Abstract
BackgroundThe treatment of non-specific chronic low back pain is often based on three different models regarding the development and maintenance of pain and especially functional limitations: the deconditioning model, the cognitive behavioral model and the biopsychosocial model.There is evidence that rehabilitation of patients with chronic low back pain is more effective than no treatment, but information is lacking about the differential effectiveness of different kinds of rehabilitation. A direct comparison of a physical, a cognitive-behavioral treatment and a combination of both has never been carried out so far.MethodsThe effectiveness of active physical, cognitive-behavioral and combined treatment for chronic non-specific low back pain compared with a waiting list control group was determined by performing a randomized controlled trial in three rehabilitation centers.Two hundred and twenty three patients were randomized, using concealed block randomization to one of the following treatments, which they attended three times a week for 10 weeks: Active Physical Treatment (APT), Cognitive-Behavioral Treatment (CBT), Combined Treatment of APT and CBT (CT), or Waiting List (WL). The outcome variables were self-reported functional limitations, patient's main complaints, pain, mood, self-rated treatment effectiveness, treatment satisfaction and physical performance including walking, standing up, reaching forward, stair climbing and lifting. Assessments were carried out by blinded research assistants at baseline and immediately post-treatment. The data were analyzed using the intention-to-treat principle.ResultsFor 212 patients, data were available for analysis. After treatment, significant reductions were observed in functional limitations, patient's main complaints and pain intensity for all three active treatments compared to the WL. Also, the self-rated treatment effectiveness and satisfaction appeared to be higher in the three active treatments. Several physical performance tasks improved in APT and CT but not in CBT. No clinically relevant differences were found between the CT and APT, or between CT and CBT.ConclusionAll three active treatments were effective in comparison to no treatment, but no clinically relevant differences between the combined and the single component treatments were found.
Highlights
The treatment of non-specific chronic low back pain is often based on three different models regarding the development and maintenance of pain and especially functional limitations: the deconditioning model, the cognitive behavioral model and the biopsychosocial model.There is evidence that rehabilitation of patients with chronic low back pain is more effective than no treatment, but information is lacking about the differential effectiveness of different kinds of rehabilitation
There is growing evidence that strengthening exercises combined with aerobic exercises as well as cognitivebehavioral treatment (CBT) are worth the effort when compared to no treatment or waiting list control
At the start of treatment, four patients, who were randomized to Active Physical Treatment (APT) (n = 1), Cognitive-Behavioral Treatment (CBT) (n = 2) and CT (n = 1) respectively, appeared not to fulfil the selection criteria
Summary
The treatment of non-specific chronic low back pain is often based on three different models regarding the development and maintenance of pain and especially functional limitations: the deconditioning model, the cognitive behavioral model and the biopsychosocial model.There is evidence that rehabilitation of patients with chronic low back pain is more effective than no treatment, but information is lacking about the differential effectiveness of different kinds of rehabilitation. Multidisciplinary treatment of at least 100 hours, combining exercise therapy, functional restoration and CBT appeared promising in comparison to other nonmultidisciplinary treatments, whereas multidisciplinary rehabilitation programs of less than 30 hours failed to prove improvements on several relevant outcome measures. It should be taken into account that there is no consensus about the content, intensity and frequency of the different training sessions and the results are based on a relative low number of studies [7]
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