Functional Restoration Program Research Articles

Interdisciplinary pain program participants with high catastrophizing scores improve function utilizing enriched therapeutic encounters and integrative health techniques: a retrospective study.

Pain catastrophizing describes helplessness, rumination, and magnification of a pain experience. High pain catastrophizing is an independent risk factor for disability, pain severity, inadequate treatment response, chronicity, and opioid misuse. Interdisciplinary pain programs (IPPs) are beneficial and cost-effective for individuals with chronic pain, but their functional impact on individuals with high pain catastrophizing is not well established. The emerging field of placebo studies suggests that patient-provider relationships, positive treatment expectations, and sociobiologically informed care trigger physiological responses that may enhance therapeutic interventions. In this retrospective observational cohort study, we compared admission and discharge data for 428 adults with high-impact chronic pain (mean 8.5 years) who completed the Spaulding-Medford Functional Restoration Program (FRP). The interdisciplinary FRP team of physiatrists, behavioral health clinicians, physical therapists, and occupational therapists specializes in evidenced-based conventional rehabilitation, integrative health, and pain psychoeducation via enriched therapeutic encounters, fostering collaboration, validation, trust, self-efficacy, and positive expectations. Clinical outcome measures included the Canadian Occupational Performance Measure (COPM) assessing functional performance (COPM-PS) and satisfaction with function (COPM-SS), the Pain Numeric Rating Scale (NRS), the Pain Catastrophizing Scale (PCS), and the Patient Health Questionnaire-9 (PHQ-9). FRP participants with clinically elevated catastrophizing at baseline (PCS ≥30, mean PCS 39) achieved statistically significant improvements in function (mean delta -2.09, CHI2 = 15.56, p < 0.001), satisfaction with function (COPM-SS mean delta -2.50, CHI2 = 7.42, p = 0.007), pain (NRS mean delta 2.7), mood (PHQ-9 mean delta 1.87, p = 0.002), and catastrophizing (PCS mean delta 4.16, p < 0.001). Subgroup analysis revealed racial disparities in pain scores, and exploratory analysis showed a trend toward reducing opiate consumption. Despite the known association of adverse outcomes with high catastrophizing, FRP participation was associated with increased productive engagement, reduced pain, reduced maladaptive thought processes, and improved mood. Although causation and efficacy cannot be established from a retrospective design, this is the first study to identify functional improvement in patients with high-impact chronic pain and clinically relevant high pain catastrophizing who participate in an IPP combining conventional and complementary rehabilitation with psychoeducation. These enriched therapeutic encounters may enhance the treatment process by promoting trust, empathy, collaboration, and beneficial reframing of patients' experiences, expectations, and goals.

A Functional Restoration Program for Active Duty Service Members With Chronic Pain: Examining the Impact of Co-occurring PTSD on Treatment Response.

Standard medical intervention for chronic pain may be less effective in the presence of co-occurring PTSD. Functional restoration programs (FRPs), which combine psychological interventions and progressive exercise rehabilitation, represent an alternative to standard medical intervention for chronic pain. The objective of the current study is to evaluate a FRP serving Active Duty Service Members with chronic pain and to examine whether co-occurring PTSD symptoms are associated with differential treatment response. This is a retrospective observational study of data previously collected at Naval Medical Center San Diego approved by the Naval Medical Center San Diego Institutional Review Board. The study included 81 Active Duty Service Members, primarily Sailors and Marines, who completed a FRP, and examined pre- to post-treatment changes in Pain Impact Score-a composite measure of pain intensity, pain interference, and physical functioning-as well as measures of mental health and pain cognitions. Co-occurring PTSD symptoms were examined as a potential moderator of treatment response. Twenty-three patients (28.4%) screened positive for PTSD during baseline assessments. Repeated measures analysis of variance showed statistically significant improvement in Pain Impact Score for the full sample (P <.001). Although no significant interactions with probable PTSD were demonstrated for measures of pain intensity and physical functioning (both Ps >.05), patients screening positive for PTSD demonstrated a lesser decrease in pain interference compared to patients screening negative for PTSD (P <.01). Improvements in measures of mental health and pain cognitions were also statistically significant for the full sample (all P values <.05) and did not differ as a function of PTSD symptoms (all P values >.05). This FRP primarily serving Sailors and Marines contributed to broad overall improvements in the domains of pain and functioning as well as mental health and pain cognitions. Co-occurring PTSD symptoms were not associated with poorer treatment response on most measured outcomes.

Changes in isokinetic trunk muscle strength and endurance after two different restoration programs in people with chronic low back pain: A longitudinal retrospective study

BackgroundMultidisciplinary functional restoration programs (FRPs) aim to improve pain and function in people with chronic low back pain (CLBP). The intensity and content of FRPs varies; the benefits of one program over another are unclear. ObjectiveTo assess changes in trunk muscle strength and endurance after an intensive (IFRP) (for people on sick leave for >6 months with high levels of fear-avoidance beliefs about physical activity and work) or semi-intensive (SIFRP) (for people working) FRP in people with CLBP. MethodsLongitudinal retrospective study from March 2016 to December 2019. Setting: rehabilitation department of a tertiary care center. Trunk flexor and extensor muscle strength (60°.s−1) and endurance (120°.s−1) were measured with the Humac NORM isokinetic dynamometer at pre and post FRP. Change in isokinetic variables (peak torque, total work and flexor/extensor ratio) after each program was assessed with a paired t-test (p < 0.05). Pearson's rho and multiple linear regression assessed associations between changes in isokinetic and clinical variables and demographic characteristics. Results125 individuals, 63.2 % female, age 43.5 (10.3) years, were included. Mean low back pain intensity was 49.8 (24.9) and 37.2 (25.8)/100 and mean activity limitation (QBPDS) was 38.8 (16.4) and 32.0 (14.6)/100 in the IFRP and SFRP groups, respectively. Trunk extensor peak torque, flexor total work, extensor total work and flexor/extensor peak ratio improved significantly in both FRPs, p < 0.001. The flexor/extensor total work ratio improved in the IFRP group only, p = 0.003. Trunk extensor endurance increased more in the IFRP than the SIFRP group, the absolute pre-post differences for extensor total work [95%CI] N.m were 611.7 [495.2; 728.3] in the IFRP group and 380.0 [300.8; 459.3] in the SIFRP group. No variables were correlated and none predicted improvement in extensor total work in either group. ConclusionThis study highlights the short-term independence of clinical and trunk muscle strength and endurance changes.

Evaluation of the efficacy, in terms of pain and disability, of a functional restoration programme in patients with chronic low back pain according to the presence of Modic 1 discopathy.

Modic type 1 disc disease (MD1) appears to be related to severe Chronic Low Back Pain (CLBP). Functional Restoration Programmes (FRP) recommended in CLBP may not be suitable for patients with MD1. The main objective was to evaluate the effectiveness of a FRP, on the perceived incapacity and the pain intensity, in patients with non-specific CLBP according to the presence of MD1. We performed a single-centre retrospective cohort study in which 271 patients were included. After one month in the FRP, this programme was considered "successful" if the pain visual analog scale had decreased by at least 20/100 millimetres and if the score of the French version of the Roland-Morris disability questionnaire had decreased by at least 4/24 points. The 271 patients had an average age of 43.2 (8.0) years and 58.3% were women. Out of our entire population, 128 (47.2%) patients were considered successful, and 51 (18.8%) patients had MD1. In patients without MD1, there was 49.1% success while this rate was 39.2% in those with MD1, but this difference was not statistically significant. We found no significant difference in the combination of pain and perceived disability after one month of a FRP in patients with CLBP without MD1 compared to those with CLBP with MD1. It therefore seems legitimate to offer FRP-type rehabilitation in patients with non-specific CLBP with MD1.

Total mandible and bilateral TMJ reconstruction combining a customized jaw implant with a free fibular flap: a case report and literature review

BackgroundThe need for whole mandibular bone reconstruction and bilateral joint replacement is fortunately rare, but it is an extremely challenging topic in maxillofacial surgery, due to its functional implications. CAD-CAM techniques development has opened new broad horizons in the surgical planning of complex maxillofacial reconstructions, in terms of accuracy, predictability, and functional cosmetic results. The review of the literature has revealed a small number of scientific reports on total mandibulectomy including the condyles, with only eleven cases from 1980. Most of the works describe reconstructions secondary to dysplastic or inflammatory diseases affecting the lower jaw. The aim of this work, reporting a rare case of massive fibrous dysplasia of the whole mandible, is to share our experience in the management of extended mandibular and bilateral joint reconstruction, using porous titanium patient-specific implants.Case presentationThe authors present a 20-year-old male patient suffering from massive bone fibrous dysplasia of the mandible. The mandibular body and both the rami and the condylar processes had been involved, causing severe functional impairment, tooth loss, and facial deformation. The young patient, after repeated ineffective conservative surgical treatments, has required a biarticular mandibular replacement. Using virtual surgical planning (VSP) software, the authors, in collaboration with medical engineers, have created a custom-made original titanium porous mandibular implant, suspended from a bilateral artificial temporomandibular joint. The mandibular titanium implant body has been specifically designed to support soft tissues and to fix, in the alveolar region, a free fibular bone graft, for delayed dental implant prosthetic rehabilitation.ConclusionThe surgical and technical details, as well as the new trends in mandibular reconstructions using porous titanium implants, are reported, and discussed, reviewing literature reports on this topic. Satisfactory functional and cosmetic restorative results have been obtained, and no major complications have occurred. The patient, currently in the 18th month clinical and radiological follow-up, has recently completed the functional restoration program by an implant-supported full-arch dental prosthesis.

The Role of Psychological Factors in Chronic Pain Treatment Outcomes in the Military

PurposeChronic pain treatment in the military includes complementary and integrative health (CIH) therapies that may affect psychological factors such as pain catastrophizing, chronic pain acceptance, pain self-efficacy, and patient activation. The unique roles that psychosocial factors play in how CIH approaches reduce pain are not clear. This study examined if a holistic pain management program improved pain outcomes through psychological mediators in service members with chronic pain. DesignSecondary analysis of a clinical trial. MethodsActive-duty service members (n = 210) were randomly assigned to a 3-week course of standard rehabilitative care or standard rehabilitative care combined with CIH therapies. Both treatments were followed by a 3-week functional restoration program. Study measures were completed pre- and post-treatment using the Military Health System's Pain Assessment Screening Tool and Outcomes Registry. Mediation analyses tested the indirect effects of the change in psychological factors before functional restoration on the change in pain impact (e.g., pain intensity, pain interference, functional status) after functional restoration. ResultsAll psychological factors except for chronic pain acceptance were related to improved pain impact (p<.05). Furthermore, a change in psychological factors prior to functional restoration was related to the change in pain impact after functional restoration. However, the addition of CIH therapies to standard rehabilitative care did not result in changes in pain outcomes mediated by the psychological factors. ConclusionsAlthough psychological factors were related to pain outcomes, the effect of CIH therapies on chronic pain did not occur via a change in the four psychological factors.

Comprehensive rehabilitation of patients with post-stroke upper limb dysfunction: a randomized controlled trial

Introduction.The restoration of manipulative activity of the upper limb after an ischemic stroke (IS) requires the development of new technologies aimed at sensorimotor training and retraining. Reduction of spasticity of the upper limb muscles is considered as a necessary component of the program of functional restoration of the handAim.To evaluate the effectiveness and safety of the integrated use of rehabilitation technology with virtual reality and biofeedback “SENSOREHAB simulator glove” (RG) and botulinum neurotoxin type A (BTA) to restore the subject-manipulative function of the hand in comparison with an individual complex of physical therapy in the late recovery period of IS.Materials and methods.A randomized controlled trial included 76 patients, age 60.8 ± 9.2 years; the duration of the transferred IS was 8.1 ± 1.3 months. The main group (n = 42) received BTA with subsequent use of RP. The control group (n = 34) – individual physical therapy. The primary results were changes in the scores on the Fugl – Meyer scales (FMA–UL), the Action Research Arm Test (ARAT), the test with pegs and nine holes (NHPT). Secondary results: dynamics of MRCS, MAS, MoCA, HADS, Bartel index and quality of life (EuroQol-5D).Results.Improvement of the motor function of the arm in the main group according to ARAT (an increase of ≥4 points) was noted in 63.8% of cases, on the FMA–UL scale (an increase of ≥7 points in sections A–D) – in 65.5% of patients (p &lt; 0.05), according to the NHPT test – a significant increase in the speed of execution The test was performed in 52.6% of patients. The dynamics of EQ-5D-5 (VAS) at the end of treatment reached 72.3 ± 5.7 in the main group (p = 0.03). In patients of the control group, a statistically significant improvement was noted in terms of pain and EQ-5D-5 (p &lt; 0.05).Conclusions.A comprehensive program of medical rehabilitation of patients with post-stroke upper limb dysfunction, including the use of BTA and RG, significantly improves the recovery of fine hand movements, functional independence of patients and their quality of life.

Evaluation of a non-pharmacological interdisciplinary pain rehabilitation and functional restoration program for chronic pain in veterans.

To conduct a quality improvement evaluation of the Empower Veterans Program (EVP), an interdisciplinary pain rehabilitation/functional restoration program option for functional restoration for high-impact chronic pain, offered in a large metro-area Veterans Health Administration (VHA) system. VHA Corporate Data Warehouse electronic medical record data for patients treated by EVP between 2015 and 2019. This retrospective design first compared EVP patients considered engaged or not engaged in completing treatment in terms of demographic characteristics and post-treatment changes in clinical measures related to opioid use and mental health. We then compared mortality risk between matched groups of treated and untreated patients with chronic pain and concurrent opioid prescriptions using propensity score matching and Cox proportional hazards methods. "Treated" in the matched groups was defined as any level of EVP participation (i.e., both engaged and not engaged). We first identified 1053 EVP patients with 1year of pre-and post-treatment follow-time and determined their engagement level. From those with chronic pain and prescription opioids, we matched 237 EVP patients to 375 untreated patients. Engaged patients (57.4% of treated patients), were somewhat older than the non-engaged (mean age 57.1 vs. 53.7, Cohen's D=0.30), and achieved lower mean PHQ9 depression scores in the post-treatment year (9.2 vs. 10.6, Cohen's D=0.20). Participation in EVP was associated with a 65% lower mortality risk among Veterans with chronic pain and opioid use when compared to the untreated patients: (HR: 0.35, 95% CI: 0.17, 0.75). EVP was associated with a large reduction in mortality risk for Veterans with both chronic pain and opioid use. This result could inform the decision process in a VA station or region when considering providing or expanding access to an interdisciplinary rehabilitation/functional restoration program for chronic pain.

Identifying the risk of opioid misuse in a chronic pain population: the utility of the MMPI-2-RF personality psychopathology five (PSY-5-RF) and higher-order scales.

Prescription-related opioid misuse, especially in chronic pain populations, is an ongoing problem and is related to increased mortality. The purpose of this study was to assess the utility of two restructured scales of the MMPI-2-RF: the Personality Psychopathology Five (PSY-5-RF) and the Higher-Order Scales to determine which of their subscales may be beneficial for identifying the risk of opioid misuse in a chronic pain population. A sample of 136 patients with chronic disabling occupational musculoskeletal disorders completed the MMPI-2-RF and the Current Opioid Misuse Measure (COMM) upon admission to a functional restoration program. The PSY-5-RF and H-O subscales were correlated with the baseline COMM scores. Correlation analyses, ROC curve analyses, and multiple binary logistic regression models were developed to determine which subscales were most associated with elevated COMM scores. The results of the regression analyses suggest that Scale elevations on two of the PSY-5-RF Scales and two Higher-Order Scales of the MMPI-2-RF demonstrated significant associations with elevated COMM scores, thus exhibiting the utility of these subscales in identifying the risk of opioid misuse among chronic pain patients. These findings are clinically meaningful in underscoring the importance of identifying specific personality traits as potential predictors of opioid misuse, and identifying those at risk through careful screening. Clinical implications based on each of the PSY-5-RF and H-O scales significantly associated with elevated COMM scores are discussed.

Fear-avoidance beliefs, anxiety and depression are associated with motor control and dynamics parameters in patients with chronic low back pain

PurposeTo evaluate the influence of fear-avoidance beliefs, anxiety and depression on dynamic and motor control parameters before and after Functional Restoration Program. MethodsPatients were divided into three groups depending on clinical scores scores. Dynamic and motor control parameters were extracted from gait analysis. ResultsPatients showed different ways based on preferred walking speed, capacity benefit, peaks of propulsion and gait stability in function of clinical scores. ConclusionFear-avoidance beliefs associated to anxiety and depression influence biomechanics on overground walking. We depicted different ways to adapt their gait in function of biopsychosocial scores. Functional Restoration Program influence these ways.

Use of Complementary and Integrative Health Therapies Before Intensive Functional Restoration in Active Duty Service Members with Chronic Pain.

Psychosocial factors are known to predict chronic pain, and the use of complementary and integrative health (CIH) therapies to address pain is emerging among the military population. However, conflicting results on pain outcomes warrant additional research. This study aimed to 1) evaluate the benefit of adding a CIH pain management program to standard rehabilitative care (SRC), as compared with SRC alone, as a precursor to an intensive functional restoration (FR) program; 2) identify factors that predict improvement in pain outcomes after treatment; and 3) determine the proportion of participants who experience a clinically meaningful response. Pragmatic randomized controlled clinical trial. Participants were randomized to a 3-week course of either SRC alone or SRC+CIH (stage 1), followed by a 3- to 6-week course of FR (stage 2). Active duty service members with chronic pain. Participants completed either SRC alone or SRC+CIH (stage 1), followed by a course of FR (stage 2). Patient-reported and provider-determined outcomes were collected at baseline, after stage 1, and after stage 2. A covariance pattern model with an unstructured residual covariance matrix was used to compare treatment arms while accounting for dependency due to repeated measurements. A total of 210 service members participated. Most were in the Army (82%) and were male (84%). Participants randomized to the SRC+CIH intervention had greater improvement in the pain impact score than did those in the SRC-alone group. Predictors of outcomes were baseline impact score, anger, depression, and educational status. This study found that military service members with the highest pain impact benefit the most from interdisciplinary pain care.

Implementation of An Adapted Physical Activity Therapy Protocol for Patients with Low Back Pain

This study set out to investigate the usefulness of an adapted physical activity protocol to improve pain and functional capacity through structured adapted exercises to muscular capacity on patients in a Functional Restoration program. Material and methods: 83 patients, aged between 19-63, who accepted to be included in this study and diagnosed as chronic low back pain. The patients were treated for a total of 12 weeks, 3 sessions per week. The level of pain severity of the participants was determined by Visual Pain Scale (VAS). Oswestry Disability Index for functional evaluation; Low Back Pain Disability Index (LBPDI). These assessments were performed at the beginning and end of the 12- week treatment program. In line with our study results, we anticipate that the planned physiotherapy and adapted physical activity (APA) protocol will reduce the health expenditures by finding a solution option for chronic low back pain commonly seen in societies.

Understanding the Process and Challenges for Return-to-Work Post-Hematopoietic Cell Transplantation from a Musculoskeletal Perspective: A Narrative Review.

The current paper seeks to inform healthcare professionals on how adapting various components of return to work (RTW) programs that are already in use by other musculoskeletal rehabilitation settings can help optimize return to work process for patients with or without musculoskeletal manifestations, posthematopoietic cell transplantation. Since there is no universally agreed RTW structure for hematopoietic cell transplant patients, a narrative approach has been taken utilizing evidence from the existing musculoskeletal return to work assessment publications to help draw parallel for the hematopoietic cell transplant patients. Databases were searched including PUBMED, CINHAL, AMED, SCOPUS, and Cochrane using keywords RTW, functional restoration program, hematopoietic cell transplant, bone marrow transplant, stem cell transplant, and musculoskeletal functional assessment. The authors have managed to outline and propose a structured RTW assessment and monitoring program which can aid in getting patients back to employment by utilizing the functional capacity and job evaluation to help hematopoietic cell transplantation patients reintegrate socially. Patients undergoing hematopoietic cell transplant require additional support and a robust assessment system to allow safe RTW. The proposed model of RTW assessment can prove to be beneficial in helping patients return to work safely. Clinical Significance. To acknowledge the individuality in functional limitation is important in determining not only the rehab needs but also the RTW capabilities. The proposed RTW plan not only promotes an individualized approach to patients but also provides a structure for return to work assessments for hematopoietic cell transplantation patients, thus, eliminating the need for guess work by healthcare professionals. In line with the International Classification of Functioning, Disability, and Health (ICF) recommendations, a RTW assessment combined with a job evaluation helps healthcare professionals and stakeholders to understand the unique challenges and strengths of a patient and thereby design an individualized therapy approach.

Activité physique et réentraînement à l’effort chez les patients lombalgiques

Low back pain (LBP) is a major public health problem in Western countries. The benign nature of LBP regularly contrasts with its impact on quality of life due to its readily recurrent nature and its potential progression to chronicity, a stage at which it is regularly accompanied by a restriction of social and professional participation. Regular physical activity (PA) and exercise (PE) are essential for the management of LBP and the prevention of recurrence. PA is therefore recommended for all stages of LBP. However, pain, mistaken beliefs and inappropriate pain-related behaviours regularly form obstacles to practicing PA. According to the biopsychosocial model, chronic LBP is linked to a set of factors that make its management complex. This observation has led to the establishment of multidisciplinary functional restoration programs including management of the physical, psycho-behavioural and socio-professional components of chronic LBP. The rehabilitation component of programs typically includes muscle strengthening and stretching exercises, aerobic activities and spinal stabilisation. Other aspects of care include improving psychosocial and behavioural parameters, notably through cognitive and behavioural therapies and therapeutic education of the patient. Lastly, most programs also offer socio-professional assessment and support with a view to improving return to work or job retention. The multidisciplinary approach to the management of chronic LBP has shown its effectiveness, particularly in terms of functional disability and pain intensity, while the effects concerning absenteeism and return to work are more heterogeneous. Promoting active behaviours and patient autonomy during the course of supervised care, over the long term, is a crucial issue. This therefore requires, on the one hand, to take into account the patient's preference for the choice of PA and PE, but also to focus on motivational strategies.

Sleep among Youth with Severely Disabling Chronic Pain: Before, during, and after Inpatient Intensive Interdisciplinary Pain Treatment.

Poor sleep is commonly reported in pediatric chronic pain. There are signals that intensive interdisciplinary pain treatments (IIPT) may inadvertently improve objective sleep, but this claim cannot be substantiated without baseline sleep data prior to IIPT. This study followed the objective sleep/wake patterns (e.g., duration, quality, timing, consistency) of pediatric patients with severely functionally disabling chronic pain before, during, and after inpatient IIPT (the Functional Independence Restoration Program—“FIRST Program”), alongside a similarly-disabled chronic pain Comparison Group. The final sample included N = 10 FIRST Patients and N = 9 Comparison Group patients. At baseline, the whole sample showed healthy sleep duration (~9 h), average sleep efficiency <90%, late sleep onset and offset (mean = 11:56 p.m.–8:50 a.m.), and highly inconsistent sleep schedules night to night. During IIPT, FIRST Patients maintained healthy sleep durations, moved sleep schedules 2 h earlier, and decreased timing and duration variability by >60 min while the Comparison Group maintained similar sleep to baseline. At follow up (1–2 months later), FIRST Patients’ sleep schedules shifted later but were still less variable than at baseline. Results point to the malleability of sleep/wake patterns within treatment contexts with strict environmental control but suggest that these gains may be difficult for youth with chronic pain to maintain in the home environment.

Evaluation of a Functional Restoration Program at Fort Bliss Interdisciplinary Pain Management Clinic.

In partnership with the Veterans Health Administration, in 2010, the Department of Defense/Veterans Health Administration Pain Management Task Force Final Report recommended a comprehensive pain management plan. Consequently, each Army medical center established an Interdisciplinary Pain Management Clinic (IPMC) for pain treatment, and each IPMC implements a multidisciplinary outpatient functional restoration program (FRP) as an alternative to or in addition to pharmacological therapy. This article reports our first-year FRP results at William Beaumont Army Medical Center IPMC. The FRP is designed to improve the participants' functionality and quality of life, both personally and professionally. Service members with chronic pain were evaluated for psychological and physical clearance before enrollment in an intense and structured FRP for 8 hours a day over 3 weeks. The program focused on physical and occupational exercises, yoga, acupuncture, and educational classes regarding pain medications, nutrition, and coping skills. The resulting data were analyzed using paired two-tailed t-tests with a predetermined significance level of 0.05 to examine the participants' mean changes upon completion of the FRP. The pre-post comparison indicated significant improvement after completion of the FRP. The fear-avoidance of physical activities and the fear of movement scores were reduced significantly (P<0.05); the Canadian occupational performance and satisfaction, physical strength and endurance were improved significantly (P < 0.0001) in sit-to-stand, plank balance, lifting and carrying, and 10-minute 7-to-1 Pyramid tests; however, fear-avoidance of work was not significantly reduced (P=0.2319). Because of the lack of randomization and the small number of subjects (N=32, 7 cohorts), unknown sources of bias may have influenced the results. Despite these limitations, the results from this report support the program's effectiveness and are consistent with the outcomes from FRP programs in other military facilities and in civilian studies.

Pain resilience and catastrophizing combine to predict functional restoration program outcomes.

Whereas decades of research have been devoted to psychological factors that confer vulnerability to disability and other negative outcomes in the face of chronic pain, recent studies have begun to emphasize psychological characteristics that contribute to enhanced adaptation and better clinical outcomes. Accordingly, the present study was conducted as a longitudinal assessment of the predictive utility of pain resilience and pain catastrophizing as indicators of clinical outcomes among patients receiving a standardized treatment for chronic pain. Using an observational design, analyses were conducted on measures of pain resilience, pain catastrophizing, quality of life, and clinical pain administered to 149 patients upon admission and prior to discharge from an 8-week outpatient functional restoration program. Hierarchical linear regressions were conducted to predict improvement in physical and mental health quality of life and clinical pain intensity at discharge based on individual differences in admission levels of pain-related catastrophizing and resilience. Results of the primary analyses indicated that pain catastrophizing and pain resilience independently predicted physical and mental health quality-of-life outcomes at discharge but did not significantly predict clinical pain intensity. Specifically, higher baseline pain resilience was associated with better quality-of-life outcomes, whereas higher baseline catastrophizing was associated with poorer outcomes. This study provides additional support for the notion that pain resilience assessment may help identify those most likely to benefit from targeted efforts to bolster resilience resources during treatment. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Benefits of a four-week functional restoration program in chronic low back pain patients and three-month follow-up: focus on paraspinal muscle aerobic metabolism responses to exercise.

Chronic low back pain (CLBP) is a major health concern characterized by paraspinal muscle fatigability. This can be improved following a functional restoration program. Muscle fatigability can be related to impairment in aerobic metabolism responses. In this study, we investigated paraspinal muscles aerobic metabolism in CLBP patients before and after a functional restoration program, in order to determine if the enhancement in patients' condition following the program is associated to changes in metabolism responses. Twenty-two CLBP patients (11 women, 11 men; 41.6±1.8 years; 73.7±3.1 kg; 1.74±0.02 m) were evaluated before and after a 4-week functional restoration program, with exercise therapy as the main component. Three months later, 12 patients were seen for a follow-up visit. During each testing session, patients performed a five-minute isokinetic trunk extension exercise in measuring pulmonary gas exchanges and paraspinal muscle oxygenation. Mechanical efficiency and onset V̇O<inf>2</inf> kinetics were also calculated, in addition to usual questionnaires and exercises designed to evaluate psychosocial and physical factors. At the end of the program, paraspinal muscle oxygenation, mechanical efficiency, and the V̇O<inf>2</inf> onset kinetics were improved (P<0.05). All measures remained stable during the three-month follow-up except for paraspinal muscle oxygenation, which deteriorated (P<0.05). Return-to-work was associated with the level of workday physical activities and to a decrease in fear-avoidance beliefs. At the end of the program, aerobic metabolism responses were improved in paraspinal muscles in patients. These improvements were not associated with return-to-work, which was primarily influenced by socio-psychological factors.

Effectiveness of a short functional restoration program for patients with chronic low back pain: A cohort study of 193 patients.

Functional restoration programs (FRPs) are integrative programs to improve function in chronic low back pain (cLBP). They are costly and time-consuming. The aim was to assess the effectiveness of a condensed FRP (CFRP) for patients with cLBP in professional activity. Longitudinal 3 months study of patients with cLBP in one tertiary care hospital, participating in a CFRP over 4 separate days. The primary outcome was the Oswestry Disability Index (ODI). Secondary outcomes included pain, quality of life (EQ5D), patient acceptable symptom state, presenteeism, absenteeism and psychological distress. Outcomes were compared using paired sample Student's t-test or Chi2 between baseline and last follow-up. Logistic regression was used to identify factors associated with better response (improvement of ODI higher than 12.8). In all, 193 patients were analysed, mean age 44.6 (standard deviation (SD) 10.4) years, mean cLBP duration 9.0 (SD 8.8) years. A small improvement was observed for ODI (mean difference -5.9, 95% confidence interval: -7.6, -4.1), as well as most other outcomes. Multivariate analysis showed an association between ODI improvement and higher duration of low back pain (odds ratio for 5 years: 1.41 (1.06,1.88)) and lower baseline back strength (Sorensen, odds ratio for 1min: 0.54 [0.29,0.99]). This CFRP showed small effect to improve function, pain and other quality of life, in cLBP. Four-day programs may be an interesting option in cLBP patients still in professional activity for whom a long 1-month FRP is difficultly manageable. Further studies with randomized controlled designs are needed to confirm the benefits.

Evaluation of the Results of Rehabilitation of Chronic Low Back Pain Syndrome in Physically Active and Inactive Patients During Leisure Time

Introduction: Movement is one of the main, modifiable factors (behaviour-dependent) that affects the health and quality of life of individuals and the entire population. Physical activity, including evidence-based active rehabilitation, is the subject of many studies on the prevention and treatment of spinal disorders, which are some of the most serious health problems. The largest group of people with spinal disorders are patients suffering from Nonspecific Low Back Pain (ang. Nonspecific Low Back Pain – NLBP), with kinesitherapy having the widest application in the chronic pain phase. A significant part of the research is devoted to the problem of movement in patients with chronic non-specific low back pain (CNLBP). One physiotherapy treatment method used in chronic low back pain syndrome is the DBC method. It is based on a detailed functional diagnosis, answers given to a standardized questionnaire, individualized treatment plans and active exercises with spinal resistance using specialized DBC equipment. Aim: The aim of this study was to evaluate the influence of leisure-time physical activity on the results of the DBC functional restoration program in patients with chronic, non-specific, low back pain after outpatient rehabilitation. The researchers tested the hypothesis that patients with regular physical activity attained better results of functional restoration compared to physically inactive participants. M aterials and Methods: The research group was comprised of one-hundred forty-seven participants. All subjects suffered from low back pain syndrome lasting for a period of at least three months without neurological symptoms. All symptoms were non-specific. The subjects were divided into two groups. Group 1 was comprised of participants who undertake regular physical activity for more than 45-minutes per exercise session, at least twice a week. Participants in Group 2 did not undertake any physical activity other than that resulting from everyday activities. The study commenced with an interview and standardized DBC questionnaire to get participants’ subjective assessment of the following parameters: current level of pain, functional limitations and scale of depression. A clinical trial was conducted prior to the measurement of objective parameters in order to exclude radicular pain (Lasegue test). Next, the objective parameters were measured: bioelectric activity of the lumbar erector spinae muscles (ang. surfasce electromyography – sEMG) on the right and left side in two positions: standing upright and leaning forward with straight legs. Also, DBC devices were used to measure the following range of motion of the lumbo-thoracic spine: flexion, extension, rotation and lateral flexion/bending. Upon completing the tests (Test 1) both groups were subject to active DBC therapeutic treatment. The therapy consisted of 12 meetings carried out within a 6 week period. Each session lasted for 1.5 hours. When the treatments ended testing was repeated for each group (Test 2). Results: Mean values of functional parameters of the lumbar spine were calculated for both groups. Statistical significance was determined between the preliminary (Test 1) and final (Test 2) tests. All the objective parameters in Group 1 showed statistically significant improvement post-therapy. Different results were observed in Group 2 for participants who did not perform regular physical activity. Although all parameters improved, only some achieved statistical significance. Significance between the two groups was also studied at the beginning of the experiment (Test 1) and after its completion (Test 2). There results showed no statistically significant difference in values of some objective parameters prior to the treatment, while some parameters differed. The treatment achieved a statistically significant improvement in the “active” group compared to the “inactive” one in almost every tested parameter excluding the extension. Significant differences between the groups were observed in the subjective parameters such as: functional limitations (ADL) (ang. Activity of Daily Living – ADL) and level of depression both in the first and last tests. Conclusions: Patients with chronic non-specific low back pain syndrome who remain physically active in leisure time and participated in the 6-week DBC rehabilitation program achieved a statistically significant improvement in the functional parameters of the spine. Patients with chronic non-specific low back pain syndrome who remain physically active in leisure time and participated in the 6-week DBC rehabilitation program improved more in the objective and subjective functional parameters of the spine in comparison with the inactive participants. Active leisure time contributes to the efficacy of physiotherapy for people with low back disorders.