Multidisciplinary Group Rehabilitation Versus Individual Physiotherapy for Chronic Nonspecific Low Back Pain
ABSTRACT A randomized trial.
To evaluate the effectiveness of a semi-intensive multidisciplinary rehabilitation for patients with chronic low back pain in an outpatient setting.
Systematic reviews have shown that there is strong evidence that intensive multidisciplinary treatment (>100 hours), which includes functional restoration, improves function among chronic patients with low back pain, and moderate evidence that it reduces pain but contradictory evidence regarding improvement of working ability. However, there is paucity of data whether semi-intensive outpatient multidisciplinary rehabilitation in groups is more effective than individual physiotherapy.
A total of 120 women employed as healthcare and social care professionals with nonspecific chronic low back pain were recruited from two occupational healthcare centers. The patients were randomized into two intervention programs. Multidisciplinary rehabilitation (n = 59) was conducted in groups and comprised of physical training, workplace interventions, back school, relaxation training, and cognitive-behavioral stress management methods for 70 hours. The individual physiotherapy (n = 61) included physical exercise and passive treatment methods administered for 10 hours. Main outcome measures were: back pain and sciatic pain intensity, disability, sick leaves, healthcare consumption, symptoms of depression, and beliefs of working ability after 2 years.
There were no statistically significant differences between the two treatment groups in main outcome measures just after rehabilitation, at 6-, at 12-, or 24-month follow-up. In both intervention arms, however, the before-and-after comparison showed favorable effects, and the effects were still maintained at 2 years follow-up.
The results of this study indicate that semilight outpatient multidisciplinary rehabilitation program for female chronic low back pain patients does not offer incremental benefits when compared with rehabilitation carried out by a physiotherapist having a cognitive-behavioral way of administering the treatment.
- SourceAvailable from: Pieter U Dijkstra
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- "2004 Roessingh Back Rehabilitation Program 79 38.5 9.8 72 * M 7 W 63 Disability d Pre Post 0.495 4 0.743 Qol s Pre Post 0.147 4 0.367 Usual Care 84 39.5 9.9 48 * M X X X Disability d Pre Post 0.000 4 0.495 Qol s Pre Post -0.114 4 0.228 Kaapa  2006 Multidisciplinary rehabilitation 64 46 7.9 100 X X X 8 W 70 Disability e Pre Post 0.420 6 0.467 12 0.607 24 0.527 Work q Pre Post 0.609 6 0.419 12 0.419 24 0.377 QoL t Post X Individual Physiotherapy 66 46.5 7.0 100 X X X 6 to 8 W 10 Disability e Pre Post 0.186 6 0.491 12 0.448 24 0.377 Work q Pre Post 0.283 6 0.354 12 0.318 24 0.035 QoL t Post X Kainz  2006 Medical training therapy (MTT) 100 47.9 X 50 X X X 15 W 27.4 Disability l Pre 6 0.347 Work r Pre 6 0.417 Qol v Pre Post 0.574 6 0.485 184 F.P.C. Waterschoot et al. / PAIN Ò Table 3 (continued) Study Year Intervention n Age, y SD % Women Duration pain Months (M)/ years (Y) SD Total duration Week (W) or month (M) Total h Outcome domain Evaluation moment, mo ES Outpatient physiotherapy (EAP) 100 47.9 X 59.9 X X X 8 W 46 Disability l Pre 6 0.255 Work r Pre 6 0.543 Qol v Pre Post 0.560 6 0.480 Outpatient rehabilitation (AR) 100 47.9 X 50 X X X 5 W 76.4 Disability l Pre 6 0.335 Work r Pre 6 0.293 Qol v Pre Post 0.610 6 0.460 Smeets  2006 Active physical treatment 53 42.7 9.1 4105 56.9 M 75,9 10 W 43.5 Disability d Pre Post 0.714 6 0.330 12 0.334 Cognitive behavioral treatment 58 42.5 9.7 58.6 68.3 M 74,2 10 W 26.5 Disability d Pre Post 0.791 6 0.357 12 0.360 Combined treatment 61 40.7 10.1 37.7 56.1 M 67,5 10 W 69.5 Disability d Pre Post 0.533 6 0.354 12 0.341 Waiting list 51 40.6 11.2 51 43.8 M 70,8 10 W 0 Disability d Pre Post 0.020 6 X 12 X Leeuw  2008 Exposure in vivo treatment 42 46.45 9.33 52.4 8.13 Y 9.95 X X 16 Disability h,i Pre Post 1.492 6 1.231 Operant graded activity 43 44.21 9.54 44.2 9.00 Y 8.94 X X 26 Disability h,i Pre Post 0.738 6 0.719 Linton  2008 Expose TAU 21 46 9.9 62 83 % >Y X X X 13 Disability i Pre Post 0.473 Waiting list TAU 25 49 7.3 48 76 % >Y X X X 0 Disability i Pre Post 0.006 Mangels  2009 Traditional orthopedic rehabilitation treatment 131 48.7 14.7 78.6 X X X 3 W 196.8 Disability g Pre Post 0.301 12 0.333 QoL u Pre Post 0.419 12 0.268 Multidisciplinary rehabilitation 113 49.5 9.0 78.8 X X X 4 W 223.2 Disability g Pre Post 0.487 12 0.344 QoL u Pre Post 0.550 12 0.396 Multidisciplinary rehabilitation + booster sessions 119 48.3 15.8 75.6 X X X 4 + 12 FU W + FU M 223.2 Disability g Pre Post 0.370 12 0.306 QoL u Pre Post 0.490 12 0.511 Dufour  2010 Group based multidisciplinary biopsychosocial rehabilitation program 129 46.6 56.6 X X X 12 W 87 Disability b,r Pre Post 0.602 53.4 6 0.515 12 0.455 24 0.549 Work m Pre Post 0.231 24 0.391 (continued on next page) F.P.C. Waterschoot et al. / PAIN Ò 155 (2014) 179–189 Table 3 (continued) Study Year Intervention n Age, y SD % Women Duration pain Months (M)/ years (Y) SD Total duration Week (W) or month (M) Total h Outcome domain Evaluation moment, mo ES Intensive individually therapist-assisted back muscle strengthening exercises 143 49.7 55.9 X X X 12 W 46 Disability b,r Pre Post 0.359 50.3 6 0.289 12 0.211 24 0.236 Work m Pre Post 0.041 24 0.362 Hellum  "
ABSTRACT: 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. RCT's 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, abstract and full text articles based on 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, influence 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.Pain 10/2013; 155(9). DOI:10.1016/j.pain.2013.10.006 · 5.84 Impact Factor
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- "The sample size calculation was based on published minimum clinically relevant change recommendations of 15 mm on a 0-100 mm VAS  and 8 points for the ODI . Standard deviations were taken from a previous publication on a comparable study population . With 90% power and α = .01 "
ABSTRACT: Electrical stimulation of central nervous system areas with surgically implanted stimulators has been shown to result in pain relief. To avoid the risks and side effects of surgery, transcranial direct current stimulation is an option to electrically stimulate the motor cortex through the skull. Previous research has shown that transcranial direct current stimulation relieves pain in patients with fibromyalgia, chronic neuropathic pain and chronic pelvic pain. Evidence indicates that the method is pain free, safe and inexpensive. A randomised controlled trial has been designed to evaluate the effect of transcranial direct current stimulation over the motor cortex for pain reduction in patients with chronic low back pain. It will also investigate whether transcranial direct current stimulation as a prior treatment enhances the symptom reduction achieved by a cognitive-behavioural group intervention. Participants will be randomised to receive a series of 5 days of transcranial direct current stimulation (2 mA, 20 mins) or 20 mins of sham stimulation; followed by a cognitive-behavioural group programme. The primary outcome parameters will measure pain (Visual Analog Scale) and disability (Oswestry Disability Index). Secondary outcome parameters will include the Fear Avoidance Beliefs Questionnaire, the Funktionsfragebogen Hannover (perceived function), Hospital Anxiety Depression Scale, bothersomeness and Health Related Quality of Life (SF 36), as well as Patient-Perceived Satisfactory Improvement. Assessments will take place immediately prior to the first application of transcranial direct current stimulation or sham, after 5 consecutive days of stimulation, immediately after the cognitive-behavioural group programme and at 4 weeks, 12 weeks and 24 weeks follow-up. This trial will help to determine, whether transcranial direct current stimulation is an effective treatment for patients with chronic low back pain and whether it can further enhance the effects of a cognitive behavioural pain management programme.BMC Musculoskeletal Disorders 12/2011; 12(10):290. DOI:10.1186/1471-2474-12-290 · 1.90 Impact Factor
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- "Efficacy and treatment compliance of a home-based rehabilitation programme for chronic low back pain: A randomized, controlled study. Ann Phys Rehabil Med (2009), doi:10.1016/j.rehab.2009.04.002 e ´tudes        . Une revue récente de la littérature conclue que l'exercice physique peut aider le lombalgique chronique a ` reprendre ses activités habituelles et son travail . "
ABSTRACT: To assess the efficacy and treatment compliance of a home-based rehabilitation programme for chronic low back pain (CLBP). CLBP outpatients treated in a Physical Medicine Rehabilitation or Rheumatology unit within a university hospital. We performed a prospective, comparative study. The participants were randomly assigned to either a home-based rehabilitation programme (Gp A) or a standard physical therapy (Gp B). The programme included four weekly sessions. In each group, we measured pain intensity (on a visual analogue scale, VAS), flexibility and muscle endurance (the Schöber MacRae test, finger-to-floor distance, thigh-leg angle, the Shirado and Sorensen test), functional and psychological repercussions (the Quebec functional index and the Hospital Anxiety and Depression scale) and handicap (on a VAS). Follow-up examinations took place at baseline and four weeks and three, six and 12 months later. One hundred and seven patients (82 women) with a mean+/-standard deviation (S.D.) age of 35.7+/-0.8 years were included (with 54 patients in Gp A). At four weeks, a significant improvement (relative to baseline) was observed for all parameters in both study groups but with a significantly greater difference in Gp A, which was maintained at one year (despite an observed regression of the improvement at six months). At one year, compliance with the home-based rehabilitation programme was good (68.1%) and 59.5% of the patients regarded the programme as useful. Our results suggest that a home-based rehabilitation programme is as effective as standard physical therapy. However, this type of programme requires patient motivation and regular follow-up.Annals of physical and rehabilitation medicine 06/2009; 52(6):485-96. DOI:10.1016/j.rehab.2009.04.002