Concepts of rehabilitation for the management of low back pain

UnumProvident Centre for Psychosocial and Disability Research, University of Cardiff, Wales, UK.
Bailli&egrave re s Best Practice and Research in Clinical Rheumatology (Impact Factor: 2.6). 09/2005; 19(4):655-70. DOI: 10.1016/j.berh.2005.03.008
Source: PubMed


This chapter develops rehabilitation principles for the clinical and occupational management of non-specific low back pain (LBP). Rehabilitation has traditionally been a secondary intervention, which focused on permanent impairment, but this is inappropriate for LBP. Most patients with LBP do not have any irremediable impairment and long-term incapacity is not inevitable: given the right care, support and opportunity, most should be able to return to work. Rehabilitation should then address obstacles to recovery and barriers to (return to) work. Rehabilitation should not be a separate, second stage after 'treatment' is complete: rehabilitation principles should be integral to clinical and occupational management. It should be possible to reduce sickness absence and long-term incapacity due to LBP by at least 30-50%, but this will require a fundamental shift in management culture.

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    • "be useful to develop effective methods of reintegrating chronic LBP patients in the work place [2]. Most of the research on the psychosocial aspects of chronic LBP was performed using instrument-based questionnaires, surveys, or epidemiological data sets. "
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    ABSTRACT: Objectives: Chronic low back pain (LBP) has an important impact on quality of life, through pain and functional incapacity, but also psychosocial distress. The social participation consequences of LBP have been less explored. The objective was to better understand experiences of patients living with chronic LBP, with a focus on impact on relationships with family, friends and work colleagues. Methods: Monocentric qualitative study in a tertiary-referral centre in Paris, France. Participants had chronic mechanical LBP. Semi-structured interviews were conducted during 4 focus groups discussions focusing on living with LBP. Verbatim was categorized and coded using thematic content analysis. Results: Twenty-five persons (11 men, 14 women) participated; ages ranged 25-81 years. Participants often reported a negative self-perception in social interactions, with shame and frustration regarding their difficulties to perform activities of daily living. They often felt misunderstood and unsupported, partly due to the absence of visible signs of the condition. Participants suffered from the negative collective image attached to LBP ("benign/psychological disease"). LBP resulted in some patients in a significant loss of social identity with perceived impossibility to perform one's social role at home and at work. In contrast, family and friends were sometimes a support and helped in pain management. Conclusion: A systematic assessment of social role is needed in LBP care.
    Osteoarthritis and Cartilage 04/2014; 22:S438. DOI:10.1016/j.joca.2014.02.828 · 4.17 Impact Factor
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    • "Fear-avoidance often represents an obstacle to recovery and is addressed in many treatment programmes (Elfving et al., 2007). The patient's attitudes, beliefs and expectations as well as possible negative emotions have been found to influence recovery (Waddell and Burton, 2005). Typically, patients with LBP demonstrate decreased strength and endurance of back muscles (Simmonds et al., 1998, Moradi et al., 2009) and decreased flexibility of the spine and trunk (Kvale et al., 2003, Strand et al., 2002), affecting performance of daily life activities. "
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    ABSTRACT: Physical tests and self-report measures are being used to measure physical functioning. The latter tends to be preferred in intervention studies. To examine whether the patients' global impression of change (PGIC) after rehabilitation was explained by change in pain, daily functioning, fear-avoidance of activities and various physical aspects, expecting contribution primarily by the self-reported measures. A test-retest design, within a prospective cohort study of patients with long-lasting low back pain. 96 patients were consecutively recruited from an outpatient spine clinic, assessed by three self-report questionnaires and seven physical tests at inclusion and after 3.5 weeks of multidisciplinary treatment. With PGIC as the dependent variable, linear regression analyses of all variables were performed. The study was approved by the Regional Committee for Medical Research Ethics and the National Data Inspectorate of Norway. In unadjusted analysis, change in pain, daily functioning and change in six physical tests contributed to the explained variance (R2: 6–24%). In the adjusted analysis, only pain and back endurance strength contributed (adjusted R2: 48%). In the final backward stepwise blockwise analyses, daily functioning and spinal mobility were also found to contribute to the explained variance (R2: 48%). The time span of 3.5 weeks of training is too short to give a lasting effect, but the contribution to explained variance of PGIC of self-report measures and physical tests were the focus of this study, not the effect of training. Most measures demonstrated change that was of significance to the patients after rehabilitation. Change in spinal mobility and back strength assessed by physical tests contributed to explain the patients' impression of change after controlling for change in pain and daily life functioning and may seem important to assess in addition to the self-report measures in intervention studies. Copyright
    Physiotherapy Research International 09/2013; 18(3). DOI:10.1002/pri.1548
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    • "Work-related prevention of MSC therefore becomes an increasingly important goal [3]. Waddell and Burton [4] proposed that it should be possible to reduce MSC-related sickness absence and long-term incapacity by at least 30e50%, but this would require a fundamental shift in management culture. Part of this shift is occupational health promotion that includes work hardening efforts [5]. "
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    ABSTRACT: Stochastic resonance whole-body vibration training (SR-WBV) was tested to reduce work-related musculoskeletal complaints. Participants were 54 white-collar employees of a Swiss organization. The controlled crossover design comprised two groups each given 4 weeks of exercise and no training during a second 4-week period. Outcome was daily musculoskeletal well-being, musculoskeletal pain, and surefootedness. In addition, participants performed a behavioral test on body balance prior to when SR-WBV started and after 4 weeks of SR-WBV. Across the 4-week training period, musculoskeletal well-being and surefootedness were significantly increased (p < 0.05), whereas musculoskeletal pain was significantly reduced only in those who reported low back pain during the last 4 weeks prior to the study (p < 0.05). Body balance was significantly increased by SR-WBV (p < 0.05). SR-WBV seems to be an efficient option in primary prevention of musculoskeletal complaints and falls at work.
    Safety and Health at Work 09/2013; 4(3):149-155. DOI:10.1016/
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