Multidisciplinary Group Rehabilitation Versus Individual Physiotherapy for Chronic Nonspecific Low Back Pain: A Randomized Trial Predictors of efficacy in treatment of chronic low back pain. 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 Multidisciplinary Rehabilitation Treatment of Patients With Chronic Low Back Pain: A Prognostic Model for Its Outcome Rehabilitation for people with multiple sclerosis: an overview of Cochrane Reviews. Functional multidisciplinary rehabilitation versus outpatient physiotherapy for non specific low back pain: randomized controlled trial. Interventional Therapies, Surgery, and Interdisciplinary Rehabilitation for Low Back Pain: An Evidence-Based Clinical Practice Guideline From the American Pain Society ISSLS Prize Winner: Early Predictors of Chronic Work Disability: A Prospective, Population-Based Study of Workers With Back Injuries Psychosocial Predictors of Outcome in Acute and Subchronic Low Back Trouble Massage for Low Back Pain: An Updated Systematic Review Within the Framework of the Cochrane Back Review Group Can It Be Predicted Which Patients With Chronic Low Back Pain Should Be Offered Tertiary Rehabilitation in a Functional Restoration Program?: A Search for Demographic, Socioeconomic, and Physical Predictors Effectiveness of physical therapist administered spinal manipulation for the treatment of low back pain: a systematic review of the literature. Lumbar supports for prevention and treatment of low back pain: a systematic review within the framework of the Cochrane Back Review Group. Low Back Pain Recurrence in Occupational Environments
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 The investigation of predictors for therapy outcome in patients with chronic low back pain date back to the early 1970s . Numerous well controlled prospect i ve longitudinal studies have confirmed the predominant predictive power of several psychological factors , which are in addition to objective work related , medical and sociodemographic variables . Studies published in the review period have reported markedly improved method ological st and ards . Further progress is seen with the enhanced search for predictors of working situation in chronic low back pain patients . Finally , there is a shift toward the investigation of predictors for efficacy of primary care in acute and subchronic low back pain patients 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 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 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 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 Study Design . Clinical practice guideline . Objective . To develop evidence -based recommendations on use of interventional diagnostic tests and therapies , surgeries , and interdisciplinary rehabilitation for low back pain of any duration , with or without leg pain . Summary of Background Data . Management of patients with persistent and disabling low back pain remains a clinical challenge . A number of interventional diagnostic tests and therapies and surgery are available and their use is increasing , but in some cases their utility remains uncertain or controversial . Interdisciplinary rehabilitation has also been proposed as a potentially effective noninvasive intervention for persistent and disabling low back pain . Methods . A multidisciplinary panel was convened by the American Pain Society . Its recommendations were based on a systematic review that focused on evidence from r and omized controlled trials . Recommendations were grade d using methods adapted from the US Preventive Services Task Force and the Grading of Recommendations , Assessment , Development , and Evaluation Working Group . Results . Investigators review ed 3348 abstract s. A total of 161 r and omized trials were deemed relevant to the recommendations in this guideline . The panel developed a total of 8 recommendations . Conclusion . Recommendations on use of interventional diagnostic tests and therapies , surgery , and interdisciplinary rehabilitation are presented . Due to important trade-offs between potential benefits , harms , costs , and burdens of alternative therapies , shared decision-making is an important component of a number of the recommendations Study Design . Prospect i ve population -based cohort study . Objective . To identify early predictors of chronic work disability after work-related back injury . Summary of Background Data . Identification of early predictors of prolonged disability after back injury could increase underst and ing concerning the development of chronic , disabling pain , and aid in secondary prevention . Few studies have examined predictors across multiple domains in a large , population -based sample . Methods . Workers ( N = 1885 ) were interviewed 3 weeks ( average ) after su bmi tting a lost work-time cl aim for a back injury .  Sociodemographic , employment-related , pain and function , clinical , health care , administrative/legal , health behavior , and psychological domain variables were assessed via worker interviews , medical records , and administrative data bases . Logistic regression analyses identified early predictors of work disability compensation 1 year after cl aim su bmi ssion . Results . Significant baseline predictors of 1-year work disability in the final multidomain model were injury severity ( rated from medical records ) , specialty of the first health care provider seen for the injury ( obtained from administrative data ) , and worker-reported physical disability ( Rol and -Morris disability question naire ) , number of pain sites , “ very hectic ” job , no offer of a job accommodation ( e.g. , light duty ) , and previous injury involving a month or more off work . The model showed excellent ability to discriminate between workers who were/were not disabled at 1 year ( area under the receiver operating characteristic curve = 0.88 , 95 % CI = 0.86–0.90 ) . Conclusion . Among workers with new lost work-time back injury cl aims , risk factors for chronic disability include radiculopathy , substantial functional disability , and to a lesser extent , more widespread pain and previous injury with extended time off work . The roles of employers and health care providers also seem important , supporting the need to incorporate factors external to the worker in models of the development of chronic disability and in disability prevention efforts Study Design A prospect i ve survey of patients seeking primary care for low back pain . Clinical and psychosocial data , available at presentation , were explored for predictors of outcome at 1 year . Objectives To determine the relative value of clinical and psychosocial variables for early identification of patients with a poor prognosis . Summary of Background Data Current treatment strategies for low back pain have failed to stem the rising levels of disability . Psychosocial factors have been shown to be important determinants of response to therapy in chronic patients , but the contribution from similar data in acute or subchronic patients has not been comprehensively investigated . Methods Two hundred fifty-two patients with low back pain , presenting to primary care , underwent a structured clinical interview and completed a battery of psychosocial instruments . Follow-up was done by mail at 1 year ; outcome was measured using a back pain disability question naire . Predictive relationships were sought between the data at presentation and disability at follow-up . Results Most patients showed improved disability and pain scores , although more than half had persisting symptoms . Eighteen percent showed significant psychological distress at presentation . Multiple regression analysis showed the level of persisting disability to depend principally on measures in the psychosocial domain ; for acute cases outcome is also dependent on the absence or presence of a previous history of low back trouble . Discriminant models successfully allocated typically 76 % of cases to recovered/not-recovered groups , largely on the basis of psychosocial factors evident at presentation . Conclusions Early identification of psychosocial problems is important in underst and ing , and hopefully preventing , the progression to chronicity in low back trouble Study Design . Systematic Review . Objectives . To assess the effects of massage therapy for nonspecific low back pain . Summary of Background Data . Low back pain is one of the most common and costly musculoskeletal problems in modern society . Proponents of massage therapy cl aim it can minimize pain and disability , and speed return to normal function . Methods . We search ed MEDLINE , EMBASE , CINAHL from their beginning to May 2008 . We also search ed the Cochrane Central Register of Controlled Trials ( The Cochrane Library 2006 , issue 3 ) , HealthSTAR and Dissertation abstract s up to 2006 . There were no language restrictions . References in the included studies and in review s of the literature were screened . The studies had to be r and omized or quasi-r and omized trials investigating the use of any type of massage ( using the h and s or a mechanical device ) as a treatment for nonspecific low back pain . Two review authors selected the studies , assessed the risk of bias using the criteria recommended by the Cochrane Back Review Group , and extracted the data using st and ardized forms . Both qualitative and meta-analyses were performed . Results . Thirteen r and omized trials were included . Eight had a high risk and 5 had a low risk of bias . One study was published in German and the rest in English . Massage was compared to an inert therapy ( sham treatment ) in 2 studies that showed that massage was superior for pain and function on both short- and long-term follow-ups . In 8 studies , massage was compared to other active treatments . They showed that massage was similar to exercises , and massage was superior to joint mobilization , relaxation therapy , physical therapy , acupuncture , and self-care education . One study showed that reflexology on the feet had no effect on pain and functioning . The beneficial effects of massage in patients with chronic low back pain  lasted at least 1 year after the end of the treatment . Two studies compared 2 different techniques of massage . One concluded that acupuncture massage produces better results than classic ( Swedish ) massage and another concluded that Thai massage produces similar results to classic ( Swedish ) massage . Conclusion . Massage might be beneficial for patients with subacute and chronic nonspecific low back pain , especially when combined with exercises and education . The evidence suggests that acupuncture massage is more effective than classic massage , but this need confirmation . More studies are needed to confirm these conclusions , to assess the impact of massage on return-to-work , and to determine cost-effectiveness of massage  as an intervention for low back pain Study Design . A prospect i ve clinical trial was conducted that involved six groups of patients with chronic low back pain selected from a large cohort ( N = 816 ) . Objectives . To correlate pretreatment baseline variables with outcome parameters after treatment in a functional restoration program or in control programs , to identify possible factors predictive of the need for functional restoration . Summary of Background Data . Since the functional restoration program was first described , research has focused on identifying patients who will or will not benefit from such a program . The value of previous studies is limited , however , because predictive factors from a control group were not " subtracted . " Methods . Eight hundred sixteen patients with chronic low back disability were included . All had a structured medical examination , including various physical tests before participation in either a functional restoration program ( n = 621 ) or shorter " control " outpatient programs ( n = 144 ) . A smaller group of the cohort ( n = 51 ) had no treatment and served as a pure control group . Six groups were selected from the cohort : Three underwent an identical functional restoration program and three underwent different outpatient control programs . Several baseline demographic , physical , and socioeconomic variables were correlated to 1‐year outcome parameters . Results . Age , days of sick leave , connection to the work force , and back pain intensity , were significantly correlated to success 1 year after entry into the study in all groups , no matter what kind of treatment was administered . Back muscle endurance , sports activity , activity of daily living scores , and vibrations were of importance in some outcome parameters for success after functional restoration . Smoking was positively correlated to disability pension . Days of sick leave and , in functional restoration , ability to work were the only factors that were correlative with statistics for people who withdrew . Conclusions . Different factors can be identified as predictive of outcome in a functional restoration program , but most of these factors were also shown to predict success for shorter control outpatient programs or of no treatment BACKGROUND CONTEXT Low back pain ( LBP ) is a prevalent disorder in society that has been associated with increased loss of work time and medical expenses . A common intervention for LBP is spinal manipulation , a technique that is not specific to one scope of practice or profession . PURPOSE The purpose of this systematic review was to examine the effectiveness of physical therapy spinal manipulations for the treatment of patients with low back pain . METHODS A search of the current literature was conducted using PubMed , CINAHL , SPORTD iscus , Pro Quest Nursing and Allied Health Source , Scopus , and Cochrane Controlled Trials Register . Studies were included if each involved : 1 ) individuals with LBP ; 2 ) spinal manipulations performed by physical therapists compared to any control group that did not receive manipulations ; 3 ) measurable clinical outcomes or efficiency of treatment measures , and 4 ) r and omized control trials . The quality of included articles was determined by two independent authors using the criteria developed and used by the Physiotherapy Evidence Data base ( PEDro ) . RESULTS Six r and omized control trials met the inclusion criteria of this systematic review . The most commonly used outcomes in these studies were some variation of pain rating scales and disability indexes . Notable results included varying degrees of effect sizes favoring physical therapy spinal manipulations and minimal adverse events result ing from this intervention . Additionally , the manipulation group in one study reported statistically significantly less medication use , health care utilization , and lost work time . CONCLUSION Based on the findings of this systematic review there is evidence to support the use of spinal manipulation by physical therapists in clinical practice . Physical therapy spinal manipulation appears to be a safe intervention that improves clinical outcomes for patients with low back pain STUDY DESIGN A systematic review of r and omized and nonr and omized controlled trials . SUMMARY OF BACKGROUND DATA Lumbar supports are used in the treatment of low back pain , but also to prevent the onset ( primary prevention ) or recurrences of a low back pain episode ( secondary prevention ) . OBJECTIVES To assess the effects of lumbar sup-ports for prevention and treatment of nonspecific low back pain .  METHODS The Medline , Cinahl , and Current Contents data bases ; the Cochrane Controlled Trials Register up to September 1999 ; and the Embase data base up to September 1998 were all search ed . References of identified trials and systematic review s were review ed and the Science Citation Index used to identify additional trials . Method ologic quality assessment and data extraction were performed by two review ers independently . A quantitative analysis was performed in which the strength of evidence was classified as strong , moderate , limited or conflicting , and no evidence . RESULTS Five r and omized and two nonr and omized preventive trials and six r and omized therapeutic trials were included in the review . Only 4 of the 13 studies were of high quality . There was moderate evidence that lumbar supports are not effective for primary prevention . No evidence was found on the effectiveness of lumbar supports for secondary prevention . The systematic review of therapeutic trials showed that there is limited evidence that lumbar supports are more effective than no treatment , whereas it is still unclear whether lumbar supports are more effective than other interventions for treatment of low back pain . CONCLUSIONS There continues to be a need for high quality r and omized trials on the effectiveness of lumbar supports . One of the most essential issues to tackle in these future trials seems to be the realization of adequate compliance Study Design . Prospect i ve assessment of return to work after low back pain . Objective . To determine which factors or combination of factors best predict recurrence of low back pain ( defined 4 different ways ) when returning to full-duty work . Summary of Background Data . Recurrent back pain is one of the more costly health problems facing industry today . Few systematic evaluations of the various factors suspected of exacerbating low back pain have been reported in the literature . Methods . A total of 206 workers who reported low back pain were evaluated as they returned to full-duty work .  Five types of assessment s were performed including : 1 ) a  low back kinematic functional assessment s  , 2 )  evaluation of job physical dem and s  , 3 )  psychosocial assessment of the job environment , 4 )  self-reported impairment including perception of symptoms and psychological measures  , and 5 )  personal ( individual ) factors . One year after return to full duty workers were interviewed to assess who had a recurrence of low back pain according to 4 different definitions of low back pain ( symptom reports , medical visits , self-reported lost days , and employer-reported lost days due to back pain ) . Multiple logistic regression models were developed to assess the best combinations of predictors . Results . The most liberal definition of recurrence , recurrent symptoms , had a significantly greater recurrence rate at 58 % than all other outcome measures ( P = 0.0001 ) . The medical visit recurrence rate of 36 % was significantly greater than the more conservative lost time measures ( P = 0.0001 ) . The recurrence rate for self-reported lost time was 15 % , whereas the more conservative employer confirmed lost time measure was significantly lower at 10 % ( P = 0.0077 ) . Multivariate predictive models associated with the various recurrence definitions yielded sensitivities varying between 78 % and 80 % and specificity between 73 % and 80 % . Conclusion . Recurrence is greatly dependent on how one defines recurrence with symptom reporting yielding 5.5 times as many recurrences compared with employer confirmed lost time . In general , more quantitative measures of worker musculoskeletal function yielded the best predictions of recurrence when predicting the more restrictive definitions of recurrence ( employer confirmed lost time )
Consistent evidence was found for the predictive value of pain intensity ( more pain-- > worse outcome ) , several work-related parameters ( e.g. , high satisfaction-- > better outcome ) , and coping style ( less active coping-- > better outcome ) .
Other sociodemographic and physical variables consistently lacked predictive value .
No consistent evidence was found for other psychological variables .
CONCLUSIONS It is impossible to define a generic set of predictors of outcome of multidisciplinary rehabilitation and back schools for patients with chronic low back pain because the review ed studies were descriptive or exploratory in nature , and most predictors were only studied once .
Nevertheless , for several predictors , consistent evidence was found .
OBJECTIVE To determine predictors of outcome of multidisciplinary rehabilitation-or back school treatment  for patients with chronic low back pain .
SUMMARY OF BACKGROUND DATA Numerous review s have been performed to gain insight into which patients benefit from which treatment .
However , no review has systematic ally focused on predictors from multiple domains ( i.e. , sociodemographic , physical , and psychological ) , or on treatment outcome measured as activity limitation or participation restriction .