Prediction of Success From a Multidisciplinary Treatment Program for Chronic Low Back Pain

Abstract

This study has demonstrated that the most important variable in determining a successful treatment of chronic low back pain is the reduction of subjective feelings of disability in patients.

Is preoperative occupation related to long-term pain in patients operated for lumbar disc herniation?

“…Hildebrandt et al 37 studied patients with low-back pain and demonstrated that a negative self-evaluation for predicting a return to work was related to a longer period out of work and an application for pension was significantly related to a low probability of a patient's return to work. Although this result was statistically insignificant, the authors also stated that patients with a low level of education or low professional status were less likely to return to work, a statement confirmed by other studies 34 .…”

Cost-Effectiveness of Early Versus Delayed Functional Restoration for Chronic Disabling Occupational Musculoskeletal Disorders

“…Developed in 1983, this rehabilitation program is a variant of chronic pain management based on the biopsychosocial model of pain and disability, and is specifically intended for rehabilitation of compensation injuries (Mayer et al, 1985). The efficacy of functional restoration for CDOMD, as well as the objective outcomes for treatment monitoring, have been extensively reviewed in the literature (Bendix et al, 1996;Hildebrandt, Pfingsten, Saur, & Jansen, 1997;Jousset et al, 2004;Mayer et al, 1998;Mayer et al, 1985;Mayer et al, 1987;Rainville, Kim, & Katz, 2007;Wright, Mayer, & Gatchel, 1999).…”

“…Objective oneyear post-rehabilitation outcomes have been obtained from cohort studies, as well as RCTs, and include: increased resumption of active occupational status and activities of daily living; decreased health care utilization; reduced levels of pain intensity; improved readiness to change; improved psychological well being; and, resolution of outstanding medico-legal issues (Becker, Sjogren, Beck, Olsen, & Eriksen, 2000;Guzman et al, 2001;Hazard et al, 1989;Mayer et al, 1985;Patrick, Altmaier, & Found, 2004). The highly satisfactory results of functional restoration have been shown to be temporally stable (Mayer et al, 1987), and can be generalized across different socioeconomic and medico-legal systems (Bendix et al, 1996;Corey, Koepfler, Etlin, & Day, 1996;Hildebrandt, Pfingsten, Saur, & Jansen, 1997;Jousset et al, 2004). Finally, it has been demonstrated that functional restoration, along with other interdisciplinary approaches to pain management, are more cost-effective than standard conservative treatment (Gatchel & Okifuji, 2006;Skouen, Grasdal, Haldorsen, & Ursin, 2002;Turk, 2002;Turk & Okifuji, 1997).…”

“…Furthermore, even at the outset of injury, it will be impossible to a priori randomly assign patients into disability duration groups. Nevertheless, randomized trials have been utilized in evaluating functional restoration within nations adopting socialized medicine, and the results have documented the superiority of the functional restoration approach in rehabilitating CDOMD patients relative to less intensive singlediscipline treatment modalities (Bendix et al, 1996;Corey, Koepfler, Etlin, & Day, 1996;Hildebrandt, Pfingsten, Saur, & Jansen, 1997;Jousset et al, 2004). Given the logistical limitations, a prospective matched cohort design was best suited to explore the research question of interest in this study, i.e., the effect of disability duration on both the treatment-and cost-effectiveness of a functional restoration program.…”

Welche Rückenschmerzpatienten profitieren von einer multimodalen Schmerztherapie? Eine komparative Kostenanalyse auf Basis von GKV-Routinedaten

“…Studien konnte gezeigt werden, dass eine verbesserte körperli che Funktionsfähigkeit aufgrund der MMT, affektiver Distress, geringere Abwesenheiten vom Arbeitsplatz sowie die Intensität der Inanspruchnahme medizinischer Leistungen vor Initiierung der MMT mit der Schmerzintensität nach der MMT assoziiert sind. [17][18][19]. Bezüglich der Patienten, die eine MMT erhielten und einen un günstigen Kostenverlauf aufwiesen, ist zu beachten, dass der un günstige Kostenverlauf nicht notwendigerweise darauf hinwei sen muss, dass diese Patienten nicht von der MMT profitieren können, da unklar bleibt, ob das Ausmaß des ungünstigen Kos tenverlauf ohne MMT höher gewesen wäre.…”