Abstract
Several treatments exist for chronic low back pain (cLBP) patients although none has shown superiority. Among group treatments, muscle reconditioning programmes (MRPs) are the most commonly used. Multidisciplinary functional rehabilitation programmes (MFRPs) are an alternative. To compare a MFRP with a MRP as few studies compare these treatments This was a prospective, nonrandomised, controlled study comparing cLBP patients participating in a MRP or MFRP in an outpatient setting. The predetermined primary outcome measure was the daily life activity subscale (DLA) of the Dallas Pain Questionnaire (DPQ) within one year after the end of the treatment. Twenty-one patients were included in the MRP and 24 in the MFRP. At inclusion, the groups were similar in terms of age (mean 40 years), sex (50%-60% males), sick leave duration (mean 6.0 months, standard deviation (SD) 4.4 months) and follow up (mean 9.0 months, SD 2.0 months). The DLA score decreased from 59.5% (SD 16.9) to 44.8% (SD 25.4), p <0.01, in the MFRP and from 62.3 (SD 20.3) to 58.8 (SD 20.7), p = 0.3, in the MRP. The between-groups difference at follow-up was 13.8, p = 0.05, and the difference in the mean improvement was -11.5 (5.9), p = 0.058. Seventy-eight percent of MFRP patients versus 47 % in the MRP group returned to work (p = 0.08). In a population of highly disabled cLBP patients, MFRP seems more effective in increasing function and return to work. Interpretation is limited by the small population included and by the type of trial. Randomised studies are needed to confirm these results and explore the cost-effectiveness of MFRP.
Highlights
Non-specific low back pain (LBP) is a major public health problem
The aim of the study was to compare muscle reconditioning programmes (MRPs) with Multidisciplinary functional rehabilitation programmes (MFRPs) in order to evaluate their respective efficacies and to explore the potential additional value of the more complex intervention. This was a prospective nonrandomised controlled study comparing patients with chronic low back pain participating in a group programme based on intensive physical exercises (MRP) with similar patients participating in a multidisciplinary rehabilitation programme (MFRP)
Twenty-one patients were included in the MRP group and 24 in the MFRP group
Summary
Non-specific low back pain (LBP) is a major public health problem. Overall, 60%-80% of the population will be affected by this problem at least once in their lifetime [1, 2]. Seven to ten percent will develop a chronic condition (pain lasting >3 months [3]) associated with numerous incapacities in daily life [4]. For these patients, several therapeutic approaches have been developed. The second group includes cognitive behavioural treatments, based on the theory and observations that avoidance behaviour and inappropriate beliefs are major factors in the development of chronicity. Treatments based on these theories have a moderate effect on pain, function and behaviour [8,9,10]. The development of an outpatient multidisciplinary functional rehabilitation program (MFRP) to replace a more tra-
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