Effectiveness of an outpatient rehabilitation program with multidisciplinary approach on return to work for patients with non-specific chronic lombal pain

Abstract

To compare the effectiveness of three treatment strategies for chronic low back pain with varying biomechanical intensity and multidisciplinary approach. A monocentric controlled trial with a 12-months follow-up, conducted in the French Valley Loire region from May 2009 to April 2013. Participants were working-aged patients with chronic low back pain referred to a French chronic low back pain care-network to support medical and occupational issues. Three treatment strategies, each for five weeks were compared: (i) intensive and multidisciplinary program conducted in a rehabilitation center; (ii) less intensive outpatient program conducted by a trained private physiotherapist; (iii) mixed strategy combining the same outpatient program associated with a weekly multidisciplinary intervention. The effects of treatment conditions were compared using an “intention to treat” approach: Number of days’ sick leave during the 12-months following treatment, and quality of life and social ability assessed by auto-questionnaires. A total of 349 patients (52.2% men, 42.5 ± 8.7 years old, median duration of sick leave = 206.0 days (92.0–301.0)) were included. Sick leave duration significantly decreased during the 12-months following treatment in the three groups. Physical capacity improved in intensive program and mixed strategy groups. There was no significant difference for the evolution of participants’ quality of life, social ability, and personal beliefs between the three groups. This study confirms that disparate treatments might show similar effectiveness because they could all work through concomitant changes in beliefs, attitudes, and coping mechanisms. The original mixed strategy can treat a larger number of chronic low back pain patients, at a lower cost and provide local community-based care.