Abstract
BackgroundCommon low back pain represents a major public health problem in terms of its direct cost to health care and its socio-economic repercussions. Ten percent of individuals who suffer from low back pain evolve toward a chronic case and as such are responsible for 75 to 80% of the direct cost of low back pain. It is therefore imperative to highlight the predictive factors of low back pain chronification in order to lighten the economic burden of low back pain-related invalidity. Despite being particularly affected by low back pain, Hospices Civils de Lyon (HCL) personnel have never been offered a specific, tailor-made treatment plan. The PRESLO study (with PRESLO referring to Secondary Low Back Pain Prevention, or in French, PREvention Secondaire de la LOmbalgie), proposed by HCL occupational health services and the Centre Médico-Chirurgical et de Réadaptation des Massues – Croix Rouge Française, is a randomized trial that aims to evaluate the feasibility and efficiency of a global secondary low back pain prevention program for the low back pain sufferers among HCL hospital personnel, a population at risk for recurrence and chronification. This program, which is based on the concept of physical retraining, employs a multidisciplinary approach uniting physical activity, cognitive education about low back pain and lumbopelvic morphotype analysis. No study targeting populations at risk for low back pain chronification has as yet evaluated the efficiency of lighter secondary prevention programs.Methods/DesignThis study is a two-arm parallel randomized controlled trial proposed to all low back pain sufferers among HCL workers, included between October 2008 and July 2011 and followed over two years. The personnel following their usual treatment (control group) and those following the global prevention program in addition to their usual treatment (intervention group) are compared in terms of low back pain recurrence and the impairments measured at the beginning and the end of the study. The global prevention program is composed of a two-hour information session about low back pain and pain pathways, followed by five weekly 90-min exercise sessions with one physiotherapist per group of eight to ten personnel. A booklet for home use with patient-managed exercise instructions and information (The Back Book) is given to each participant at the end of the program.An X-ray assessment of the entire spinal column of each participant (in both the control and intervention groups) is performed at the onset of the study in order to analyze sagittal spinopelvic balance as well as lombopelvic morphotype.DiscussionThe results of this study, which is innovative and unique in France, will be available in 2014 and will make it possible to draw conclusions regarding the program’s impact on the risk of recurrence and chronification of low back pain.Trial registrationhttp://www.clinicaltrials.gov # NCT00782925
Highlights
Common low back pain represents a major public health problem in terms of its direct cost to health care and its socio-economic repercussions
If the efficiency of such a secondary prevention program is demonstrated at the end of the study, it could initially be perpetuated among the training sessions offered by the Hospices Civils de Lyon to their workers, and later implemented in other hospitals or health care institutions
This program could be adapted and tested for professional sectors other than the hospital environment, since it is not specific to hospital personnel and could be offered a priori to all low back pain sufferers regardless of their background. The purpose of this randomized study is to demonstrate the impact of a global secondary low back pain prevention program on a decrease in low back pain recurrence among personnel working in a health care institution
Summary
The estimated annual prevalence of low back pain is between 35 and 50% in France. As the third most important cause of chronic disability, low back pain is the chronic pathology that most often leads to activity limitations in persons aged 45 through 65 years old. For dealing with chronic severe low back pain that has resisted conventional treatment, such programs are effective, especially in terms of returns to work Due to their ponderous and expensive nature, these programs are reserved for chronic low back pain sufferers. Through its approach that takes into account the biomedical, environmental and psycho-behavioral factors of low back pain, this study provides a unique perspective This program, inspired by the concept of physical retraining, is based on an overall evaluation of physical, emotional and social dimensions, with for the biomedical angle the novel addition of a lumbopelvic morphotype analysis; and on a multidisciplinary approach and care plan combining physical activity (training program followed by a home-based program) as well as cognitive learning on the topics of low back pain, pain pathways and the factors favoring the development of chronic low back pain
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