The effect of an integrated multidisciplinary rehabilitation programme for patients with chronic low back pain: Long-term follow up of a randomised controlled trial

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Abstract

Objective:

To compare the long-term effectiveness of an integrated rehabilitation programme with an existing rehabilitation programme, in terms of back-specific disability, in patients with chronic low back pain.

Design:

A single-centre, pragmatic, two-arm parallel, randomised controlled trial.

Setting:

A rheumatology rehabilitation centre in Denmark.

Subjects:

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

Interventions:

An integrated programme (a pre-admission day, two weeks at home, two weeks inpatient followed by home-based activities, plus two 2-day inpatient booster sessions, and six-month follow-up visit) was compared with an existing programme (four-week inpatient, and six-month follow-up visit).

Main measure:

The primary outcome was disability measured using the Oswestry Disability Index after one year. 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). Analysis was by intention-to-treat, using linear mixed models.

Results:

303 patients were assessed for eligibility of whom 165 patients (mean age 50 years (SD 13) with a mean Oswestry Disability Index score of 42 (SD 11)) were randomly allocated (1:1 ratio) to the integrated programme ( n = 82) or the existing programme ( n = 83). The mean difference (integrated programme minus existing programme) in disability was –0.53 (95% CI –4.08 to 3.02); p = 0.770). No statistically significant differences were found in the secondary outcomes.

Conclusion:

The integrated programme was not more effective in reducing long-term disability in patients with chronic low back pain than the existing programme.

Related collections

Most cited references 30

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Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide

T C Hoffmann, P P Glasziou, I Boutron … (2015)

Without a complete published description of interventions, clinicians and patients cannot reliably implement interventions that are shown to be useful, and other researchers cannot replicate or build on research findings. The quality of description of interventions in publications, however, is remarkably poor. To improve the completeness of reporting, and ultimately the replicability, of interventions, an international group of experts and stakeholders developed the Template for Intervention Description and Replication (TIDieR) checklist and guide. The process involved a literature review for relevant checklists and research, a Delphi survey of an international panel of experts to guide item selection, and a face to face panel meeting. The resultant 12 item TIDieR checklist (brief name, why, what (materials), what (procedure), who provided, how, where, when and how much, tailoring, modifications, how well (planned), how well (actual)) is an extension of the CONSORT 2010 statement (item 5) and the SPIRIT 2013 statement (item 11). While the emphasis of the checklist is on trials, the guidance is intended to apply across all evaluative study designs. This paper presents the TIDieR checklist and guide, with an explanation and elaboration for each item, and examples of good reporting. The TIDieR checklist and guide should improve the reporting of interventions and make it easier for authors to structure accounts of their interventions, reviewers and editors to assess the descriptions, and readers to use the information.

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What low back pain is and why we need to pay attention

Paulo Ferreira, Manuela Ferreira, Peter Croft … (2018)

Low back pain is a very common symptom. It occurs in high-income, middle-income, and low-income countries and all age groups from children to the elderly population. Globally, years lived with disability caused by low back pain increased by 54% between 1990 and 2015, mainly because of population increase and ageing, with the biggest increase seen in low-income and middle-income countries. Low back pain is now the leading cause of disability worldwide. For nearly all people with low back pain, it is not possible to identify a specific nociceptive cause. Only a small proportion of people have a well understood pathological cause-eg, a vertebral fracture, malignancy, or infection. People with physically demanding jobs, physical and mental comorbidities, smokers, and obese individuals are at greatest risk of reporting low back pain. Disabling low back pain is over-represented among people with low socioeconomic status. Most people with new episodes of low back pain recover quickly; however, recurrence is common and in a small proportion of people, low back pain becomes persistent and disabling. Initial high pain intensity, psychological distress, and accompanying pain at multiple body sites increases the risk of persistent disabling low back pain. Increasing evidence shows that central pain-modulating mechanisms and pain cognitions have important roles in the development of persistent disabling low back pain. Cost, health-care use, and disability from low back pain vary substantially between countries and are influenced by local culture and social systems, as well as by beliefs about cause and effect. Disability and costs attributed to low back pain are projected to increase in coming decades, in particular in low-income and middle-income countries, where health and other systems are often fragile and not equipped to cope with this growing burden. Intensified research efforts and global initiatives are clearly needed to address the burden of low back pain as a public health problem.

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The Oswestry Disability Index.

Jeremy C. T. Fairbank, Paul B Pynsent (2000)

The Oswestry Disability Index (ODI) has become one of the principal condition-specific outcome measures used in the management of spinal disorders. This review is based on publications using the ODI identified from the authors' personal databases, the Science Citation Index, and hand searches of Spine and current textbooks of spinal disorders. To review the versions of this instrument, document methods by which it has been validated, collate data from scores found in normal and back pain populations, provide curves for power calculations in studies using the ODI, and maintain the ODI as a gold standard outcome measure. It has now been 20 years since its original publication. More than 200 citations exist in the Science Citation Index. The authors have a large correspondence file relating to the ODI, that is cited in most of the large textbooks related to spinal disorders. All the published versions of the questionnaire were identified. A systematic review of this literature was made. The various reports of validation were collated and related to a version. Four versions of the ODI are available in English and nine in other languages. Some published versions contain misprints, and many omit the scoring system. At least 114 studies contain usable data. These data provide both validation and standards for other users and indicate the power of the instrument for detecting change in sample populations. The ODI remains a valid and vigorous measure and has been a worthwhile outcome measure. The process of using the ODI is reviewed and should be the subject of further research. The receiver operating characteristics should be explored in a population with higher self-report disabilities. The behavior of the instrument is incompletely understood, particularly in sensitivity to real change.

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Author and article information

Journal

Journal ID (nlm-ta): Clin Rehabil

Journal ID (iso-abbrev): Clin Rehabil

Journal ID (publisher-id): CRE

Journal ID (hwp): spcre

Title: Clinical Rehabilitation

Publisher: SAGE Publications (Sage UK: London, England )

ISSN (Print): 0269-2155

ISSN (Electronic): 1477-0873

Publication date (Electronic): 11 October 2020

Publication date (Print): February 2021

Volume: 35

Issue: 2

Pages: 232-241

Affiliations

[1 ]Department of Public Health, Centre for Rehabilitation Research, Aarhus University, Aarhus C, Denmark

[2 ]Sano, Højbjerg, Denmark

[3 ]DEFACTUM, Central Denmark Region, Aarhus C, Denmark

[4 ]Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark

[5 ]Spine Centre, Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark

[6 ]Spine Centre of Southern Denmark, University Hospital Lillebælt, Middelfart, Denmark

[7 ]Institute for Regional Health Research, University of Southern Denmark, Middelfart, Denmark

Author notes

[*]Anne Mette Schmidt, Sano, Egernvej 5, Hoejbjerg, 8270, Denmark. Email: anne.mette.schmidt@ 123456stab.rm.dk

Author information

Anne Mette Schmidt https://orcid.org/0000-0002-3077-4985

Article

Publisher ID: 10.1177_0269215520963856

DOI: 10.1177/0269215520963856

PMC ID: 7874370

PubMed ID: 33040598

SO-VID: 9f5e0721-0494-46fa-a84e-4f704cd47fde

License:

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

Date received : 30 March 2020

Date accepted : 12 September 2020

Funding

Funded by: Sano, ;

Funded by: Aarhus Universitet, FundRef https://doi.org/10.13039/100007605;

Award ID: 19526435

Funded by: The Danish Rheumatism Association, ;

Award ID: R150-A4394-B1251

Funded by: Familien Hede Nielsens Fond, FundRef https://doi.org/10.13039/501100007438;

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ScienceOpen disciplines: Medicine

Keywords: chronic low back pain,multidisciplinary rehabilitation,biopsychosocial approach,complex interventions

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ScienceOpen disciplines: Medicine

Keywords: chronic low back pain, multidisciplinary rehabilitation, biopsychosocial approach, complex interventions

The effect of an integrated multidisciplinary rehabilitation programme for patients with chronic low back pain: Long-term follow up of a randomised controlled trial

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Results:

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Most cited references 30

Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide

What low back pain is and why we need to pay attention

The Oswestry Disability Index.

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