Summary
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 LBP. 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.
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References
Bigos SJ, Spengler DM, Martin NA, et al (1986) Back injuries in industry: a retrospective study. III. Employee-related factors. Spine 11:252–256
Cooke C, Menard MR, Beach GN, Locke SR, Hirsch GH (1992) Serial lumbar dynamometry in low back pain. Spine 17: 653–662
Danish Institute of Clinical Epidemiology (1993) Musculoskeletal disorders in the Danish Population (in Danish) Danish Institute of Clinical Epidemilogy, Copenhagen
Deyo RA (1983) Conservative therapy for low back pain: distinguishing useful from useless therapy. JAMA 250:1057–1062
Estlander AM, Mellin G, Vanharanta H, Hupli M (1991) Effects and follow-up of a multimodel treatment program including intensive physical training for low back pain patients. Scand J Rehabil Med 23:97–102
Fordyce W, McMahon R, Rainwater G, et al (1981) Pain complaint-exercise performance relationship in chronic pain. Pain 10:311–321
Gatchel RJ, Mayer TG (1988) Functional restoration for spinal disorders: the sports medicine approach. Lea & Febiger, Philadelphia
Gatchel R, Mayer TG, Hazard RG, Rainville J, Mooney V (1992) Editorial: Functional restoration. Spine 17:988–995
Gibson T, Grahame R, Harkness J et al (1985) Controlled comparison of soft-wave diathermy treatment with osteopathic treatment in nonspecific low back pain. Lancet (June):1258–1261
Hadler N, Curtis P, Gillings D, Stinnett S (1987) A benefit of spinal manipulation as adjunctive therapy for acute low-back pain: a stratified controlled trial. Spine 12:703–706
Hansen FR, Bendix T, Skoy P, Jensen CV, Kristensen JH, Krohn L, Schøler H (1993) Intensive, dynamic back muscle exercises, conventional physical therapy or placebo-controlled treatment of low back pain: a randomized, observer-blind trial. Spine 18:98–108
Hazard R, Fenwick J, Kalisch S, Redmond J, Reeves V, Reid S, Frymoyer J (1989) Functional restoration with behavioral support. A one-year prospective study of patients with chronic low-back pain. Spine 14:157–161
Hoffa K (1925) Orthopädische Chirurgie. Enke, Stuttgart
Koes B, Bouter L, Beckerman H, van der Heiden G, Knipschild P (1991) Physiotherapy exercises and back pain: a blinded review. BMJ 302:1572–1576
Kottke FJ, Stillwell GK, Lehmann JF (1982) Krusen's handbook of physical medicine and rehabilitation, 3rd edn. Saunders, London
Mannicke C, Lundberg E, Christensen I, Bentzen L, Hesselsøe G (1991) Intensive dynamic back exercisec for chronic low back pain: a clinical trial. Pain 47:53–63
Manniche C, Asmussen K, Lauritsen B, Vinterberg H, Kreiner S, Jordan A (1994) Low Back Pain Rating Scale. Validation of a tool for assessment of low back pain. Pain 57:317–326
Mayer TG, Gatchel RJ, Mayer H et al (1987) A prospective two-year study of functional restoration in industrial low back injury: an objective assessment procedure. JAMA 258:1763–1767
Mellin G, Hurri H, Harkapaa K, Jarvikoski A (1989) A controlled study of the outcome of inpatient and outpatient treatment of low back pain. II. Effects on physical measurements three months after treatment. Scand J Rehabil Med 21:91–95
Nachemson A (1960) Lumbar intra-disc pressure (thesis). Acta Orthop Scand [Suppl 43]
Nachemson A (1990) Back pain — a community problem. The Swedish Counceil on Technology assessment in Health Care (in Swedish). SBU conference, Stockholm, Sweden
Oland G, Tveiten G (1991) A trial of modern rehabilitation for chronic low-back pain and disability. Spine 16:457–459
Powell FC, Hanigan WC, Olivero WC (1993) A risk/benefit analysis of spinal manipulation therapy for relief of lumbar or cervical pain. Neurosurg 33:73–78
Rainville J, Ahern DK, Phalen L, Childs LA, Sutherland R (1992) The association of pain with physical activities in chronic low back pain. Spine 17:1060–1064
Romano JM, Syrjala KL, Levy RL et al (1988) Overt pain behaviors: relationship to patient functioning and treatment outcome. Behav Ther 19:191–201
Sachs BL, David JF, Olimpio D,Scala AD, Lacroix M (1990) Spinal rehabilitation by work tolerance based on objective physical capacity. Spine 15:1325–1332
Spitzer WO, LeBlanc FF, Dupuis M (1987) Scientific approach to the assessment and management of activity-related spinal disorders. Spine 12:S1-S5
Taves DR (1974) Minimization: a new method of assigning patients to treatment and control groups. Clin Pharmacol Ther 15:443–453
Waddell G (1987) A new clinical model for the treatment of low back pain. Spine 12:632–644
Waddell G, Main CJ (1984) Assessment of severity in low-back disorders. Spine 9:204–208
Zachrisson-Forssell M (1981) The back school. Spine 6: 104–105
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Bendix, A.F., Bendix, T., Ostenfeld, S. et al. Active treatment programs for patients with chronic low back pain: a prospective, randomized, observer-blinded study. Eur Spine J 4, 148–152 (1995). https://doi.org/10.1007/BF00298239
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DOI: https://doi.org/10.1007/BF00298239