Further research is required to evaluate work-focused interventions with this client group.
