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      The effect of an integrated multidisciplinary rehabilitation programme alternating inpatient interventions with home-based activities for patients with chronic low back pain: a randomized controlled trial

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          Abstract

          Objective:

          To compare the effectiveness of an integrated rehabilitation programme with an existing rehabilitation programme in patients with chronic low back pain.

          Design:

          A single-centre, pragmatic, two-arm parallel, randomized controlled trial (1:1 ratio).

          Setting:

          A rheumatology inpatient rehabilitation centre in Denmark.

          Subjects:

          A total of 165 adults (aged ⩾ 18 years) with chronic low back pain.

          Interventions:

          An integrated rehabilitation programme comprising an alternation of three weeks of inpatient stay and 12 weeks of home-based activities was compared with an existing rehabilitation programme of four weeks of inpatient stay.

          Main measures:

          Patient-reported outcomes were collected at baseline and at the 26-week follow-up. The primary outcome was back-specific disability (Oswestry Disability Index). Secondary outcomes included pain intensity (Numerical Rating Scale), pain self-efficacy (Pain Self-Efficacy Questionnaire), health-related quality of life (EuroQol-5 Domain 5-level (EQ-5D)), and depression (Major Depression Inventory). A complete case analysis was performed.

          Results:

          A total of 303 patients were assessed for eligibility of whom 165 (mean age: 50 years (SD 13) and mean Oswestry Disability Index score 42 (SD 11)) were randomized (83 to existing rehabilitation programme and 82 to integrated rehabilitation programme). Overall, 139 patients provided the 26-week follow-up data. Baseline demographic and clinical characteristics were comparable between programmes. The between-group difference in the Oswestry Disability Index score when adjusting for the corresponding baseline score was −0.28 (95% confidence interval (CI): −4.02, 3.45) which was neither statistically nor clinically significant. No significant differences were found in the secondary outcomes.

          Conclusion:

          An integrated rehabilitation programme was no more effective than an existing rehabilitation programme at the 26-week follow-up.

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          Most cited references18

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          CONSORT 2010 Statement: Updated guidelines for reporting parallel group randomised trials.

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            Low back pain

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              Core outcome measurement instruments for clinical trials in nonspecific low back pain

              Supplemental Digital Content is Available in the Text. Consensus-based recommendations are provided on outcome measurement instruments for physical functioning, pain intensity, and health-related quality of life in patients with nonspecific low back pain.
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                Author and article information

                Journal
                Clin Rehabil
                Clin Rehabil
                CRE
                spcre
                Clinical Rehabilitation
                SAGE Publications (Sage UK: London, England )
                0269-2155
                1477-0873
                8 January 2020
                March 2020
                : 34
                : 3
                : 382-393
                Affiliations
                [1 ]Department of Public Health, Centre for Rehabilitation Research, Aarhus University, Aarhus, Denmark
                [2 ]Sano, Højbjerg, Denmark
                [3 ]DEFACTUM, Central Denmark Region, Aarhus, Denmark
                [4 ]Spine Centre of Southern Denmark, Lillebælt Hospital, Middelfart, Denmark
                [5 ]Institute for Regional Health Research, University of Southern Denmark, Middelfart, Denmark
                [6 ]Clinical Trials Unit, School of Primary, Community and Social Care, Faculty of Medicine and Health Sciences, Keele University, Staffordshire, UK
                [7 ]Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
                Author notes
                [*]Anne Mette Schmidt, Egernvej 5, 8270 Hoejbjerg, Denmark. Emails: aschmidt@ 123456sanocenter.dk ; anne.mette.schmidt@ 123456stab.rm.dk
                Author information
                https://orcid.org/0000-0002-3077-4985
                Article
                10.1177_0269215519897968
                10.1177/0269215519897968
                7029437
                31912752
                71bc7e47-eeed-4b74-8cb7-271fcaa20d09
                © The Author(s) 2020

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 23 August 2019
                : 6 December 2019
                Funding
                Funded by: Familien Heden Nielsens Fond, ;
                Funded by: Aarhus Universitet, FundRef https://doi.org/10.13039/100007605;
                Award ID: 19526435
                Funded by: Sano, ;
                Funded by: gigtforeningen, FundRef https://doi.org/10.13039/100008368;
                Award ID: R150-A4394-B1251
                Categories
                Evaluative Studies
                Custom metadata
                ts1

                Medicine
                chronic low back pain,multidisciplinary rehabilitation,biopsychosocial approach,complex interventions

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