Effectiveness of a rehabilitation and occupational behavioral cognitive group intervention for chronic low back pain with low disability. Prospective study with a 6-month follow-up
Monticone, M.; Montironi, C.; Tomba, A.; Righini, C.; Nido, N.; Giovanazzi, E.
Giornale Italiano di Medicina del Lavoro Ed Ergonomia 30(2): 162-168
2008
ISSN/ISBN: 1592-7830 PMID: 19068864 Document Number: 615560
Literature suggests a bio-psychosocial approach to chronic low back pain, heralding disability. A multidisciplinary combination of motor, occupational and cognitive behavioural therapies constitutes a rehabilitative approach provided with growing evidence in the clinic field of spinal chronic pain. To evaluate the effectiveness of a motor, occupational and cognitive behavioural approach, carried out in group, for subjects with low disability chronic low back pain. Prospective trial, with a six-month follow-up. We selected patients with chronic low back pain considered at low disability (Roland Morris Disability Questionnaire, RMDQ, score lower than 12/24), in the absence of serious co-morbidities, consecutively admitted to a Physical Medicine and Rehabilitation Unit. The patients underwent ten sessions of a rehabilitative and cognitive behavioural treatment, made in group. We identified the following outcome measures, administered pre-treatment, posttreatment and during six-month follow-up: pain (VAS), disability (RMDQ), health status (SF-36). We performed a parametric analysis for repeated measures (Student t test, significance: p < 0.05); we also searched the clinical importance for pain and disability. 37 subjects, 21 females, 16 males, mean age 52 +/- 11 years old, low back pain mean duration 10 +/- 4 months. The described approach was successful (VAS p = 0.001, RMDQ p = 0.001, SF-36 domains 0.001 < p < 0.014), with persistence of results at the six-month follow-up for Physical Role, Pain, Emotional Role and Mental Health SF-36 domains; further significance increase was achieved for Physical Activities (p = 0.009), General Health (p = 0.006), and Vitality SF-36 domains (p = 0.007). The Social Activities domain of the SF-36 questionnaire was not significant (p = 0.260) at the end of the trial, getting significance at the six-month follow-up (p = 0.001). Clinical significance was furthermore achieved for pain and disability outcome measures, unchanging six months later. The trial showed evidence in favour of a combined motor, occupational and cognitive-behavioural approach, carried out in group, for low disability chronic low back pain. Considering methodological biases of the study, we recommend confirmation of these results through randomized controlled trial.