Changes in the health status and patient reported disability after multimodal low back pain rehabilitation

Abstract

Multimodal rehabilitation concepts based on the biopsychosocial model significantly improve patient reported outcomes in chronic low back pain (cLBP) but so far there is no study investigating the health status before and after such intervention. 1463 patients (65% females) aged 18 to 90 years [mean 50,8 (SD 6,8) years] suffering from nonspecific chronic low back pain performed six months of therapy comprising muscle strength and proprioceptive training, psychological interventions, and education in a referral outpatient rehabilitation center twice weekly. They answered the Roland Morris Disability Questionnaire (RMDQ), the Pain Disability Index (PDI), and rated their pain on a visual analoge scale (1–100) prior to (t1) and at the end of rehabilitation (t2). A preliminary study revealed that the most relevant activity and participation categories of the brief International Classification of Functioning, Disability and Health (ICF) core set for low back pain can be predicted from the RMDQ and the PDI with good performance. 314 patients (21,5%) dropped out from rehabilitation. RMDQ improved from 9,27 to 5,85, the PDI from 20,3 to 17,0, and the pain score from 49,7 to 25,2. D530 ‘toileting’ was reported with low frequencies and was thus excluded from recording. The percentage of patients reporting impairment in the various activity and participation categories differed when 85% of the patients had difficulty with d415 ‘maintaining a body position’ and 34% with walking ‘d450‘. All categories improved from t1 to t2. Multimodal rehabilitation improves patient reported disability measurement scores beyond minimal clinically important differences. Assessment of the activity and participation ICF categories helps to track the aspects of the individual functional status enabling specific goal setting and treatment guidance and it shades light to the effects of the rehab communitie's therapeutic doing to the overall health state of cLBP patients.