Effectiveness of a multidisciplinary BIOPSYCHOSOCIAL intervention for non-specific SUBACUTE low back pain in a working population: a cluster randomized clinical trial

Abstract

BackgroundLow back pain (LBP) is a multifactorial condition with individual and societal impact that affects populations globally. Current guidelines for the treatment of LBP recommend pharmacological and non-pharmacological strategies. The aim of this study was to compare usual clinical practice with the effectiveness of a biopsychosocial multidisciplinary intervention in reducing disability, severity of pain and improving quality of life in a working population of patients with subacute (2–12 weeks), non-specific LBP.MethodsLongitudinal cluster randomized clinical trial conducted in 39 Primary Health Care Centres (PHCC) of Barcelona, with patients aged 18–65 years (n = 501; control group = 239; 26 PHCC, intervention group = 262; 13 PHCC). The control group received usual clinical care. The intervention group received usual clinical care plus a biopsychosocial multidisciplinary intervention, which consisted of physiotherapy, cognitive-behavioural therapy and medication. The main outcomes were changes in the Roland Morris Disability Questionnaire (RMDQ), and the minimal clinically important differences. Secondary outcomes were changes in the McGill Pain (MGPQ) and Quality of Life (SF-12) questionnaires. Assessment was conducted at baseline, 3 and 12 months. Analysis was by intention-to-treat and analyst-blinded. Multiple imputations were used.ResultsOf the 501 enrolled patients, 421 (84%) provided data at 3 months, and 387 (77.2%) at 12 months. Mean age was 46.8 years (SD: 11.5) and 64.7% were women. In the adjusted analysis of the RMDQ outcome, only the intervention group showed significant changes at 3 months (− 1.33 points, p = 0.005) and at 12 months (− 1.11 points, p = 0.027), but minimal clinically important difference were detected in both groups. In the adjusted analysis of the RMDQ outcome, the intervention group improvement more than the control group at 3 months (− 1.33 points, p = 0.005) and at 12 months (− 1.11 points, p = 0.027). The intervention group presented a significant difference. Both groups presented a minimal clinically important difference, but more difference in the intervention group. The intervention group presented significant differences in the MGPQ scales of current pain intensity and VAS scores at 3 months. No statistically significant differences were found in the physical and mental domains of the SF-12.ConclusionsA multidisciplinary biopsychosocial intervention in a working population with non-specific subacute LBP has a small positive impact on disability, and on the level of pain, mainly at short-term, but no difference on quality of life.Trial registrationISRCTN21392091 (17 oct 2018) (Prospectively registred).

The Efficacy and Effectiveness of Education for Preventing and Treating Non-Specific Low Back Pain in the Hispanic Cultural Setting: A Systematic Review

“…Among the 1148 unique references, 908 were excluded based on their title and abstract. The full texts of the remaining 240 were assessed, after screening for inclusion criteria, 231 records were excluded since they did not conducted in the hispanic cultural setting (211), and 20 for other reasons: not a study (description of a study protocol) (3) [25][26][27], education mixed with other interventions (8) [28][29][30][31][32][33][34][35], patients with LBP mixed with patients with other conditions (2) [36,37], not a randomized controlled trial (7) [36,[38][39][40][41][42][43] and less than 10 patients per group (1) [44]; and nine RCTs were finally included in this review. Figure 1 shows the PRISMA flow diagram of this study.…”

Disability and return to work after a multidisciplinary intervention for (sub)acute low back pain: A systematic review

“…After deleting the duplicates (n = 727) and running the two screening phases, 12 eligible articles remained. [28][29][30][31][32][33][34][35][36][37][38][39] The screening process and the reasons for exclusion can be found in the flow diagram of Figure 1.…”

“…Key study characteristics are summarized in Supplementary materials (E). Eleven of the 12 included articles were randomized controlled trials, [29][30][31][32][33][34][35][36][37][38][39] studying a total sample of 2571 patients in eight different cohort populations (considering three follow-up studies). 31,34,37 Furthermore, one systematic review was included, the Cochrane review and meta-analysis by Marin et al, 28 which involved nine studies conducted before 2016, studying a total of 351 patients.…”

Effect of multidimensional physiotherapy on non-specific chronic low back pain: a randomized controlled trial

“…The effective management of NSCLBP is a major concern for individuals, the economy, and society [6]. While there is a wide range of guideline-based management for NSCLBP, disability and burden have been increasing, leading to persistent, worsening, and recurrent pain [3,[7][8][9][10]. Despite the large volume of clinical research focused on identifying effective treatments for NSCLBP, optimal management remains a point of contention [11].…”