Effectiveness of three treatment strategies on occupational limitations and quality of life for patients with non-specific chronic low back pain: Is a multidisciplinary approach the key feature to success: study protocol for a randomized controlled trial

Abstract

BackgroundChronic low back pain (cLBP) is a significant public health problem, being the primary cause of work absenteeism, as well as affecting sufferers’ quality of life, in industrialized society. International guidelines recommend intensive multidisciplinary approaches for patients with cLBP. However, these costly and time-consuming programs can only be offered to a minority of the most heavily affected patients and therefore do not seem likely to respond to public health requirements. Lighter programs may be an alternative to full time hospital-based programs with valuable results in terms of disability and occupational activity for cLBP patients. It is therefore important to define both what the determining components of management to improve activity restriction are and how to treat a larger number of patients more effectively at a lower cost. The aim of this study is to compare three programs with various levels of intensity and multidisciplinary.Methods/DesignThis paper describes the protocol for a prospective, randomized, controlled, clinical trial in working aged patients with cLBP. Three treatment strategies are compared: (1) intensive and multidisciplinary program conducted in a rehabilitation center; (2) less intensive outpatient program conducted by a private physiotherapist; (3) mixed strategy combining the same out program with a multidisciplinary intervention. The primary outcome of the trial is the impact of the mixed strategy on being able to work compared to hospital centered-program and out program. The secondary outcome is the impact of the mixed strategy on quality of life and social ability compared to the two others programs. The intervention part of the trial programs will take 5 weeks and observational follow-up will take 12 months. The sample size will be 180 participants (60 for each arm). The project has been approved by the Ethical Committee of Angers Hospital, France.DiscussionOn the hypothesis that a multidisciplinary approach is the key feature to programs success in reducing social and occupational impairment in cLBP patients, we suggest that it is possible to achieve the same results with less intensive strategies if a multidisciplinary approach is maintained.Trial registrationCurrent Controlled Trials NCT02030171.

Fundamentos e Práticas da Fisioterapia 6

“…A large number of systematic reviews of the literature have indicated that the treatment of low back pain is difficult and many established interventions have limited effectiveness(DEYO et al, 2015;PATTI et al, 2015; HIDALGO et al, 2014; GUZMÁN et al, 2001). Studies have been conducted to find effective therapies aimed at reducing complaints related to chronic low back pain and its consequences(DA LUZ et al, 2013;PATTI et al, 2015, PETIT et al, 2014. Physical agents and kinesiotherapy can minimize the perception of pain symptoms, are inexpensive and have few or no side effects, as demonstrated by the present findings, since the use of an additional physical resource combined with an exercise program led to greater effect sizes(ALEXANDRIA, 2014) …”

Development and Validation of a Pain Behavior Assessment in Patients with Chronic Low Back Pain

“…(1) Grip strength: In an unpublished study by Kool et al 2005, the 10th percentile for the item was found to be 10 kg for women. Thus, scores lower than the 10th percentile was defined as high level of pain behavior; (2) Lifting: the cutoff was set at the 10th percentile of the lifting-weight/body-weight ratio, with values below 8 % indicating the presence of pain behavior. (3) One-hand carry: the 10th percentile of our own sample was chosen.…”

“…Multidisciplinary rehabilitation and functional rehabilitation programs (FRP) [1] for such patients with physically demanding jobs focus on musculoskeletal reconditioning, work reintegration and behavioral training, but are timeconsuming and expensive [2,3]. Patients with physically demanding jobs are often migrants with lower socio-economic status, different cultural backgrounds and language barriers.…”

Effectiveness of Three Treatment Strategies on Quality of Life for Patients with Chronic Low Back Pain: A Multidisciplinary Approach as Key to Success

“…Petit A & Ronzi Y and colleagues reported a protocol based in a set of physiotherapies, which consisted in: 1) Intensive and multidisciplinary program conducted in a rehabilitation center; 2) Less intensive outpatient program conducted by a trained private physiotherapist; and 3) Mixed strategy combining the same outpatient program associated with a weekly multidisciplinary intervention. They did not find significant difference for the evolution of participants' quality of life, social ability, and personal beliefs between the three groups [15,16]. Liu L and coworkers presented a classic no invasive method based on acupuncture.…”