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Clinical Production Model for Multidisciplinary Treatment of Chronic Low Back Pain Not Supported

Chronic low back pain (CLBP) is a common problem in the developed world. Because of the wide variety of patients affected, the methods of injury, and the injuries themselves, it has so far not been possible to develop a one-size fits all approach to managing CLBP nor providing accurate prognosis. The authors of this article sought to determine if there could be a multidisciplinary outcome in CLBP that could be predicted with a model.

The researchers recruited patients who had experienced CLBP for longer than three months and had not had spinal surgery within three months. The 163 patients were randomized to the control group or the intervention group; measurements were obtained at the start of the study (T0), in the week after treatment (T1), and then again four months after treatment (T5). The control group was called the "waiting list" group and their T1 assessment was done eight weeks after T0, T5 was done at 6 months after T0.

The patients in the treatment groups participated in the Roessingh Back Rehabilitation Program, RBRP, within two to three weeks of randomization. The program is based on the assumption that patients with CLBP develop a deconditioning syndrome: back pain causing limited activity, which leads to lowered physical capacity, which then leads back to overloading of the back. The treatment attempts to help the patients reduce this thinking and improve their physical conditioning and learn more about their back and its function.

The treatment also includes physiotherapy, sports, education, and occupational rehabilitation. The patients are required to be in the program a minimum of 90 percent of the time; groups consist of eight participants.

Data were obtained from both groups using the Visual Analog Scale (VAS), a scale of zero to 10, with zero being no pain and 10 being the most severe, work status ("yes" to full-time or part-time work, "no" to not working), the Multidementional Pain Inventory, MPI, to measure the psychosocial aspects of pain, sick leave as reported by the employee, financial compensation, depression, and fear of physical activity.

Twenty-one patients were lost during follow-up, but didn't affect the final analysis. Patients who were in the control group were allowed to use their regular interventions during the non-treatment period. The researchers found that, at eight weeks and six months follow-up, the patients showed fewer physical limitations and a higher quality-of-life in both groups. This meant that there was no difference in the overall outcome, regardless of the group that subjects were in. The authors write, "Our hypothesis that less pain, the ability to work, and classification as DYS [dysfunctional] or ID [interpersonally distressed] predicted more improvement after rehabilitation treatment was not supported. However, the value of several predefined factors for improvement after rehabilitation treatment was partly confirmed." This was shown by the higher quality-of-life outcomes in the control group at short-term follow up.

The authors concluded that their study did not support the idea that a clinical prediction model would aid in the prognosis of CLBP, but that the patients' feelings and actions (fear avoidance, pain intensity, etc) may contribute to prognosis.


Marije van der Hulst, MD, et al. Multidisciplinary Rehabilitation Treatment of Patients with Chronic Low Back Pain: A Prognostic Model for its Outcome. In Clinical Journal of Pain. June 2008. Vol. 24. No. 5. Pp. 421-429.

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