One hundred sixteen consecutive patients entered a functional restoration treatment program for chronic low back pain and were compared with 72 patients not treated. A two-year follow-up survey reached more than 85% of both groups; its findings were compared with earlier results of a five-month and one-year follow-up. Analysis demonstrated that 87% of the treatment group was actively working after two years, as compared with only 41% of the nontreatment comparison group. Moreover, about twice as many of the comparison group patients had additional spine surgery relative to the treatment group. The comparison group continued with an approximately five times higher rate of patient visits to health professionals in the second year as the treatment group. Also, treatment group reinjury rates were no higher than those expected in the general population, while nontreatment subjects had a higher incidence of reinjury. Finally, a small treatment "dropout" group did poorest of all, with results in almost all areas even worse than those of the comparison group patients.
The present study utilized recently developed diagnostic tests that permit recognition of functional deficits in spine mobility, trunk strength, endurance, coordination, and dynamic lifting capacity. Changes in these tests were compared to changes in psychological functioning (e.g., self-report of pain) as well as to outcome criteria such as return-to-work and resolution of litigation. The study utilized these tests repeatedly during a new treatment approach to feed back objective information of the patient's functional capacity, not amenable to simple visual inspection, to both the patient and the surgeon. The program itself integrated a low back physical rehabilitation program with a multimodal pain management program and was guided by repeated functional capacity measurements. A total of 66 patients were evaluated. Results demonstrated significant improvement in physical function in these patients, which was also accompanied by changes in self-report of pain complaints. Moreover, an 82% return-to-work rate was achieved in this sample which was initially 92% unemployed. These results indicate that the physician dealing with chronic low back dysfunction can employ objective measures of functional capacity as an alternative to the sole reliance on pain patient self-report or structured tests, such as radiographic imaging, which merely document a universal, progressive degenerative process.
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