POS1273 A CHANGE IN A REHABILITATION MODEL INCREASES WORK CAPACITY AT 36 MONTHS IN LOW BACK PAIN

Abstract

Background:In chronic low back pain, the most expensive patients are them with long-standing sick-leave of more than 6 months. Several studies have showed the importance of rehabilitation models working with kinesiophobia (fear of movement). One possibility of treating chronic low back pain is a multidisciplinary rehabilitation program.Objectives:The aim of this study was to analyze the impact of a change in a rehabilitation program for chronic lumbar pain by introducing a progressive exposure procedure to decrease apprehension associated with low back pain. We studied its impact on work capacity after 3 years, compared to our classic program.Methods:We have compared the results of 1004 of our patients that have accomplished a multi-disciplinary program and that have been followed over 12 months. They were divided in two groups: one before the implantation of PHODA (PHOto of Daily Activity: photos showing activites) associated with occupational training and work exposure. Then a second one including 200 patients that followed the new program. The program contained physical training, occupational tasks developed on the basis of the apprehension following a cogntivo-comportemental approach.We have analyzed the evolution of apprehension according to different questionnaires (FABQ, Tampa scale (TSK) and PACT (evaluating the subjective work capacity)), the Phoda results and the official work capacity at beginning of the program and after 36 months.Results:We saw a clear increase in the global work capacity at 12 months after completing the program: passing from 40 to 79% (p < 0.01) in the old program comparing to the new one with an increase of 86% (p< 0.01). These results were confirmed at 36 months, with stabilized results. In parallel there was an increase in the subjective sensation of physical capacity (Pact), but less in the new program. This increase was correlated with a decrease in fear-avoidance according to the Fabq, and in the TSKConclusion:In chronic low back, a multidisciplinary rehabilitation program, gives a global work capacity of 79%. This capacity could be increased on focalising on patient’s apprehensions with gradual exposure according the fear-avoidance model developed by Waddell and explored by Vlayen. The correlation were confirmed on the psychological part, with less apprehension and less anxiety.Finally, the SF 36 showed an increase in body confidence as an important factor in these functional restoration programs.