Rehabilitation For Chronic Back Pain Research Articles

Chronic musculoskeletal pain in patients with low back pain

Low back pain is the most common musculoskeletal pain disorder. It is estimated that a large percentage of people will experience at least one episode of low back pain during their lifetime. When low back pain exceeds the normal time of tissue healingit is characterized as chronic. In chronic low back pain, the patient’s clinical picture, in addition to its biological background, is also affected by psychological, social and cognitive parameters. This study refers to the self-reported assessment tools and the proposed physiotherapeutic and non-physiotherapeutic rehabilitation of chronic back pain. keywords : chronic low back pain, self-reported assessment, rehabilitation

Health Economic Effects of Rehabilitation for Chronic Back Pain - An Observational Study with Combined Secondary Data from Statutory Health Insurance and German Pension Fund

Chronic back pain is the most common indication in medical rehabilitation. Numerous studies hint on positive effects of rehabilitation on health state. However, there is no evidence about the effectiveness of rehabilitation due to the lack of a valid comparison group. Based on combined secondary data from German Pension Fund and statutory health insurance, a comparison group of insured persons was identified by their typical patient career that did not apply for rehabilitation for unclear reasons. Effectiveness was measured by direct and indirect costs of back pain between rehabilitants and non-rehabilitants. Costs of rehabilitation split in 2.742 € direct costs and 2.597 € indirect costs. In the 2 years following rehabilitation, rehabilitants were hospitalized less frequent and caused less indirect costs due to disability. Therefore, the benefit of rehabilitation was 727 € in the first year after rehabilitation and additional 37 € in the subsequent year. Rehabilitation for chronic back pain contributes to maintain the ability to work. Moreover, rehabilitation reduces duration of disability and healthcare utilization, hence direct and indirect costs of illness are lowered compared to a treatment without rehabilitation. Effects of rehabilitation by avoidance and delay of retirement are not yet recorded.

Evaluation of the short-term effects of recovery tools in the rehabilitation of chronic back pain: a feasibility study

Background: Recovery represents an individualised, psychological construct serving as a buffer for health complaints and back pain. Recovery might also help in reducing chronic back pain (CBP) but has not been examined within CBP rehabilitation.Aim: Testing the acute effects of recovery tools to reduce CBP and stress and to improve recovery.Methods: A longitudinal, quasi-randomised pilot study with 55 individuals on sick leave caused by CBP was conducted. The acute effects of a multimodal out-patient rehabilitation programme were evaluated, while recovery tools were conveyed within the intervention group. The control group received regular treatment. Validated psychometric questionnaires to measure CBP, stress and recovery were used.Results: Repeated measures ANOVA indicated significant reductions for Pain Intensity (p < .001, ηp2 = 0.39), Disability (p < .001, ηp2 = 0.55), Overall Stress (p = .001, ηp2 = 0.19), and a significant improvement for Overall Recovery (p = .010, ηp2 = 0.12) in both groups. A more pronounced increase for recovery was registered in the intervention group considering the descriptive values.Conclusions: Both groups displayed significant short-term improvements for CBP, stress and recovery, while the intervention group did not show statistically superior effects. Long-term intervention effects should be monitored within the programme to assess the sustainable efficacy and feasibility of the recovery tools.

Risk and protective factors in the clinical rehabilitation of chronic back pain.

ObjectivesChronic back pain (CBP) can lead to disability and burden. In addition to its medical causes, its development is influenced by psychosocial risk factors, the so-called flag factors, which are categorized and integrated into many treatment guidelines. Currently, most studies investigate single flag factors, which limit the estimation of individual factor significance in the development of chronic pain. Furthermore, factors concerning patients’ lifestyle, biography and treatment history are often neglected. Therefore, the objectives of the present study are to identify commonly neglected factors of CBP and integrate them into an analysis model comparing their significance with established flag factors.MethodsA total of 24 patients and therapists were cross-sectionally interviewed to identify commonly neglected factors of CBP. Subsequently, the impact of these factors was surveyed in a longitudinal study. In two rehabilitation clinics, CBP patients (n = 145) were examined before and 6 months after a 3-week inpatient rehabilitation. Outcome variables, chronification factor pain experience (CF-PE) and chronification factor disability (CF-D), were ascertained with confirmatory factor analysis (CFA) of standardized questionnaires. Predictors were evaluated using stepwise calculations of simple and multiple regression models.ResultsThrough interviews, medical history, iatrogenic factors, poor compliance, critical life events (LEs), social support (SS) type and effort–reward were identified as commonly neglected factors. However, only the final three held significance in comparison to established factors such as depression and pain-related cognitions. Longitudinally, lifestyle factors found to influence future pain were initial pain, physically demanding work, nicotine consumption, gender and rehabilitation clinic. LEs were unexpectedly found to be a strong predictor of future pain, as were the protective factors, reward at work and perceived SS.DiscussionThese findings shed insight regarding often overlooked factors in the development of CBP, suggesting that more detailed operationalization and superordinate frameworks would be beneficial to further research.ConclusionIn particular, LEs should be taken into account in future research. Protective factors should be integrated in therapeutic settings.

Psychische Komorbidität

Psychosocial comorbidity in somatic disorders is considered an important problem from the epidemiological point of view as well as from the perspective of care. Therefore, the different origins or development are etiologically discussed. In this article, an overview of the prevalence of psychiatric comorbidity of musculoskeletal disorders, using chronic back pain in somatic medical rehabilitation as an example, is given. According to the statistics of the German pension insurance fund, musculoskeletal diseases are the most common indication. In this article, the opportunities and the challenges for medical rehabilitation in managing psychosocial comorbidity are discussed. Starting with the description of medical rehabilitation in Germany, the significance of psychosocial comorbidity in medical rehabilitation and the resulting opportunities arising from this special setting to screen for psychological comorbidity are examined. These aspects are discussed based on articles from 2000-2010 in the field of orthopedic inpatient medical rehabilitation. A total of ten studies, focusing on the medical rehabilitation of chronic back pain, were identified. It was found that three papers reported data on the prevalence of psychological comorbidity and addressed diagnostic screening. This is discussed from a perspective that addresses potential barriers on the part of therapists as well as the patients. More attention should be directed to implementing the appropriate screening and follow-up care.

A bio-psycho-social exercise program (RÜCKGEWINN) for chronic low back pain in rehabilitation aftercare - Study protocol for a randomised controlled trial

BackgroundThere is strong, internationally confirmed evidence for the short-term effectiveness of multimodal interdisciplinary specific treatment programs for chronic back pain. However, the verification of long-term sustainability of achieved effects is missing so far. For long-term improvement of pain and functional ability high intervention intensity or high volume seems to be necessary (> 100 therapy hours). Especially in chronic back pain rehabilitation, purposefully refined aftercare treatments offer the possibility to intensify positive effects or to increase their sustainability. However, quality assured goal-conscious specific aftercare programs for the rehabilitation of chronic back pain are absent.Methods/DesignThis study aims to examine the efficacy of a specially developed bio-psycho-social chronic back pain specific aftercare intervention (RÜCKGEWINN) in comparison to the current usual aftercare (IRENA) and a control group that is given an educational booklet addressing pain-conditioned functional ability and back pain episodes. Overall rehabilitation effects as well as predictors for compliance to the aftercare programs are analysed. Therefore, a multicenter prospective 3-armed randomised controlled trial is conducted. 456 participants will be consecutively enrolled in inpatient and outpatient rehabilitation and assigned to either one of the three study arms. Outcomes are measured before and after rehabilitation. Aftercare programs are assessed at ten month follow up after dismissal form rehabilitation.DiscussionSpecial methodological and logistic challenges are to be mastered in this trial, which accrue from the interconnection of aftercare interventions to their residential district and the fact that the proportion of patients who take part in aftercare programs is low. The usability of the aftercare program is based on the transference into the routine care and is also reinforced by developed manuals with structured contents, media and material for organisation assistance as well as training manuals for therapists in the aftercare.Trial RegistrationTrial Registration number: NCT01070849

Best-Practice-Empfehlungen zu Zielsetzungen, Inhalten und Methoden ambulanter und stationärer Rehabilitationsmaßnahmen von Patienten mit chronifizierenden oder chronischen Rückenschmerzen,

Das Kooperationsprojekt Qualitätsmanagement im Versorgungsprozess von Rückenschmerzen der Bertelsmann-Stiftung und dem Institut für Community Medicine der Universität Greifswald sowie 20 weiteren Partnern richtete sich auf die Entwicklung eines integrierten Versorgungskonzeptes zur Verbesserung der Qualität in der Versorgung von Rückenschmerzen. Ausgehend von bestehenden Qualitätsdefiziten im rehabilitativen Sektor mit den Schnittstellen zur Kuration und Nachsorge, war es das Ziel der Arbeitsgruppe Rehabilitation, Lösungsansätze im Versorgungsprozess von Rückenschmerzpatienten zu erarbeiten. Ein Schwerpunkt richtete sich auf die Formulierung von Best-Practice-Empfehlungen zu Zielsetzungen, Behandlungsprinzipien und Behandlungsbausteinen in der Rehabilitation chronischer Rückenschmerzen für Personen im arbeitsfähigen Alter von 18 – 65 Jahren. Es erfolgte eine Zusammenfassung und konsensuale Bewertung des wissenschaftlichen Kenntnisstands zu erfolgreichen Interventionsformen, wie er in vorliegenden systematischen Übersichtsarbeiten und einzelnen nationalen Studien berichtet wird. Dies bildet die Grundlage für ein evidenzbasiertes und einheitliches konzeptionelles Vorgehen in der Rehabilitation von Rückenschmerzen.

Best-Practice-Empfehlungen zu Zielsetzungen, Inhalten und Methoden ambulanter und stationärer Rehabilitationsmaßnahmen von Patienten mit chronifizierenden oder chronischen Rückenschmerzen

The cooperative project “Quality management in the process of care management of back pain” of the Bertelsmann foundation, the Institute of Community Medicine at the University Greifswald and 20 other partners focuses on the development of an integrative care management conception to improve the quality of the care of back pain. Paying attention to existing quality deficits in the sector of rehabilitation with its interfaces to curation and aftercare, the aim of the task force “rehabilitation” was to develop new approaches for the care management process of back pain. One key aspect is the development of best-practice recommendations for objectives, treatment principles and components of therapy in the rehabilitation of chronic back pain for persons in the working age of 18-65 years. For that purpose the scientific standard of knowledge concerning successful interventions, being reported in existing systematic reviews and national studies, was summarized and consensually evaluated. The results constitute the fundamentals for an evidence based, standardized conceptual course of action in the rehabilitation of back pain.

Effects of multidisciplinary inpatient rehabilitation for chronic back or neck pain: a register-linkage study of sickness absences and analgesic purchases in an occupational cohort

Objective: To determine the effects of multidisciplinary in-patient rehabilitation for chronic back or neck pain on sickness absences and analgesic purchases. Design: A prospective observational study. Setting: 10 towns in...

Zur Wirksamkeit von stationärer medizinischer Rehabilitation in Deutschland bei chronischen Rückenschmerzen: Aktualisierung und methodenkritische Diskussion einer Literaturübersicht

The ninth book of the German social code, SGB IX, has intensified questions on the effectiveness and usefulness of medical rehabilitation, a multimodal multidisciplinary team care model, especially but not exclusively for chronic back pain. In 2002 back pain was the reported leading cause for 29 % of all medical and other rehabilitative services provided by German statutory pension funds. A previous systematic review of all available German studies (January 1980 to June 2001) analysed the effectiveness of inpatient rehabilitation for chronic back pain. The present report provides an update and critical appraisal of the review. Again we conducted a systematic search for relevant German studies from between July 2001 and December 2003 using electronic data bases, hand-searching of congress abstracts and postal questionnaires. The quality of relevant studies was assessed according to the recommendations of the Cochrane Back Review Group. For each study effect sizes for up to six central outcome parameters were calculated using pre-post comparisons from short and medium term follow-ups, they were correlated with prognostically relevant characteristics of the studies and samples. The combined weighted intra-group effect sizes were compared with results from international studies. 16 studies, both controlled and uncontrolled, were included. Again we could not identify any study confirming the effectiveness of medical rehabilitation in chronic back pain compared to no treatment or usual care. The methodological quality of the new studies did not seem to exceed that of the earlier ones. Depending on the outcome variable, small effects (e. g. on functional ability) to relevant effects (e. g. vitality) can be observed at or immediately after the end of rehabilitation. Now the effects after three to 12 months seem to be smaller than previously observed. The small size of medium term effects indicates a basic problem of inpatient rehabilitation for chronic back pain in Germany. This becomes even greater when the results of international controlled studies are used as reference. Possible reasons for the disappointing situation (weak methodology, inappropriate selection of patients, weak intervention) are to be discussed. At present, we have no convincing evidence for a general effectiveness of Germany's system of inpatient rehabilitation for chronic back pain.

Group rehabilitation for chronic back pain: a pilot study

Twelve subjects recruited by an advertisement in the Sheffield University newsletter and from referral from the pain clinic at the Royal Hallamshire Hospital, began a 12-week group exercise. Emphasis was placed on identifying specific impairments in back function and focusing on the functional restoration of these deficits using mobility, progressive strengthening and stretching exercises for the trunk, pelvis and hips. Physical function was assessed by measuring total lumbosacral flexion and extension, straight leg raising, hip extension, trunk curl and lifting capacity. Disability and pain beliefs were measured using the Oswestry Low Back Pain Disability questionnaire and Survey of Pain Attitudes questionnaire respectively. Ten subjects completed the exercise programme (mean attendance of 16 sessions). Patients showed statistically significant (P&lt;0.05) improvements in total lumbosacral extension, trunk curl and lifting capacity and perceived disability was reduced from a classification of ‘moderate’ to ‘minimal’ (Oswestry). There were also significant favourable changes in the pain beliefs about control and disability. The results demonstrated that moderately disabled subjects with chronic low back pain can benefit from a structured group exercise programme. This type of programme may be suitable for small groups of 10–12 patients, requires simple equipment and a modest amount of space.

Multidisciplinary rehabilitation for chronic back pain in an outpatient setting: a controlled randomized trial

Based on existing models for pain chronicity and effective treatment strategies for patients with chronic low back pain, a multidisciplinary rehabilitation programme for an outpatient group setting was developed. The main treatment components address the patient's physical functional capacity (functional restoring), cognitive and affective processes (pain management strategies), and behavioural and ergonomical aspects (back school elements). Short-term (immediately after intervention) and long-term effects (at 6-months follow-up) of the intervention were assessed in a randomized controlled study. Dependent variables were pain measures, functional capacity, disability, muscular strength and endurance, pain and posture-related self-efficacy, attitudes, depression, well-being, beiavioural habits and posture assessed by a standardized behavioural observation method. Immediately after the intervention, patients in the treatment group ( n = 36) showed significant improvement over patients in the control group ( n = 29) in all variables except depression and muscular strength and endurance. At 6-months follow-up, compared to pretreatment scores, patients continued to show beneficial effects in pain intensity and frequency, posture, posture-related self-efficacy and well-being. In contrast to post-treatment results, there were also significant improvements in strength and endurance. Overall results testify to the effectiveness of the intervention programme. Future studies (with larger sample sizes) should aim at a further improvement of functional capacity and disability perception, an analysis of differential treatment effects, and strategies for an improved long-term maintenance of the changes induced by the programme.

The use of the MMPI in a chronic back pain rehabilitation program.

Assessed the usefulness of the MMPI in predicting treatment outcome for chronic low back pain patients. One hundred and thirty-two chronic low back pain patients who participated in a 6-week rehabilitation program were differentiated according to "successful" outcome. Outcome was defined in three major ways: Vocational restoration, significantly improved physical mobility, and patients' subjective evaluations of improved functional level. Pretreatment MMPIs of all outcome groups were compared. Data were analyzed by examining individual scale scores and code-types and by applying multiple regression analyses to the data. Results demonstrate that the MMPI can predict successful outcome. However, the strength of the relationship varies according to the outcome measure employed and the type of analysis completed on the data. It is concluded that, though an interesting research tool, at this time the MMPI is not a consistently valid clinical tool with the chronic back pain population in terms of predicting response to rehabilitation.