Prediction of function in daily life following multidisciplinary rehabilitation for individuals with chronic musculoskeletal pain; a prospective study Role of Physical Exercise in Low Back Pain Rehabilitation: A Randomized Controlled Trial of a Three-Month Exercise Program in Patients Who Have Completed Multidisciplinary Rehabilitation Course and prognosis of recovery for chronic non-specific low back pain: design, therapy program and baseline data of a prospective cohort study Rehabilitation for people with multiple sclerosis: an overview of Cochrane Reviews. Multidisciplinary Rehabilitation Treatment of Patients With Chronic Low Back Pain: A Prognostic Model for Its Outcome Multidisciplinary Group Rehabilitation Versus Individual Physiotherapy for Chronic Nonspecific Low Back Pain: A Randomized Trial Does Teaching Physical Therapists to Deliver a Biopsychosocial Treatment Program Result in Better Patient Outcomes? A Randomized Controlled Trial Can inpatient multidisciplinary rehabilitation improve health-related quality of life in MS patients on the long term - The Danish MS Hospitals Rehabilitation Study. Functional multidisciplinary rehabilitation versus outpatient physiotherapy for non specific low back pain: randomized controlled trial. Effects of Multidisciplinary Rehabilitation on Chronic Fatigue in Multiple Sclerosis: A Randomized Controlled Trial
Background The prevalence of chronic musculoskeletal pain is high , with widespread negative economic , psychological , and social consequences for the individual . It is therefore important to find ways to predict the outcome of rehabilitation programmes in terms of function in daily life . The aims of this study were to investigate the improvements over time from multidisciplinary rehabilitation in terms of pain and function , and analyse the relative impact of individual and psychosocial factors as predictors of function in daily life in individuals with chronic musculoskeletal pain . Methods A prospect i ve study was conducted among one hundred and forty three ( N = 143 ) musculoskeletal pain patients .  Measures of pain , function , and functional health status were obtained at baseline , after 5 weeks of intensive training , at the end of the 57-week rehabilitation programme , and at a 1 year follow-up , using vali date d self-administrated measures . Linear regression analysis was applied to investigate the relative impact of musculoskeletal pain , individual- , and psychosocial factors in function . Results The participants studied showed a significant increase in function during the 57 weeks rehabilitation period . There was also a significant increase in function from the end of the rehabilitation period ( 57th week ) to the one year follow-up measures . Pain intensity associated significantly with pain experience over all measurement periods . High levels of pain intensity ( β = .42 * * ) and pain experience ( β = .37 * ) , and poor psychological capacity ( β = -.68 * ) at baseline , as well as poor physiological capacity ( β = -.44 * * ) and high levels of anxiety ( β = .48 * * ) and depression ( β = .58 * * * ) at the end of the rehabilitation program were the most important prognostic factors of variance in functioning over the 4 measurement periods . Conclusion The data suggest that physical capacity , emotional distress and coping skills should be priority areas in rehabilitation programmes to improve functioning in daily life Study Design . R and omized controlled trial with 1-year follow-up . Objective . To analyze the effects of an exercise program or routine follow-up on patients with chronic low back pain who have completed functional multidisciplinary rehabilitation . The short- and long-term outcome in terms of symptoms and physical and social functioning was compared . Summary of Background Data . Systematic review s have shown that functional multidisciplinary rehabilitation improves physical function and reduces pain in patients with chronic low back pain . However , long-term maintenance of these improvements is inconsistent and the role of exercise in achieving this goal is unclear . Methods . One hundred five chronic patients with low back pain who had completed a 3-week functional multidisciplinary rehabilitation program were r and omized to either a 3-month exercise program ( n = 56 ) or routine follow-up ( n = 49 ) . The exercise program consisted of 24 training sessions during 12 weeks . Patients underwent evaluations of trunk muscle endurance , cardiovascular endurance , lumbar spine mobility ( flexion and extension range-of-motion , fingertip-to-floor distance ) , pain and perceived functional ability at the beginning and the end of functional multidisciplinary rehabilitation , at the end of the exercise program ( 3 months ) and at 1-year follow-up . Disability was also assessed at the same time points except at the beginning of functional multidisciplinary rehabilitation . Results . At the end of the functional multidisciplinary rehabilitation , both groups improved significantly in all physical parameters except flexion and extension range-of-motion . At the 3 month and 1 year follow-up , both groups maintained improvements in all parameters except for cardiovascular endurance . Only the exercise program group improved in disability score and trunk muscle endurance . No differences between groups were found . Conclusion . A favorable long-term outcome was observed after functional multidisciplinary rehabilitation in both patient groups . Patients who participated in an exercise program obtained some additional benefits . The relevance of these benefits to overall health status need to be further investigated Background There has been increasing focus on factors predicting the development of chronic musculoskeletal disorders . For patients already experiencing chronic non-specific low back pain it is also relevant to investigate which prognostic factors predict recovery . We present the design of a cohort study that aims to determine the course and prognostic factors for recovery in patients with chronic non-specific low back pain . Methods / Design All participating patients were recruited ( Jan 2003-Dec 2008 ) from the same rehabilitation centre and were evaluated by means of ( postal ) question naires and physical examinations at baseline , during the 2-month therapy program , and at 5 and 12 months after start of therapy . The therapy protocol at the rehabilitation centre used a bio-psychosocial approach to stimulate patients to adopt adequate ( movement ) behaviour aim ed at physical and functional recovery . The program is part of regular care and consists of 16 sessions of 3 hours each , over an 8-week period ( in total 48 hours ) , followed by a 3-month self-management program . The primary outcomes are low back pain intensity , disability , quality of life , patient 's global perceived effect of recovery , and participation in work . Baseline characteristics include information on socio-demographics , low back pain , employment status , and additional clinical items status such as fatigue , duration of activities , and fear of kinesiophobia . Prognostic variables are determined for recovery at short-term ( 5 months ) and long-term ( 12 months ) follow-up after start of therapy . Discussion In a routine clinical setting it is important to provide patients suffering from chronic non-specific low back pain with adequate information about the prognosis of their complaint BACKGROUND Multiple sclerosis ( MS ) is a major cause of chronic , neurological disability , with a significant long-term disability burden , often requiring comprehensive rehabilitation . OBJECTIVES To systematic ally evaluate evidence from published Cochrane Review s of clinical trials to summarise the evidence regarding the effectiveness and safety of rehabilitation interventions for people with MS ( pwMS ) , to improve patient outcomes , and to highlight current gaps in knowledge . METHODS We search ed the Cochrane Data base of Systematic Review s up to December 2017 , to identify Cochrane Review s that assessed the effectiveness of organised rehabilitation interventions for pwMS . Two review ers independently assessed the quality of included review s , using the Revised Assessment of Multiple Systematic Review s ( R-AMSTAR ) tool , and the quality of the evidence for reported outcomes , using the GRADE framework . MAIN RESULTS Overall , we included 15 review s published in the Cochrane Library , comprising 164 r and omised controlled trials ( RCTs ) and four controlled clinical trials , with a total of 10,396 participants . The included review s evaluated a wide range of rehabilitation interventions , including : physical activity and exercise therapy , hyperbaric oxygen therapy ( HBOT ) , whole-body vibration , occupational therapy , cognitive and psychological interventions , nutritional and dietary supplements , vocational rehabilitation , information provision , telerehabilitation , and interventions for the management of spasticity . We assessed all review s to be of high to moderate method ological quality , based on R-AMSTAR criteria .Moderate- quality evidence suggested that physical therapeutic modalities ( exercise and physical activities ) improved functional outcomes ( mobility , muscular strength ) , reduced impairment ( fatigue ) , and improved participation ( quality of life ) . Moderate- quality evidence suggested that inpatient or outpatient multidisciplinary rehabilitation programmes led to longer-term gains at the levels of activity and participation , and interventions that provided information improved patient knowledge . Low-qualitty evidence suggested that neuropsychological interventions , symptom-management programmes ( spasticity ) , whole body vibration , and telerehabilitation improved some patient outcomes . Evidence for other rehabilitation modalities was inconclusive , due to lack of robust studies . AUTHORS ' CONCLUSIONS The evidence suggests that regular specialist evaluation and follow-up to assess the needs of patients with all types of MS for appropriate rehabilitation interventions may be of benefit , although the certainty of evidence varies across the different types of interventions evaluated by the review s. Structured , multidisciplinary rehabilitation programmes and physical therapy ( exercise or physical activities ) can improve functional outcomes ( mobility , muscle strength , aerobic capacity ) , and quality of life . Overall , the evidence for many rehabilitation interventions should be interpreted cautiously , as the majority of included review s did not include data from current studies . More studies , with appropriate design , which report the type and intensity of modalities and their cost-effectiveness are needed to address the current gaps in knowledge Objectives ( 1 ) To determine if treatment outcome in chronic low back pain can be predicted by a predefined multivariate prognostic model based on consistent predictors from the literature and ( 2 ) to explore the value of potentially prognostic factors further . Methods Data were derived from a r and omized controlled trial on the effect of a multidisciplinary rehabilitation program for chronic low back pain compared with usual care .  The primary outcome measure was the Rol and and Morris Disability Question naire and secondary outcomes were the Physical and Mental Component Summary Scales , derived from the Short Form Health Survey . Outcomes were expressed as the differences between baseline and follow-up ( 8 wk and 6 mo ) values . A confirmatory and an exploratory model were defined . Baseline predictors included in the confirmatory model were pain intensity , work status , and Multidimensional Pain Inventory subgroup membership . The exploratory model included sick leave , compensation , depression , and fear-avoidance beliefs . Statistical analysis was performed using multiple linear regression analysis . Results One hundred and sixty-three patients participated in the study . More pain was prognostic for more improvement in the rehabilitation group . No value was found for work status or the Multidimensional Pain Inventory subgroups . For the exploratory model , more depression and fear-avoidance beliefs predicted more improvement after rehabilitation . The explained variance ranged from 18.5 % to 43.8 % depending on the length of follow-up evaluation , the treatment group , and the outcome variable of interest . Discussion The results of this study do not support the construction of a clinical prediction model . Future confirmative studies of homogeneous rehabilitation treatments and outcome measures are needed to shed more light on relevant prognostic factors Study Design . A r and omized trial . Objective . To evaluate the effectiveness of a semi-intensive multidisciplinary rehabilitation for patients with chronic low back pain in an outpatient setting . Summary and Background Data . Systematic review s have shown that there is strong evidence that intensive multidisciplinary treatment ( > 100 hours ) , which includes functional restoration , improves function among chronic patients with low back pain , and moderate evidence that it reduces pain but contradictory evidence regarding improvement of working ability . However , there is paucity of data whether semi-intensive outpatient multidisciplinary rehabilitation in groups is more effective than individual physiotherapy . Material s and Methods . A total of 120 women employed as healthcare and social care professionals with nonspecific chronic low back pain were recruited from two occupational healthcare centers . The patients were r and omized into two intervention programs . Multidisciplinary rehabilitation ( n = 59 ) was conducted in groups and comprised of physical training , workplace interventions , back school , relaxation training , and cognitive-behavioral stress management methods for 70 hours . The individual physiotherapy ( n = 61 ) included physical exercise and passive treatment methods administered for 10 hours . Main outcome measures were : back pain and sciatic pain intensity , disability , sick leaves , healthcare consumption , symptoms of depression , and beliefs of working ability after 2 years . Results . There were no statistically significant differences between the two treatment groups in main outcome measures just after rehabilitation , at 6- , at 12- , or 24-month follow-up . In both intervention arms , however , the before- and -after comparison showed favorable effects , and the effects were still maintained at 2 years follow-up . Conclusions . The results of this study indicate that semilight outpatient multidisciplinary rehabilitation program for female chronic low back pain patients does not offer incremental benefits when compared with rehabilitation carried out by a physiotherapist having a cognitive-behavioral way of administering the treatment Background Psychosocial prognostic factors are important in the development of chronic pain , but treatment providers often lack knowledge and skills to assess and address these risk factors . Objective The aim of this study was to examine the effects on outcomes ( pain and disability ) in patients of a course about psychosocial prognostic factors for physical therapists . Design This study was a r and omized , controlled trial . Setting The setting was primary care practice . Participants Forty-two primary care physical therapists attended an 8-day university course ( over 8 weeks ) aim ed at identifying and addressing psychosocial risk factors . Intervention The physical therapists were r and omly assigned to either the course or a waiting list . They treated consecutive patients with acute and subacute musculoskeletal pain both before and after the course . Measurements We measured physical therapists ' attitudes and beliefs about psychosocial factors , knowledge , and skills before and after the course . We measured patients ' pain , disability , catastrophizing , and mood at the start of treatment and at a 6-month follow-up . Methods The physical therapists were r and omly assigned to either the course or a waiting list . They treated consecutive patients with acute and subacute musculoskeletal pain both before and after the course . Results Pain and disability outcomes in all patients of physical therapists who had participated in the course or in patients at risk of developing long-term disability who had higher levels of catastrophizing or depression were not significantly different from those outcomes in patients of physical therapists who had not participated in the course . Pain and disability outcomes in patients with a low risk of developing long-term disability— and pain outcomes in patients with a high risk of developing long-term disability — were not dependent upon whether the attitudes and beliefs of their physical therapists changed during the course . However , disability outcomes in patients with a high risk of developing long-term disability may have been influenced by whether the attitudes and beliefs of their physical therapists changed . Limitations A limitation of this study was that actual practice behavior was not measured . Conclusions An 8-day university course for physical therapists did not improve outcomes in a group of patients as a whole or in patients with a risk of developing long-term disability . However , patients who had a risk of developing long-term disability and had higher levels of catastrophizing or depression may have shown greater reductions in disability if the attitudes and beliefs of their physical therapists changed during the course BACKGROUND Inpatient multidisciplinary rehabilitation ( MDR ) can improve health-related quality of life ( HRQoL ) in multiple sclerosis ( MS ) patients . However , the evidence of a long-term benefit is limited . OBJECTIVES To investigate the long-term effectiveness of inpatient MDR on HRQoL in MS patients . METHODS We conducted a r and omized controlled partial crossover trial with 427 MS patients . RESULTS Statistical significant long-term improvements in HRQoL were found in three of the six outcome measures at 12-month follow-up . Three in four suggested minimal clinical ly important differences ( MCIDs ) were unmet . CONCLUSION These results indicate that the administration of inpatient MDR may lead to long-lasting improvements in HRQoL in MS patients INTRODUCTION In recent decades the treatment of non-specific low back pain has turned to active modalities , some of which were based on cognitive-behavioural principles . Non-r and omised studies clearly favour functional multidisciplinary rehabilitation over outpatient physiotherapy . However , systematic review s and meta- analysis provide contradictory evidence regarding the effects on return to work and functional status . The aim of the present r and omised study was to compare long-term functional and work status after 3-week functional multidisciplinary rehabilitation or 18 supervised outpatient physiotherapy sessions . METHODS 109 patients with non-specific low back pain were r and omised to either a 3-week functional multidisciplinary rehabilitation programme , including physical and ergonomic training , psychological pain management , back school and information , or 18 sessions of active outpatient physiotherapy over 9 weeks . Primary outcomes were functional disability ( Oswestry ) and work status . Secondary outcomes were lifting capacity ( Spinal Function Sort and PILE test ) , lumbar range-of-motion ( modified-modified Schöber and fingertip-to-floor tests ) , trunk muscle endurance ( Shirado and Biering-Sörensen tests ) and aerobic capacity ( modified Bruce test ) . RESULTS Oswestry disability index was improved to a significantly greater extent after functional multidisciplinary rehabilitation compared to outpatient physiotherapy at follow-up of 9 weeks ( P = 0.012 ) , 9 months ( P = 0.023 ) and 12 months ( P = 0.011 ) . Work status was significantly improved after functional multidisciplinary rehabilitation only ( P = 0.012 ) , result ing in a significant difference compared to outpatient physiotherapy at 12 months ' follow-up ( P = 0.012 ) . Secondary outcome results were more contrasted . CONCLUSIONS Functional multidisciplinary rehabilitation was better than outpatient physiotherapy in improving functional and work status . From an economic point of view , these results should be backed up by a cost-effectiveness study Background Several rehabilitation programmes aim at reducing the impact of fatigue in MS patients . Acute and chronic fatigue should require different management . Objectives To assess the effects of individually tailored , multidisciplinary outpatient rehabilitation ( MDR ) on chronic fatigue . Methods Forty-eight ambulatory MS patients with chronic fatigue were r and omized to MDR or to  MS – nurse consultation .  Fatigue was assessed by the Checklist Individual Strength ( CIS-20R ) . Secondary outcomes included the Modified Fatigue Impact Scale , Fatigue Severity Scale , Functional Independence Measure , Disability and Impact Profile ( DIP ) , Multiple Sclerosis Impact Scale and the Impact on Participation and Autonomy ( IPA ) . Results The primary outcome measure CIS-20R overall score showed no significant differences between groups at 12 weeks ( P = 0.39 ) and 24 weeks follow-up ( P = 0.14 ) , nor for subscales ( t = 12 and t = 24 , 0.19≤P≤0.88 ) . No significant within-group effects were found for both groups with respect to the primary ( 0.57≤p≤0.97 ) and secondary ( 0.11≤p≤0.92 ) outcome measures from baseline to 12 or 24 weeks . Conclusion Multidisciplinary rehabilitation was not more effective in terms of reducing self-reported fatigue  in MS patients  compared to MS-nurse consultation . Our results suggest that chronic fatigue in patients with MS may be highly invariant over time , irrespective of interventions . Trial Registration controlled-trials.com IS RCT
Discussion : While pain intensity and long-term chronicity did not predict physical functioning in chronic pain patients after MDR , poor pretreatment physical and psychological functioning influenced the prognosis negatively .
Thus , treatment should further target and optimize these modifiable factors and an increased focus on positive , psychological protective factors may perhaps provide an opening for yet untapped clinical gains
Objectives : This systematic review aim ed to identify and evaluate prognostic factors for long-term ( ≥6 mo ) physical functioning in patients with chronic musculoskeletal pain following multidisciplinary rehabilitation ( MDR ) .