Chronic low back pain (CLBP) is associated with persistent or recurrent disability which results in high costs for society. Cognitive behavioral treatments produce clinically relevant benefits for patients with CLBP. Nevertheless, no clear evidence for the most appropriate intervention is yet available. The purpose of this study is to evaluate the mid-term effects of treatment in a cohort of patients with CLBP participating in an intensive pain management programme. The programme provided by RealHealth-Netherlands is based on cognitive behavioral principles and executed in collaboration with orthopedic surgeons. Main outcome parameters were daily functioning (Roland and Morris Disability Questionnaire and Oswestry Disability Questionnaire), self-efficacy (Pain Self-Efficacy Questionnaire) and quality of life (Short Form 36 Physical Component Score). All parameters were measured at baseline, last day of residential programme and at 1 and 12 months follow-up. Repeated measures analysis was applied to examine changes over time. Clinical relevance was examined using minimal clinical important differences (MCID) estimates for main outcomes. To compare results with literature effect sizes (Cohen’s d) and Standardized Morbidity Ratios (SMR) were determined. 107 patients with CLBP participated in this programme. Mean scores on outcome measures showed a similar pattern: improvement after residential programme and maintenance of results over time. Effect sizes were 0.9 for functioning, 0.8 for self-efficacy and 1.3 for physical functioning related quality of life. Clinical relevancy: 79% reached MCID on functioning, 53% on self-efficacy and 80% on quality of life. Study results on functioning were found to be 36% better and 2% worse when related to previous research on, respectively, rehabilitation programmes and spinal surgery for similar conditions (SMR 136 and 98%, respectively). The participants of this evidence-based programme learned to manage CLBP, improved in daily functioning and quality of life. The study results are meaningful and comparable with results of spinal surgery and even better than results from less intensive rehabilitation programmes.

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In the light of past development failures, coupled with the pressure on government to deliver on their promises made towards agricultural development, a need was developed for a framework to assist government in choosing between agricultural development projects in the North West Province, consequently assisting government with their budget allocation towards agricultural development. Consequently, detailed agricultural development plans were drafted with the intent to provide a framework or roadmap that will enable small-scale farmers to be more successful over the long term. With a government that is often faced with strict budget constraints, budget allocations to agricultural development initiatives should be done in a way that will yield the highest economic, social and environmental returns. Hence, a decision support system that will guide budget allocation for agricultural development initiatives is sorely needed. This article provides a framework on how multiple criteria analysis can be used as a decision support tool that will ensure optimal budget allocation for agricultural development. Findings from the study concluded that the beef production (based on a joint venture business concept and linked to the Western Frontier Beef Beneficiation program) is one of the most viable and sustainable agricultural projects in the North West Province. Following beef production is vegetable production which makes use of the contract grower concept, goat meat (Public Private Partnership), grain (joint venture), veldt management and the Taung Irrigation Scheme which employs contract farming.