Multidisciplinary Group Rehabilitation Versus Individual Physiotherapy for Chronic Nonspecific Low Back Pain

Department of Surgery, Physical Medicine and Rehabilitation, Hus, Finland.
Spine (Impact Factor: 2.3). 03/2006; 31(4):371-6. DOI: 10.1097/01.brs.0000200104.90759.8c
Source: PubMed


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.

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    • "Through observation, there did not appear to be a relationship between study quality and the number of BCTs reported. Specifically, out of the 12 studies which reportedly used a greater than average number of BCTs (>8) (Correa Dias et al., 2003; Hughes et al., 2004, 2006; Kaapa et al., 2006; Ferreira et al., 2007; Hurley et al., 2007; Johnson et al., 2007; Van Der Roer et al., 2008; Jessep et al., 2009; Coleman et al., 2012; Hunter et al., 2012; Hurley et al., 2012) six were at an 'unclear' to 'high' risk of bias in 4 or more items. In comparison, within the 13 studies documenting the use of the mean number of BCTs, or less (<8), five were at an 'unclear' to 'high' risk of bias in four or more items (Table 4). "
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    ABSTRACT: Medical Research Council (MRC) guidelines recommend applying theory within complex interventions to explain how behaviour change occurs. Guidelines endorse self-management of chronic low back pain (CLBP) and osteoarthritis (OA), but evidence for its effectiveness is weak. This literature review aimed to determine the use of behaviour change theory and techniques within randomised controlled trials of group-based self-management programmes for chronic musculoskeletal pain, specifically CLBP and OA. A two-phase search strategy of electronic databases was used to identify systematic reviews and studies relevant to this area. Articles were coded for their use of behaviour change theory, and the number of behaviour change techniques (BCTs) was identified using a 93-item taxonomy, Taxonomy (v1). 25 articles of 22 studies met the inclusion criteria, of which only three reported having based their intervention on theory, and all used Social Cognitive Theory. A total of 33 BCTs were coded across all articles with the most commonly identified techniques being 'instruction on how to perform the behaviour', 'demonstration of the behaviour', 'behavioural practice', 'credible source', 'graded tasks' and 'body changes'. Results demonstrate that theoretically driven research within group based self-management programmes for chronic musculoskeletal pain is lacking, or is poorly reported. Future research that follows recommended guidelines regarding the use of theory in study design and reporting is warranted. Copyright © 2015 Elsevier Ltd. All rights reserved.
    No preview · Article · Mar 2015 · Manual therapy
    • "Overall studies: n ¼ 4 (Kaapa et al., 2006; Hurley et al., 2007, 2012; Jessep et al., 2009; Dufour et al., 2010) "
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    ABSTRACT: Background Osteoarthritis (OA) and chronic low back pain (CLBP) are two of the most common and costly musculoskeletal conditions globally. Healthcare service demands mean that multiple condition group-based interventions are of increasing clinical interest, but no reviews have evaluated the effectiveness of group-based physiotherapy-led self-management interventions (GPSMI) for both conditions. Objectives This rapid review aimed to evaluate the effectiveness of GPSMI for OA and CLBP. Design Rapid reviews are an increasingly valid means of expediting knowledge dissemination and are particularly useful for addressing focused research questions. Method The electronic databases MEDLINE, EMBASE, CINAHL, Cochrane Database of Systematic Reviews and Cochrane Register of Controlled Trials were searched. Structured group-based interventions that aimed to promote self-management delivered by health-care professionals (including at least one physiotherapist) involving adults' with OA and/or CLBP were included. The screening and selection of studies, data extraction and risk of bias assessment were conducted independently by two reviewers. Results 22 Studies were found (10 OA, 12 CLBP). No significant difference was found between the effectiveness of GPSMI and individual physiotherapy or usual medical management for any outcome. Conclusions GPSMI is as clinically effective as individual physiotherapy or usual medical management, but the best methods of measuring clinical effectiveness warrant further investigation. Further research is also needed to determine the cost-effectiveness of GPSMI and its implications.
    No preview · Article · Nov 2014 · Manual Therapy
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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 [32] and 8 points for the ODI [33]. Standard deviations were taken from a previous publication on a comparable study population [49]. With 90% power and α = .01 "
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    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.
    Full-text · Article · Dec 2011 · BMC Musculoskeletal Disorders
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