V. Dubus

Return to work of 87 severely impaired low back pain patients two years after a program of intensive functional restoration

UNLABELLED Return to work is the main long-term objective of rehabilitation programs for patients with chronic low back pain (LBP). OBJECTIVES Evaluation of work status and number of sick leaves in 87 severely impaired LBP patients 2 years after a functional restoration program. PATIENTS AND METHODS Open prospective study. POPULATION 87 chronic LBP patients. INTERVENTION multidisciplinary functional restoration program. Ergonomic advice on the workplace was performed for 53 patients. OUTCOME work status and number of sick leaves due to LBP. RESULTS The characteristics of the 26 patients lost to follow-up did not differ significantly from the rest of the population before the program. In the 61 remaining patients, 48 (78%) were at work at 2 years, 43 full-time and 22 at the same job. Nineteen worked in a different environment. Sick leaves were reduced by 60% compared to the 2 years prior to the program: 128 days (+/-200 days) versus 329 days (+/-179 days); p<0.005. CONCLUSION Sick leaves remained significantly reduced and the number of workers who were at work significantly increased at 2 years after an intensive program.

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

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.

Management of low back pain in primary care prior to multidisciplinary functional restoration: a retrospective study of 72 patients.

OBJECTIVE Chronic low back pain is a major socioeconomic health issue, due to the high direct (healthcare) and indirect (sick leave) costs. The aim of the present study was to describe the primary care management of low back pain patients prior to their inclusion in a multidisciplinary functional restoration network. METHODS A descriptive, retrospective, questionnaire-based survey of the general practitioners dealing with 72 low back pain patients. RESULTS Patients had been monitored by their general practitioner for an average of four years, with a mean frequency of eight appointments per year per patient. Ninety-three percent and 60% of the patients had been referred to a rheumatologist and a surgeon, respectively. Ninety-eight percent had had lumbar radiographies, 80% had undergone a computed tomography scan and 64% had undergone magnetic resonance imaging. The most commonly prescribed medications were anti-inflammatories and first- or second-line analgesics. Thirty percent had already received morphine analgesics and 50% had taken antidepressants. Thirty-two percent had undergone lumbar surgery. Physiotherapy was frequently reported and, indeed, 6% of patients had participated in over 100 sessions. Total sick leave averaged 8.25 months over the studys follow-up period. CONCLUSION The time interval before referral to a multidisciplinary care team is long and so GPs should be encouraged and helped to organize this process earlier. It is also essential to determine factors which predict progression to chronic LBP.

Efficiency of three treatment strategies on occupational and quality of life impairments for chronic low back pain patients: is the multidisciplinary approach the key feature to success?

Objective: To compare the effectiveness of three treatment strategies for chronic low back pain with varying biomechanical intensity and multidisciplinary approach. Methods: A monocentric randomized controlled trial with a 12-months follow-up, conducted in the French Valley Loire region from May 2009 to April 2013. Participants were working-aged patients with chronic low back pain referred to a French chronic low back pain care-network to support medical and occupational issues. Three treatment strategies, each for five weeks were compared: (i) intensive and multidisciplinary program conducted in a rehabilitation center; (ii) less intensive outpatient program conducted by a trained private physiotherapist; (iii) mixed strategy combining the same outpatient program associated with a weekly multidisciplinary intervention. The effects of treatment conditions were compared using an “intention to treat” approach: Number of days’ sick leave during the 12-months following treatment, and quality of life and social ability assessed by auto-questionnaires. Results: A total of 159 patients (58.9% men, 41.5 ± 10.3 years old, median duration of sick leave = 221.0 days (127.5–319.0)) were included. Sick leave duration significantly decreased during the 12-months following treatment in the three groups. There was no significant difference for the evolution of participants’ quality of life, social ability, and personal beliefs between the three groups. Conclusion: This study confirms that disparate treatments might show similar effectiveness because they could all work through concomitant changes in beliefs, attitudes, and coping mechanisms. The original mixed strategy can treat a larger number of chronic low back pain patients, at a lower cost and provide local community-based care. Clinical Trial registration: NCT02030171

Comparison of three physical conditioning strategies for chronic low back pain: A randomized controlled trial

back pain having participated from 2008 till 2012. The main objective is the evaluation of the presence in work at 6 months and at 12 months. Results.– The percentage of patients in service passed of 43,4% in the inclusion in 64,2% at 6 months, in 58,2% at 12 months (P < 0,0003). The intensity of the pain and the scores of the auto-questionnaires of Dallas, Quebec and FABQ decrease in a significant way at 6 months. We don’t find predictive factors on returning to the work. There are significantly more patients who practise a physical activity in 6 months and 12 months (35.2% in j0,68.4 in 6 months,54.4 in 1 year) and a regular auto-reeducation in 6 months of the program (56.8% against 1% initially). In 3 weeks and at 6 months, there is a significant decrease of the consumption of analgesic (more than half). At 6 months 55% of the educational objectives are reached and the satisfaction is close to 90%. Conclusion.– This program of Functional Restoration and Education for low back pain had a positive effect on the resumption and the preservation of a professional and physical activity in 6 months and in 12 months.